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MOTOR VEHICLE LICENSING BUREAU (Mississippi)

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77-697-10-1-1-000
MOTOR VEHICLE LICENSING BUREAU
P. O. Box 1140 Jackson, MS 39215 www.dor.ms.gov
Phone: 601.923.7200
FAX: 601.923.7134
INSTRUCTIONS FOR COMPLETING APPLICATIONS FOR
MOTOR VEHICLE DEALER PERMIT AND TAG(S)
These procedures must be followed when applying for any type of Motor Vehicle Dealer Permit:
1. Please review the Motor Vehicle Dealer Tag Permit Law Book which includes Dealer Tag Regulations
#1, #2, and #3 before completing the application forms. The Dealer Tag Permit Application must be
typed or printed. Incomplete forms will be returned without processing.
2. You must have the Bond of Designated Agent executed by an insurance company in the amount of
$15,000.00. This surety bond must be written by an insurance company qualified to do business in
the State of Mississippi. The bond must have a seal affixed to it and a valid Power of Attorney
attached. If the business is a sole ownership, the owners name as well as the business name must
be shown on line 1 of the bond. If the business is a partnership, all partner’s names including the
business name must be shown on line 1. The business name will be shown as a d/b/a. If the business
is a corporation, the correct corporate name as registered with the Secretary of State must be on line
1. If the corporation has a trade name or dba, both names must be shown on line 1 (i.e. ABC Corp
dba ABC Used Cars). The bond must be signed by the principal(s), the Attorney-in-Fact and the
Mississippi resident agent where indicated on the bond. The second line of the bond must show the
city in which the business will be located and operated.
3. All persons applying for a Motor Vehicle Dealer Permit are required to complete the eight (8) hour
educational seminar conducted by the Mississippi Independent Auto Dealers Association (MIADA).
Your application must be accompanied by the certificate of completion for the
class during the twelve-
month period immediately preceding the date of the application.
4. You are required to maintain motor vehicle liability insurance providing blanket coverage on vehicles
operated on the public streets and highways of this state, including vehicles in dealership inventory.
Evidence of liability insurance for business and inventory vehicles shall be filed with the initial
application for license and at each renewal.
Applicants applying for Trailer only and Dismantler only
permits are excluded from the liability insurance requirement.
5. The registration application for a sales tax number must be completed and a sales tax number
assigned. A sales tax number will be required for each motor vehicle dealer location. Also, if you
plan to rent vehicles, another sales tax number is required. These forms may be found at
www.dor.ms.gov.
6. Wholesale only dealers must meet all the requirements outlined in the sections above. However,
they are not allowed to retail vehicles to individuals, only to licensed dealers. They are not required
to have a physical location, but may only maintain an inventory of two (2) vehicles and can receive
one (1) wholesale dealer tag. A wholesale only dealer will be issued a sales tax wholesale account
number. These permits are issued only for Mississippi Residents.
7. If you are applying for a license as a “Dismantler Only” and you sign the affidavit attesting to the
fact that you will not sell any motor vehicles and/or manufactured homes, the requirement of the bond
of designated agent and number will be waived and no dealer tags will be issued.
8. The completed dealer application including sales tax number assigned, bond of designated agent,
notarized affidavit, certification of completion for the educational seminar, and proof of liability
insurance should be forwarded to:
Mississippi Department of Revenue
Motor Vehicle Services Bureau
P. O. Box 1140
Jackson, MS 39215
If you have any questions, please call the Motor Vehicle Services Bureau at (601) 923-7143.
Vo12710
AFFIDAVIT OF MOTOR VEHICLE LICENSE APPLICANT
STATE OF MISSISSIPPI
COUNTY OF __________________
PERSONALLY APPEARED before me, the undersigned authority in and or for the aforesaid
jurisdiction, ___________________________, who after being duly sworn, did depose and say:
(Name of Affiant)
1. My name is ________________________ and I operate a business selling motor
ve
hicles, located at__________________________________________________
(Business Address)
2. I have personal knowledge of the matters set forth in this Affidavit and I am
competent to testify as to these matters
.
3. I have met the definition of “Established place of business” as provided in Section
27-19-303, Miss. Code. Ann., by having:
A place owned or leased and regularly occupied by me for the primary an
d
pr
incipal purpose of and where it is apparent that I am holding out to the general
public that I am offering motor vehicles, tractors, trailers or semitrailers for sale.
4. By initialing the appropriate selection, I testify that I have:
_______ A. An office separate from and not in conjunction with or related to any
other business for the purpose of transacting the business of offering motor vehicles,
tractors, trailers or semitrailers for sale.
Or
_______ B. A sign indicating the name of the business, the name of the owner,
telephone number and that the business is a motor vehicle dealer that is clearly
visible and located at the front of the lot, and a lot which is separate and apart from
