Fillable RENEWALFIRST TIME TOW CAR OWNER OFFICE OF THE (Town of Hempstead)

Fill Online, Printable, Fillable, Blank RENEWALFIRST TIME TOW CAR OWNER OFFICE OF THE (Town of Hempstead) Form

Use Fill to complete blank online TOWN OF HEMPSTEAD (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

RENEWALFIRST TIME TOW CAR OWNER OFFICE OF THE (Town of Hempstead)

On average this form takes 41 minutes to complete

The RENEWALFIRST TIME TOW CAR OWNER OFFICE OF THE (Town of Hempstead) form is 2 pages long and contains:

  • 1 signature
  • 2 check-boxes
  • 160 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Hempstead

BROWSE TOWN OF HEMPSTEAD (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
OFFICE OF THE TOWN CLERK
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
TOW CAR OWNER
RENEWALFIRST TIME
Rev. 12-14 W
Individual Owner
Name of applicant: DBA
Address:
Email Address:
Exact location of depot or dispatching office:
Corporation, or trade name:
Main office:
Incorporated ?
Partner or
President
What connection has above named individual, co-partnership or corporation
with ownership or operation of vehicles described herein ?
Partner or
Vice President
Partner or
Secretary
Partner or
Treasurer
Date: / /
YES
Corporation, Co-partnership or Individual using a trade name
Business hours Business phone #
Phone # ( ) -
Phone # ( ) -
Corporation
State:
Office Use Only
APPLICATION #
FILING FEE
VEHICLE LIC. #
TO
ISSUED
FEE PAID $
CERTIFICATE #
CERTIFICATE DATE
Owner Holding company Lessee Operating company
NO
YES NO YES NO
YES NO YES NO
YES NO YES NO
YES NO YES NO
If corporation, co-partnership or individual using a trade name, �ill in blank spaces below
Co-Partnership
Name Address
Birth place Age Date CourtNaturalized
Name Declared Intentions
To be �illed out in relation to each individual or partner and each of�icer of corporation making this application
Please indicate type of ownership
SUBMIT TWO PHOTOS
TAKEN WITHIN THE
PAST THIRTY DAYS
EACH 1 x 1
SHOWING ONLY NECK
SHOULDERS AND
UNCOVERED HEAD
SUBMIT TWO PHOTOS
TAKEN WITHIN THE
PAST THIRTY DAYS
EACH 1 x 1
SHOWING ONLY NECK
SHOULDERS AND
UNCOVERED HEAD
1/2’’ 1/2’’
Citizenship
Rev. 12-14 W
Certificate of insurance must be attached showing coverage
on all vehicles’ public liability insurance
Are there any unpaid judgements outstanding against the applicant? ANSWER
If yes, attach separate paper stating amount unpaid and nature of the transaction or act giving rise to said judgements.
Include location of court and date on which judgement was entered.
List all violations of any traffic law, ordinance or regulation for which you or any member of firm or corporation
have been arrested or convicted within the past 18 months.
Were you, or any member of firm or corporation, ever convicted of any crime or offense other than traffic infractions ?
Describe below each vehicle for which application is made for a towcar license.
Property damage insurance
Amount:
Policy #:
Company:
Amount:
Policy #:
Company:
I solemnly swear to the truth of the above statements
Sworn to before me this
Day of
20
NOTARY PUBLIC
YES NO
Signature of Applicant
Title
Date
Violation
Name and Location of Court
Date
Violation
Name and Location of Court
Penalty imposed
Car #
Make Model
Seating
Capacity
Vin #
N.Y. State
Lic. plate #
Current tow #
New License #
NUMBER OF VEHICLES
APPLICANT INTENDS
TO OPERATE:
Please supply additional info if needed
Office Use Only
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

RENEWALFIRST TIME TOW CAR OWNER OFFICE OF THE (Town of Hempstead)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document