Form Dlb-7a - Application For Motor Vehicle Or Trailer Finance Company License
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1DLB-7A
STATE OF NEBRASKA
NEBRASKA MOTOR VEHICLE INDUSTRY LICENSING BOARD
301 CENTENNIAL MALL SOUTH, P.O. BOX 94697
LINCOLN, NE 68509
Phone: 402-471-2148
Application for:
MOTOR VEHICLE OR TRAILER FINANCE COMPANY LICENSE
FEE $ 120.00
This license permits the licensee to engage in the activities of repossession of motor vehicles or trailers and the sale of
such motor vehicles or trailers so repossessed.
Application of ____________________________________________________________ for a license to engage
(Firm name under which business is conducted)
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 connection herewith makes the following material statements:
1. Finance Company address:
____________________________________________________________________________________________
Street
PO Box
City
State
Zip
2. Your declared office hours: _______ A.M. to _______ P.M.
3. Telephone number: (_______) __________________
Facsimile number: (_______) __________________
4. Provide the name(s) and address(es) of the owner. Check only one ownership type.
__ Individual: Name and address of individual owner _________________________________________________
Social Security number: _______________________________________
__ Partnership: Names and addresses of partners ____________________________________________________
_____________________________________________________________________________________________
__ Corporation or LLC
:
(Corporation name or LLC if different than the name under which the business is conducted)
_____________________________________________________________________________________________
List below the names, titles, and addresses of the principal officers of the corporation or members of the LLC
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
The OATH must be signed and notarized.
)
STATE OF _______________________
)
County of ________________________
___________________________________________________________, being first duly sworn, upon oath deposes and says: That
(printed name of individual owner, partners, corporate officer, or LLC member)
he/she is the applicant who makes the above and foregoing application, that he/she has read the same, knows the contents thereof,
and that all statements therein contained are true.
___________________________________________
_____________________________________________
(Signature of Applicant)
(Signature of Applicant)
SUBSCRIBED in my presence and sworn to before me this _______day of ____________________, __________
___________________________________________________
(Notary Public)
Please send a certified check, postal money order or cashier’s check in the proper amount, made payable to Nebraska
Motor Vehicle Industry Licensing Board. No currency please.
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Parent category: Financial