Form Bls 14 - Application For New Car Inspection Stickers

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Business Licensing Services Bureau
New Jersey
P.O. Box 172, Trenton, NJ 08666-0172
609-292-6500 # 5014
Motor Vehicle Commission
A P P L I C A T I O N F O R N E W C A R I N S P E C T I O N S T I C K E R S
FOR OFFICE USE ONLY
Date _____________________
No. ________________________
Approved By: _________________________________
Corp Code
No. ___________________________________________________________
2. Does the business entity intend to trade or conduct
. ______________________________________________________________________
1
business under a name other than the name in which
Business Name
the application is filed?
_______________________________________________________________________
[ ] No
Street Address
[ ] Yes If yes, complete information below:
_______________________________________________________________________
City
Zip Code
_______________________________________________________________________
___________________________________________________
Business Number
Contact
Trade Name
Type of Business Entity:
_____________________________________________
3
.
Street Address
[ ] Corporation
[ ] Partnership Type: ______________________
___________________________________________________________________
[ ] LLC
[ ] Sole Proprietorship
City / Zip Code
[ ] Other: ________________________________
____________________________________________
Business Phone Number
All applicants please provide the following information and attach copies of proof thereof:
.
4
**Attach copy of Certificate
A.
NJ State Tax Identification Number
_______________________________________________
of Incorporation/ Formation
filed with the NJ Secretary
NJ Unemployment Registration Number
B.
__________________________________________
of State. Foreign corporation
must submit a copy of its
C.
State of Incorporation / Formation
** _____________________________________________
certificate of authority to
conduct business in NJ
D.
Date of Incorporation / Formation
** _________________________________________
as a foreign corporation in
addition to a copy of its
Date of authorization to do business in New Jersey
E.
_________________________________
corporation/formation papers
5. Print the Full Name(s) of the owners, partners, or officers applying for this registration and indicate each stockholder’s percentage of stock:
Name
Title
Stock %
______________________________________________________________
_____________________________________
__________
____________________________________________________________
_____________________________________
__________
____________________________________________________________
_____________________________________
__________
______________________________________________________________
______________________________________
__________
______________________________________________________________
______________________________________
__________
If additional space is needed, please attach a separate sheet.
Do you have any employees? [ ] No
[ ] Yes
6.
,
If yes
please provide your Federal Employer Identification Number _______________________________________________________
Have the owners, partners, or officers ever been arrested, charged or convicted of a criminal or disorderly person’s offense in this or any other state?
7.
[ ] Yes
If yes, please explain: ________________________________________________________________________________________
[ ] No
______________________________________________________________________________________________________________________________________________
BLS 143 (R09/15)

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