Form Mv-253g - Request For Business Amendment/duplicate Certificate

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New York State Department of Motor Vehicles
REQUEST FOR BUSINESS AMENDMENT/DUPLICATE CERTIFICATE
I
Use this form to tell DMV about an amendment or to request a duplicate Business Certificate (you must fill out an original
NSTRUCTIONS
application if you are acquiring a business). There is no fee for amendments or duplicate certificates.
If you are making a change, please call (518)
. Failure to provide all documentation will delay processing of your request.
474-0919 for information about required documentation
D
C
C
: Complete items 1, 2, 3, 9 and 10 and the “Certification” section at the bottom of page 2.
UPLICATE
ERTIFICATE
USTOMERS
A
C
: Complete items 1, 2, 3, 9 and 10 and the “Certification” section at the bottom of page 2. Also, complete items 4 - 8
MENDMENT
USTOMERS
only if they apply to the change you are making.
D
OCUMENTATION REQUIREMENTS FOR AMENDMENT CUSTOMERS ONLY
D
: All dismantlers must provide a letter of zoning approval with this request. New York City Only - all “Secondhand Dealer - General”, and
ISMANTLERS
“Secondhand Dealer - Auto”, amendment requests
a Fire Department permit and an NYC Department of Consumer Affairs License.
MUST INCLUDE
C
: If you are changing location, complete Form VS-19 (“Statement of Ownership and/or Permission to
USTOMERS MAKING LOCATION CHANGES
Use Place of Business”) and submit it with this request.
must also provide a Certificate of Occupancy, local license or town
Repair shops
letter as proof of zoning approval. If the
location was previously registered as a Repair Shop, please tell us the Facility number or Facility
new
name of that shop. This can be used as proof of zoning.
D
: All dealers (excluding those who are exempt under the law) are required to have a bond. If you are a dealer requesting an
EALERS
amendment, please call (518) 474-0919 to determine if you have to provide a revised bond with your request. If you are a franchised dealer
requesting an address change, you must provide franchise papers showing the new address.
R
,
,
:
ETURN THIS COMPLETED REQUEST
AND ANY REQUIRED DOCUMENTATION
TO
Bureau of Consumer and Facility Services, Application Unit, PO Box 2700, Albany NY 12220-0700
1.
Requested change:
Amendment
Duplicate Reason: __________________________________________________________________
Present Facility Number Present Facility Name
Facility Phone Number
(
)
.
2
Business(es) requesting amendment/duplicate certificate(s) — check all that apply:
Repair Shop
Dealer
Dismantler
Itin. Veh. Collector
Salvage Pool
Transporter
.
3
Inspection Station
Boat Dealer
Scrap Collector
Scrap Processor
Mobile Car Crusher
Other
Business name change to:
4.
Business address change:
New Address
Old Address
Number and Street
County
Number and Street
County
5.
City
State
Zip Code
City
State
Zip Code
Inspection Stations or Dealers
a) Change in business type (for example, Fleet to Public, Wholesale to Retail, etc.):
6.
To:
From:
b) Change in groups approved for inspection (check the box(es) for the group(s) you want to inspect):
VEHICLE GROUPS
GROUP
(Weights shown are maximum gross weights)
1a
All motor vehicles that have a seating capacity under fifteen passengers, and all motor vehicles, except trailers and
motorcycles, that have an MGW under 18,001 pounds.
1b
All trailers, except semi-trailers, that have an MGW under 18,001 pounds.
2a
All motor vehicles that have a seating capacity over fourteen passengers, and all motor vehicles and trailers that have an
MGW over 18,000 pounds.
2b
All semi-trailers.
3
All motorcycles.
DL
Diesel Emissions Testing for all non-exempt vehicles registered in the New York Metropolitan Area.
c) If you will perform diesel emissions inspections, print the manufacturer’s name and the model number of the testing equipment here.
This information is required in order to process your request.
Model Number
Manufacturer’s Name
____________________________________________________________________________
____________________________________________________________________________
d) Please provide the name(s) and certification number(s), including expiration date, of your Certified Inspector(s). Use additional sheet(s)
if necessary. This information is required in order to process your request.
Name
Certification Number
Expiration Date
_________________________________________________________________________
_________________________________________________
_________________________
_________________________________________________________________________
_________________________________________________
_________________________
_________________________________________________________________________
_________________________________________________
_________________________
PAGE 1 OF 2
MV-253G (2/11)

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