Form Bmv 4319 - Statement Of Manufacturer/distributor Franchise Page 2
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1
2Completion of this form and signatures by both parties, affirm that a franchise exists between the Manufacturer/Distributor
and Distributor/Dealer in accordance with ORC Sections 4517.04, and 4517.50 - 4517.65. Pursuant to ORC 4517.23, the
appropriate party shall notify the BMV of any change in status of such contract/agreement within 15 days after such
change.
7. Signature of Manufacturer’s/Distributors authorized agent listed in #1
X
SIGNATURE
DATE
8. NOTARY:
Sworn to before me and subscribed in my presence this
day of
,
X
(SEAL)
NOTARY PUBLIC
MY COMMISSION EXPIRES
9. Signature of Distributor's/Dealership's owner, partner, officer, member, or trustee listed in #2
X
SIGNATURE
DATE
10. NOTARY:
Sworn to before me and subscribed in my presence this _________ day of
,
X
(SEAL)
NOTARY PUBLIC
MY COMMISSION EXPIRES
IMPORTANT INFORMATION
• This form must be on file with the Ohio Bureau of Motor Vehicles, Dealer Licensing Section,
before transactional sales may be made.
• Forms may be mailed or faxed. To locate the appropriate fax number for your county, please
visit From the home page click on Contract Dealer Licensing, click
on HERE under “by Telephone or Fax” then click on the county in which the distributor/dealer,
listed in #2, is located.
• Ohio Revised Code 4517.23 requires the appropriate party to notify the Dealer Licensing
Section of any change in status of such contract/agreement within 15 days after such change.
All sections must be completed and returned.
NOTE: ALTERED FORMS WILL NOT BE ACCEPTED.
If Mailing, Mail to:
Ohio Bureau of Motor Vehicles Attn: Dealer Licensing Section, P.O. Box 16521, Columbus, Ohio
43216-6521
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