2004/06/01 - LAND USE - CUP - Conditional Use Permit - 1213

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• MOTOR VEHICLE DEALER Wisconsin Department of Transportation Dealer Section TWO YEAR LICENSE APPLICATION FOR OFFICE USE ONLY 4802 Sheboygan Avenue MV2186 1/2001 Ch.218 Wis.Stats. Issued Expires P.O.Box 7909 Amending Current Madison,WI 53707-7909 i Submit in duplicate. License Information Legal Name Area Code-Telephone Number Dealer License Number Sj RL U 1."CM005 Qo.t1-.s 'I ts-)C_ 7 I S - 3`t 9 -'7S7 k Trade Name(s)or DBAs Federal Employer Identification Number 4 - i9a—r (.:� Street Address or RFD Post Office Box Number City State Zip Code County where business located i 4v iCS STS 9OA:) 70 Sl2t-� U.,'-r-- S44s7a LZNC i` Type of Vehicles to be Sold Business Entity If Corporation or LLC, ❑City ❑Village XTownship Date Licensed i Wisconsin Autos Name: 1 A—) El Proprietorship ❑Association '`� �� Trucks H Partnership WI Corporation I 91/411 04 State of Incorporation or Organization 1:j Motorcycles ❑ LLC ' List makes of new vehicles to be sold Address of NONADJACENT Sales Location in SAME MUNICIPALITY \ Branch: 7(Di\- s( - 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. • '�,P,v l'1� J a•NiV `74:41.-s--,N't--L)L_t_ (PC- ^ 0k;/L)eA-) TA-L S t cs,-Yr Completely describe other business,if any,engaged in by your firm Same location? License Numbers of Additional Dealerships C) ❑No ❑Yes W- there a licensed dealer at this same location previously this year? Do ou own and op ate y r own service department'? No ❑ Yes,Name dealer Yes No,Attach completed service agreement ,J--Ilav�e you,as ani "dual and your above-named fiirmmm,been licensed as a dealer before? Complete ONE o he (lowing(whichever applicable): YES NO �Y R I-1] Is business real estate owned by: IrY,ll No .L, Yes,Same location? No Yes ❑ ❑ Owner of sole proprietorship If no, as our motor vehicle dealer license ever been denied,suspended or revoked? One partner of partnership ❑ ❑ send copy No ❑ Yes,When and what state? ❑ AArreyypu licensed as a motor vehicle salvage dealer at same location'? of lease Corporate dealership I Y I No ❑ Yes,Give license number • LLC ❑ ❑ T AUTOS TRVS MOTORCYCLES OTHERS pecify) SALES TAX SELLER PERMIT NUMBER Number of New Used New Used New O Used New Used vehicles sold Retail Li in last 12 month period U0 0 • /) Wholesale (� (�/ Please check only ONE box that applies to your dealership. Dealer License(Required fee) $40.00 H 0 • 00 1608-261-9555 if you have questions about these fees. 10 1. During the next two years our dealership will sell all vehicles Branch License $40.00 0 r....)c.) on a cash only basis. Fee due is$20. Sublot License $2.00 0 C)D 2. Our dealership originates retail installment sales contracts Salesperson License Number 2._ x$8.00 4E6" - `='''G and/or consumer leases. (If test required,pay examiner) ❑a. All of the contracts or leases we originate are sold or Buyer ID Card(s) Number x$12.00 0 - U D transferred to a third party. Fee due is$100. ElU v b. Some or all of the contracts or leases are retained by Dealer License Plates Required First 2 plates=$150.00 l our dealership. Fee due is$100. Number of additional plates LA @$10.00 kib - 00 ❑3. The total amount of installment contracts and/or consumer List letters of all missing plates leases originated and retained in the last 12 months was $ ,which is$100,000 or less. Fee due is$100. ❑4. The total amount of installment contracts and/orconsumer Replacement License Plates for lost,damaged, leases)originated and retained in the last 12 months was or illegible plates each plate$2.00 © U $ ,which is greater than$100,000. Do not ,,,_,-;,, - submit a fee. You will receive a separate bill. CHECK PAYABLE TO: REGISTRATION FEE TRUST $ S - • Does your dealership write credit insurance? No 111Yes CHECK PAYABLE TO: Department of Financ al nstitutions 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 ap. •-ti•n- e h d•i•rr iito the best of my knowledge. See reverse side. - 1��1 I I&- ` •y r(Authorized Dealep Agent,Title) (Date)