Form Bmv 4319 - Statement Of Manufacturer/distributor Franchise
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1
2OHIO BUREAU OF MOTOR VEHICLES
STATEMENT OF MANUFACTURER/DISTRIBUTOR FRANCHISE
1.
PLEASE PRINT LEGIBLY OR TYPE THE FOLLOWING INFORMATION
MANUFACTURER/DISTRIBUTOR NAME OF BUSINESS
E-MAIL ADDRESS/WEB SITE
ADDRESS
CITY
STATE
ZIP CODE
2.
THE ABOVE MANUFACTURER OR DISTRIBUTOR HEREBY CERTIFIES THAT THE FOLLOWING DISTRIBUTOR/DEALER IS
DULY AUTHORIZED TO DISTRIBUTE/SELL THE MAKES INDICATED IN #4 :
EXACT NAME OF DISTRIBUTOR/DEALER
ADDRESS
PERMIT NUMBER
CITY
STATE
ZIP CODE
COUNTY
3.
USING A BLACK PEN, SHADE IN A BOX IN EACH COLUMN, UNDER DEALERSHIP COUNTY, TO INDICATE THE COUNTY
NUMBER IN WHICH YOUR DEALERSHIP IS LOCATED. SEE CHART BELOW FOR THE APPROPRIATE COUNTY NUMBER.
DEALERSHIP
01
ADAMS
16
COSHOCTON
31
HAMILTON
46
LOGAN
61
NOBLE
76
STARK
Butler Co.
COUNTY
= 09
02
ALLEN
17
CRAWFORD
32
HANCOCK
47
LORAIN
62
OTTAWA
77
SUMMIT
03
ASHLAND
18
CUYAHOGA
33
HARDIN
48
LUCAS
63
PAULDING
78
TRUMBULL
0
0
0
0
S
04
ASHTABULA
19
DARKE
34
HARRISON
49
MADISON
64
PERRY
79
TUSCARAWAS
1
1
1
1
A
05
ATHENS
20
DEFIANCE
35
HENRY
50
MAHOINING
65
PICKAWAY
80
UNION
2
2
2
2
M
06
AUGLAIZE
21
DELAWARE
36
HIGHLAND
51
MARION
66
PIKE
81
VAN WERT
3
3
3
3
P
07
BELMONT
22
ERIE
37
HOCKING
52
MEDINA
67
PORTAGE
82
VINTON
4
4
4
4
L
08
BROWN
23
FAIRFIELD
38
HOLMES
53
MEIGS
68
PREBLE
83
WARREN
5
5
5
5
E
09
BUTLER
24
FAYETTE
39
HURON
54
MERCER
69
PUTNAM
84
WASHINGTON
6
6
6
6
10
CARROLL
25
FRANKLIN
40
JACKSON
55
MIAMI
70
RICHLAND
85
WAYNE
7
7
7
7
11
CHAMPAIGN
26
FULTON
41
JEFFERSON
56
MONROE
71
ROSS
86
WILLIAMS
8
8
8
8
12
CLARK
27
GALLIA
42
KNOX
57
MONTGOMERY
72
SANDUSKY
87
WOOD
9
9
9
9
13
CLERMONT
28
GEAUGA
43
LAKE
58
MORGAN
73
SCIOTO
88
WYANDOT
14
CLINTON
29
GREENE
44
LAWRENCE
59
MORROW
74
SENECA
15
COLUMBIANA
30
GUERNSEY
45
LICKING
60
MUSKINGUM
75
SHELBY
99
OUT OF STATE
4.
LIST AUTHORIZED MAKES (DO NOT LIST MODELS):
A. MAKE
B. VEHICLE TYPE
A. MAKE
B. VEHICLE TYPE
5. Is there another authorized dealer selling the same make of vehicle(s) within a ten (10) mile radius of the above
named dealer? (25 mile radius RV Dealers)
YES
NO If yes, list dealer name and address:
DEALER
ADDRESS
CITY
STATE
ZIP CODE
6. Has dealer in #5 been notified, pursuant to Chapter 4517 of the Ohio revised Code, of the new franchise
__________________________
appointment?
YES
NO If yes, give date of notification
4319
1/04
BMV
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