any other business.
5. I understand that improper testimony may result in the revocation of any
subsequently issued Motor Vehicle Dealer Permit and subject me to other penalties
related to false testimony.
6. I agree to return all unused titling paperwork, including but not limited to tit
le
app
lications and remittance advices, upon the closing of my business.
________________________________
Name of Officer/Retail Business Owner
SWORN TO AND SUBSCRIBED before me, this the ________ day of ______________, 20_____.
__________________
________
N
otary Public
My commission expires:
___________________________________
Sole Proprietor
Sales Tax Number
County Code
ZipCity
Legal Name
SSN
Primary Address (Number and Street, Including Rural Route)
State
Corporation
Number of Full Time Employees
Mississippi
Application for Motor Vehicle Dealer License
Partnership
761051581000
Form 76-105-15-8-1-000 (Rev. 07/15)
New
Appropriate Types
FEIN
Supplement
Application for year beginning November 1,
County Code
ZipCity
Business Name (DBA)
MS Physical Address (Number and Street, Including Rural Route)
State
Phone Fax
DA/Permit Number
Permit Fee Quantity Tags Fee Per Tag Total Tag Fees
1
2
Franchise (New)
Motorcycle
Trailer
ONLY
Wholesale ONLY
Used
Dismantler
Manufacturer
Heavy Truck
3
4
5
6
7
8
$100.00
$100.00
$100.00
$100.00
$100.00
$50.00
$50.00
$75.00
N/A N/A
1st 12 $43.75 (ea.)
over 12 $83.75 (ea.)
$14.75 (ea.)
$18.75 (ea.)
$133.75 (ea.)
Totals
Amount Due State
Applicant Signature
Title Date
All Permits and Tags Expire October 31
Total Not To Exceed $100.00.
N/A
Ext.
I hereby certify that the above statements are true and correct to the best of my knowledge and make
application for a permit to engage in business on the condition that I will comply in all respects with the
applicable Mississippi Tax Laws and the rules and regulations hereunder.
1 only $43.75 (ea.)
$18.75 (ea.)
$43.75 (ea.)
Reset Form
Print Form
Forms 76-950-10-1-1-000
MISSISSIPPI DEPARTMENT OF REVENUE
BOND OF DESIGNATED AGENT
(For Motor Vehicle Dealers)
BOND NUMBER________________
KNOW ALL MEN BY THESE PRESENTS
That we, _________________________________________________________________________________________
of ____________________________, Mississippi, as Principal, and __________________________________________
of _______________________________________________, a corporation incorporated under the law of the State of
____________________________ as Surety are held firmly bound into the State of Mississippi, as Obligee, in the sum of Fifteen
Thousand ($15,000.00) dollars, for the payment of which we bind ourselves, our heirs, executors, administrators, successors, and assigns,
jointly, and severally, firmly by these present.
Whereas, the Principal has been duly appointed a “Designated Agent” as provided for in Section 6, Senate Bill 1688, Laws of 1968
known as The Mississippi Motor Vehicle Title Act, and such “Designated Agent” is required to furnish this bond.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the aforesaid Principal shall well and faithfully perform his duties as
such “Designated Agent” then, this obligation shall be void, otherwise to remain in full force and effect.
THE PARTIES HERETO mutually agree that the Surety may cancel this bond by giving thirty (30) day notice in writing to the
Mississippi Department of Revenue. Such cancellation shall be effective only as to acts committed by the Principal as such “Designated
Agent” after the expiration of said thirty (30) day period.
SIGNED, SEALED AND DELIVERED, this the ________ day of ___________________________ 20_______,
____________________________________ ________________________________
Agent PRINCIPAL
____________________________________ ________________________________
Insurance Co
mpany Name Owner, Agent or Officer
___________________________________ _______________________________
Mailing Address Surety
____________________________________
City State Zip Code BY_____________________________________
ATTORNEY-IN-FACT
____________________________________________
AFFIX SEAL HERE:
Phone Number
www.dor.ms.gov
Phone: 601.923.7200
FAX: 601.923.7134
Jackson, MS 39215
P. O. Box 1140
77-699-10-1-1-000
MOTOR VEHICLE LICENSING BUREAU
P. O. Box 1140 Jackson, MS 39215 www.dor.ms.gov
Phone: 601.923.7200
FAX: 601.923.7134
AFFIDAVIT OF MOTOR VEHICLE DISMANTLER LICENSE
I, _____________________________________________, doing business as
_______________________________ do hereby attest that I will not sell any motor
vehicles and/or manufactured homes through my business as a dismantler.
I understand that if I sell motor vehicles and/or manufactured homes, my Dismantlers
License will be revoked by the Mississippi Department of Revenue.
__________
____________________________ Sworn to and subscribed before me, this______________
Signature Day of ________________________________, 20________
____________________________
__________________________________________________
Date
__________________________________________________
Form 77-105-15-8
Mail To: MS Department of Revenue
Motor Vehicle Licensing Bureau
P.O. Box 1140
Jackson, MS 39215-1140
Dealer Tag Daily Log
Date
20
Dealer Tag
Number
Vehicle Identification Number
Vehicle Year Make &
Model
Vehicle
Color
Assigned to
Employee (person)
Purpose
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MOTOR VEHICLE LICENSING BUREAU (Mississippi)

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Completed 12 October 2020

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