Form Dlb-1a - Application For Combination Motor Vehicle, Trailer & Motorcycle Dealer License
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1
2FEE $ 225.00
DLB-1A revised 2010
(Collected after inspection & approval)
STATE OF NEBRASKA
NEBRASKA MOTOR VEHICLE INDUSTRY LICENSING BOARD
301 CENTENNIAL MALL SOUTH, P.O. BOX 94697, LINCOLN, NE 68509
APPLICATION FOR
(INDICATE THE CLASS OF DEALER BY PLACING AN "X" IN THE APPROPRIATE BLOCK.)
•
COMBINATION MOTOR VEHICLE & TRAILER DEALER LICENSE
• )
(
• )
(Used motor vehicles/motorcycles/trailers
Enfranchised motor vehicles/motorcycles/trailers
•
TRAILER DEALER LICENSE (New and/or used Trailers only)
•
MOTORCYCLE DEALER LICENSE (New and/or used Motorcycles only)
Application for a license to engage in the business of selling or exchanging motor vehicles or trailers in accordance with Ch. 60, art. 14,
R.R.S., 1943, as amended, and in accordance with rules and regulations of the Nebraska Motor Vehicle Industry Licensing Board, as the
same may be now, or as amended hereafter:
1. Applicant is doing business as (name of the dealership): ______________________________________________________________
_____________________________________________________________________________________________________________
(Street)
(PO Box)
(City, Town or Village)
(State)
(Zip Code)
(County)
If the above address is a rural location, please give directions to find the dealership.
____________________________________________________________________________________________________________
2. Does the above location conform to applicable zoning laws?____________
(Please supply a zoning permit or letter from the proper authority confirming your zoning compliance.)
3. Indicate your declared office hours: From_______A.M. to_______P.M.
Dealership Phone Number (________)_________________
__________________
(Must be open 40 hours per week - 20 of those during regular business hours.)
FAX Number
(
)
4. Describe fully the building and actual premises where the business is to be operated (include square feet of building and display area):
______________________________________________________________________________________________________________
5. Indicate whether the proposed location is owned or leased by the applicant ______________. If the location is leased, a copy of the lease
not ending before Dec. 31st of the current year must accompany this application.
6. Will there be one contiguous area for the display of ten or more motor vehicles, trailers, or motorcycles in a presentable manner where
this business is to be operated? ___________
7. Will all trailer or motor vehicle and trailer records be kept separately and apart from other business or personal records?___________
8. Will the applicant have repair facilities and tools to properly and actually service warranties on motor vehicles, motorcycles, or trailers
sold at such place of business and to make other repairs arising out of the conduct of the licensee's business? A mobile truck equipped
with repair facilities to properly perform warranty functions and other repairs shall be deemed adequate repair facilities for trailers.
___ YES; ___ NO If NO, complete the “Service Agreement Statement” or attach an executed service agreement for such repairs.
9. Ownership of the dealership (check only one):
__
Individual owner: Name and address ____________________________________________________________________________
Social Security Number ________________________________________
__
Partnership: Names and addresses of all partners___________________________________________________________________
____________________________________________________________________________________________________________
__
Corporation or LLC: ___________________________________________________ (registered with the Nebraska Secretary of State)
List the names, titles and addresses of principal corporate officers or names and addresses of LLC members:
_____________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
(SEE THE INSTRUCTIONS REGARDING THE ISSUANCE OF THE DEALER BOND TO REFLECT OWNERSHIP)
10. (a) Have any of the above named persons ever been found guilty of any felony that has not been pardoned?
Yes____No____
(b) Ever been found guilty of any misdemeanor concerning fraud or conversion?
Yes____No____
(c) Suffered any judgment in any civil action involving fraud, misrepresentation or conversion?
Yes____No____
(d) Are any felony charges pending at the present time?
Yes____No____
If any of the above named persons answered yes to any of the above questions, please give details._______________________________
______________________________________________________________________________________________________________
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