Was there a licensed dealer at this same location previously this year?
If yes, Name dealer ____________________________________________
Have you, as an individual and your above-named rm, been licensed as a dealer before?
If yes, Same location? No Yes
Has your motor vehicle dealer license ever been denied, suspended or revoked?
If yes, When and what state? _____________________________________
Are you licensed as a motor vehicle dealer at same location?
If yes, Give license number _______________________________________
You must submit 2 letters from the WI Dept. of Natural Resources: One conrm-
ing your coverage under a storm water permit and a second conrming your reg-
istration with the refrigerant recovery program or that you have certied through
another refrigerant recovery compliance method.
Type 4 - Salvage does not need a storm water permit.
State ZIP Code
County where business located
(Authorized Dealership Agent, Title) (Date)
Legal Name
Dealer License Number
X
Area Code - Telephone Number
Trade Name(s) or DBAs
Type 1. Facilites include business oce on or adjacent to the salvage yard where motor vehicles are dismantled and/or stored.
Type 2. Facilities are provided and salvage business is conducted strictly within building, in which business oce is provided and motor vehicles
are stored and dismantled; there is no adjacent salvage yard.
Type 3. Facilities include business oce on or adjacent to the scrap metal recycling operation (shredder, baler, etc.) where salvage motor vehicles
and other scrap metal commodities are reduced in size for shipment to metal producing companies.
Type 4. Facilities do not include a salvage yard, but only a business oce for maintenance of required motor vehicle salvage records. Salvage
motor vehicles are purchased from vehicle owners and transported directly to salvage yards or scrap metal recyclers. The vehicle(s) used
for transporting salvage metals shall be parked and stored at the following location, which has been approved by local authorities:
Check one of the following statements, which properly explains the minimum type business facilities provided and the extent of this motor vehicle sal-
vage or recycling operation at main location. If you listed above an additional salvage business address within the same municipality, also check type of
facilities and operation for such additional location, below right.
Completely describe other business, if any, engaged in by your rm
Same location?
No Yes
SALES TAX SELLER PERMIT NUMBER
Business Address Post Oce Box Number
City
FOR OFFICE USE ONLY
Issued
Expires
Submit this application with completed Entity/Owner State-
ment, nancial statement on form enclosed and $150.00
two year license fee payable to: Registration Fee Trust.
Anticipated Date Business Facilities Will Be Ready
I, the undersigned, certify under penalty of s.946.32 or s.345.17 Wisconsin Stat-
utes, that the answers and statements on this application are true and correct to
the best of my knowledge.
VillageCity
Name:
Township
Sole Proprietorship
Partnership
Business Entity If Corporation or LLC,
Date Licensed in Wisconsin
Address of Additional Salvage or Recycling Location in Same Municipality, which conforms with local zoning requirement
See reverse side.
MOTOR VEHICLE SALVAGE DEALER OR RECYCLER
TWO YEAR LICENSE APPLICATION
MV2180 10/2019 Ch. 218 Wis. Stats.
Wisconsin Department of Transportation
Dealer Section
PO Box 7909
Madison, WI 53707-7909
Association
Corporation
LLC
State of Incorporation or Organization
YES
NO
Is business real estate owned by:
Owner of sole proprietorship
One partner of partnership
Corporate dealership
LLC
If no,
send copy
of lease.
Amending Current License Information
Name and Title of Owner, Partners, Association Members, Corporation Ocers and Shareholders, LLC Managers and Members
Complete an Entity/Owner Statement (Form MV2844) for each individual listed.
Federal Employer Identication Number
YESNO
Complete ONE of the following (whichever applicable):
E-mail Address
Business Type
