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MOTOR VEHICLE DEALER Wisconsin Department of Transportation TWO YEAR LICENSE APPLICATION FOR OFFICE USE ONLY Dealer x Section MV2186 3/2005 Ch.218 Wis.Stats. Issued Expires Madison,WI 53707-7909 Amending Current Submit in duplicate. Licenselnformation Legal Name A I, IlEcn-Telephone Number Deal cen Number Trade Name(s)or DBAs - Federal Employer dentif on Number p ~z /gvT6 5A,ies 4/77- 91/- A Street Address or RFD v Post Office Box Number City Slate ZIP Code Count whole buss located y 4/c c , ,_gb i T" s� - id f: -- - - Type of Vehicles to be Sold Business Entity If Corporation or LLC, ❑City ❑Village XTownship Autos O Sole Proprietorship ❑Association Date Licensed in Wisconsin Name: S vN ?no /t. X Trucks El Partnership ❑Corporation 1/r L7 a C� State of Incorporation or Organization ❑Motorcycles l LLC / List makes of new vehicles to be sold • Address of NONADJACENT Sales Location in SAME MUNICIPALITY Branch: Sublot Name and Title of Owner,Partners,Association Members,Corporation Officers snd Shareholders,LLC Managers and Members Complete an Entity/Owner Statement(Form MV2844)for each individual listed. • Co Rlately describe other business,if any,engaged in by your firm` y� Same location? License Numbers of Additional Dealerships tyro 4. 780(k 8 P P4/ Vti ❑No Yes.54 Was there a licensed dealer at this same location previously this year? Do ou own and operate your own service department? IXINo ❑ Yes,Name dealer Yes ❑No,Attach completed service agreement Have you,as an individual and your above-named firm,been licensed as a dealer before? omplete ONE of the following(whichever applicable). YES NO ❑ No ❑ Yes,Same location? El No IXI Yes Is business real estate owned by El ❑ `"� Owner of sole proprietorship If no, Has your motor vehicle dealer license ever been denied,suspended or revoked? vlt No ❑ Yes,When and what state? One partner of partnership Li ❑ send copy Are you licensed as a motor vehicle salvage dealer at same location? Corporate dealership El ❑ of lease. ® No ❑ Yes,Give license number LLC ,® ❑ AUTOS I TRUCKS MOTORCYCLES OTHERS(specify) Used SALES TAX Number of New ( Used I New sed New Used New vehicles sold Retail J( SELLER PERMIT NUMBER •) in last 12 - /�V-pD01)357.2.V-a3 month period I Wholesale / Please check onlyONEboxthatappliestoyourdealership. Dealer License (Required fee) $40.00 Call 608-261-9555 if you have questions about these fees. Branch License $40.00 t41. During the next two years our dealership will sell all vehicles on a cash only basis. Fee due is$20. Sublot License $2.00 2. Our dealership originatesretail installment sales contracts Salesperson License(s) Number x$8.00 0.00 and/or consumer leases. (If test required, pay examiner) ❑a. All of the contracts or leases we originate are sold or Wisconsin Buyer's License(s) Number_x$12.00 0.00 transferred to a third party. Fee due is$100. ❑b. Some or all of the contracts or leases are retained by Buyer ID Card(s) Number x$12.00 0.00 our dealership. Fee due is$100. Dealer License Plates Required First 2 plates=$150.00 0 3. The total amount of installment contracts and/or consumer Number of additional plates @$10.00 0.00 leases originated and retained in the last 12 months was List letters of all missing plates $ ,which is$100,000 or less. Fee due is$100. • 04. The total amount of installment contracts and/orconsumer leases)originated and retained in the last 12 months was Replacement License Plates for lost,damaged, • $ ,which is greater than$100,000. Do not or illegible plates each plate$2.00 submit a fee. You will receive a separate bill. 0.00 Does your dealership write credit insurance? No ❑Yes CHECK PAYABLE TO: REGISTRATION FEE TRUST $ CHECK PAYABLE TO: Department of Financla Institutions I,the undersigned,certify under penalty of s.345.17 Wisconsin Statutes,that(1)a lease agr-- a ent covering at least the licensing year has been executed,if premises are not owned by applicant,and(2)the answers and statements on this applic-•. -true- •J o4 fit ct to the best of my knowledge. 9 Q See reverse side. X - / "III- ` 'l ` e- /2 (Au orized De=lership Agent,Title (Date)