Fillable Moped Dealer - Two Year License Application (Wisconsin)

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Moped Dealer - Two Year License Application (Wisconsin)

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The Moped Dealer - Two Year License Application (Wisconsin) form is 2 pages long and contains:

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  • 33 check-boxes
  • 46 other fields

Country of origin: US
File type: PDF

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MOPED DEALER
TWO YEAR LICENSE APPLICATION
MV2861 10/2018 Ch. 218 Wis. Stats.
Amending Current License Information
Wisconsin Department of Transportation
Dealer Section
4822 Madison Yards Way
P.O. Box 7909
Madison, WI 53707-7909
FOR OFFICE USE ONLY
Issued
Expires
Legal Name
(Area Code) Telephone Number
If Previously Licensed, Give Year and License Number
Federal Employer Identification Number (FEIN)
County where business located
Business Entity
Sole Proprietorship
Partnership
Association
Corporation
LLC
If Corporation or LLC,
Date Licensed in Wisconsin
State of Incorporation or Organization
City Village Town
Name:
Address of NONADJACENT Sales Location in SAME MUNICIPALITY
Branch:
Sublot:
Name and Title of Owner, Partners, Association Members, Corporation Officers and Shareholders, LLC Managers and Members
Complete an Entity/Owner Statement (Form MV2844) for each individual listed.
Was there a licensed dealer at this same location previously this year?
No Yes, Name dealer
Have you, as an individual and your above-named firm, been licensed as a dealer before?
No Yes, Same location? No Yes
Has your motor vehicle dealer license ever been denied, suspended or revoked?
No Yes, When and what state?
Are you licensed as a motor vehicle salvage dealer at same location?
No Yes, Give license number
Do you own and operate your own service department?
Yes No, Attach completed service agreement
Complete ONE of the following (whichever applicable):
Is business real estate owned by:
Owner of sole proprietorship
One partner of partnership
Corporate dealership
LLC
YES NO
If no,
send copy
of lease.
Number of vehicles sold at RETAIL in last 12 month period
Sales Tax Seller Permit Number
NEW
USED
Dealer License (Required fee) $40.00
Dealer License Plates Required only if moped is operated
on public highways or streets First 2 plates = $150.00
Number of additional plates @ $10.00
List letters of all missing plates
Replacement License Plates for lost, damaged,
or illegible plates each plate $4.00
CHECK PAYABLE TO: REGISTRATION FEE TRUST $
License Numbers of Additional Dealerships
Completely describe other business, if any, engaged in by your firm - Same location?
No Yes
I, the undersigned, certify under penalty of s.345.17 Wisconsin Statutes, that: (1) A lease agreement covering at least the licensing year has been executed,
if premises are not owned by applicant, and; (2) The answers and statements on this application are true and correct to the best of my knowledge.
See reverse side. X
(Authorized Dealership Agent, Title) (Date)
click to sign
signature
click to edit
Following Applies to First-time Dealer Applicant or
Application for Amended License Because of
Business Relocation or Ownership Change
Proper local officials must sign below, BEFORE submitting this application. All applicants complete section A.
If business is located in a town, complete both sections A and B.
Section A
1. Operation of this dealer business at the location(s) as stated on the reverse side is in accordance with local
zoning regulation.
X
(Signature) (Official Title) (Municipality)
2. Check one box and sign below:
A local permit or license is required and has been issued.
A local permit or license is not required.
X
(Signature) (Official Title) (Municipality)
Section B
County Zoning Approval - required only if business is located in a town.
Operation of this dealer business at the location(s) as stated on the reverse side is in accordance with local zoning
regulation.
X
(Signature) (Official Title) (County)
If business address on reverse side does not include a specific street number, furnish directions to your business location,
including highway numbers or letters and distances.
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Moped Dealer - Two Year License Application (Wisconsin)

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Completed 12 August 2020

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