Fillable TS 1 TS 1.pdf (Harris County Tax Office)

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TS 1 TS 1.pdf (Harris County Tax Office)

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TS-1 www.hctax.net rev. 09/19
Application for Motor Vehicle Title Service License
Pursuant to Texas Administrative Code: Title 43, Part 5, Chapter 95, Rule 95.1 individuals wishing to complete an application to register as a new
Motor Vehicle Title Service MUST apply in person at the Harris County Administration Building: 1001 Preston, Room 100, Houston, TX 77002.
Please complete this printable form online or write legibly in blue or black ink ONLY within the lines provided.
This form will NOT be accepted and the application fee will be forfeited if it is illegible, altered or incomplete.
You are required to notify us immediately of any changes that pertain to your Motor Vehicle Title Service License.
☐
New Application
☐
Renewal Application
Type of
Company
☐
Individual
☐
Partnership
☐
Limited Partnership
☐
Limited Liability Partnership
☐
Corporation
☐
Limited Liability Corporation
Business Information
Business Name (as listed on DBA or Secretary of State documents):
Business Location – Address #1 (physical address of each office from which the applicant will conduct business)
Street:
State:
Zip:
County:
Business Location – Address #2 (physical address of each office from which the applicant will conduct business)
Street:
State:
Zip:
County:
Mailing Address (if different from above)
Street:
State:
Zip:
County:
Business Phone:
( )
Alt. Phone:
( )
Business Email Address:
Federal Tax ID Number
State Sales Tax Number
Applicant Information
1. Full Legal Name of Applicant (first, middle, last)
Applicant Residential Address:
Street:
State:
Zip:
County:
Applicant Phone:
( )
Alt. Phone:
( )
Applicant Email Address:
Date of Birth (mm-dd-yy)
Social Security Number
Valid Texas DL or ID Number
Expiration Date
Please list below each individual and entity holding ownership in the business (attach additional pages if necessary)
2. Full Legal Name of Applicant (first, middle, last)
Applicant Residential Address:
Street:
State:
Zip:
County:
Applicant Phone:
( )
Alt. Phone:
( )
Applicant Email Address:
Date of Birth (mm-dd-yy)
Social Security Number
Valid Texas DL or ID Number
Expiration Date
3. Full Legal Name of Applicant (first, middle, last)
Applicant Residential Address:
Street:
State:
Zip:
County:
Applicant Phone:
( )
Alt. Phone:
( )
Applicant Email Address:
Date of Birth (mm-dd-yy)
Social Security Number
Valid Texas DL or ID Number
Expiration Date
TS-1 www.hctax.net rev. 09/19
Application for Motor Vehicle Title Service License
Please complete this printable form online or write legibly in blue or black ink ONLY within the lines provided.
This form will NOT be accepted and the application fee will be forfeited if it is illegible, altered or incomplete.
You are required to notify us immediately of any changes that pertain to your Motor Vehicle Title Service License.
Full Legal Name of Applicant (
first, middle, last
)
Are you a United States Citizen? YES
☐
NO
☐
If No, are you a legal resident? YES
☐
NO
☐
If you are not a non-legal resident, what is your INS/DHS number?
Background Information
Each individual holding ownership must answer background information separately.
1. Have you ever applied for a Motor Vehicle Title Service License?
NO
☐
YES
☐
If yes, list YEAR and COUNTY
2. Have you ever applied for a Motor Vehicle Title Service Runner License?
NO
☐
YES
☐
If yes, list YEAR and COUNTY
3. Have you ever had a Motor Vehicle Title Service License or Runner License
NO
☐
YES
☐
If yes, list YEAR and COUNTY
revoked or suspended?
4. Have you ever been denied a Motor Vehicle Title Service License
NO
☐
YES
☐
If yes, list YEAR and COUNTY
or Runner License?
5. Have you now or in the past 5 years been under court supervision through
NO
☐
YES
☐
If yes, list YEAR and COUNTY
probation, parole, or deferred adjudication for any criminal offense or crime
of moral turpitude?
6. Have you ever been finally convicted for any felony offense or any offense
NO
☐
YES
☐
If yes, list YEAR and COUNTY
involving moral turpitude?
7. Do you currently owe any county any taxes, fines, or fees?
NO
☐
YES
☐
If yes, list YEAR and COUNTY
If yes, you may not be eligible to conduct business with Harris County until cleared.
Banking Information
Bank Name:
Branch Location:
Account Number:
I swear and affirm that all the information I have provided in this application is true and accurate to the best of my knowledge. By signing this
document, I willfully give permission for Harris County Tax Office and local law enforcement agencies to conduct a criminal background check.
Applicant Signature: ___________________________________________________________ Date: ________________
WARNING: Falsifying information on any required statement or government document is a criminal offense and is
punishable by fine and/or imprisonment.
Submit the following ORIGINAL documents with your application to the Harris County Tax Assessor-Collector’s Office:
• Valid Texas Driver License or Texas Identification Card
• Social Security Card (provide your INS or DHA documents if your Social Security Card requires it)
• Photo of building where business is physically located (business name as listed on DBA must be evident on the outside of the building)
• Assumed Name Certificate (DBA). If a corporation, also include current Secretary of State documents listing all officers
Names MUST match
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TS 1 TS 1.pdf (Harris County Tax Office)

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Completed 19 July 2020

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