Form D-17a - Application For A Vehicle Dealer License (Page 3 of 3) in pdf

Form D-17a - Application For A Vehicle Dealer License Page 3

PERSONAL PROPERTY TAX CERTIFICATION

12. I, the undersigned County Treasurer, certify that personal property tax levied for the preceding year against all firm owners

shown hereon have been paid in full; have been paid for the half of the preceding year, or that satisfactory evidence has been

presented to this office that said owners had no taxable property for the preceding year.

Dated at

, Kansas, this

day of

Co. Treasurer's Signature

County

OWNER CERTIFICATION

13. I certify that, as proprietor, partner or corporate officer of the firm, I have authority to sign and submit this application; and that

all statements contained therein are true and correct.

I further state that by applying for a vehicle dealer’s license that I am granting the Dealer Licensing Bureau Representative to

access all sales tax information for my dealership.

Owner’s Name

(Please Print)

Signature of Owner

Date

Signature

yes

no

14. Have you filed a Federal and State Income Tax return for each of the last 3 years?

Year



Copy of current Certificate of Insurance is enclosed.

Your insurance policy must stay in effect, with no lapse in coverage or your license may be revoked pending a Dealer License Hearing.

Insurance must be written in the Business Name and Address of Dealer Location.



Original Bond form with Power of Attorney attached is enclosed.

Any time you make a change; such as your business name, business address, entity or owners, you must notify your bond company.

Your bond must stay in effect, with no lapse in coverage or your license may be revoked pending a Dealer License Hearing.

Surety Bond must be written in the Business Name and Address of Dealer Location.



Tax Clearance Certificate is enclosed.

All dealers are required to provide a Certificate of Tax Clearance.

You can obtain Tax Clearance Certificate by going to



Copy of Sales Tax Certificate is enclosed.



Articles of Corporation from Secretary of State or Three Credit References are enclosed.



Franchise Agreement and D-100 are enclosed if applicable.



Zoning Certification is complete.



Personal Property Tax Certification is complete.



D-35 KDOT Certificate is enclosed if applicable.



License/Plate Fees are enclosed.

Please make a copy of this application and all supporting documents for your records, prior to mailing. Thank you.

D-17a(Rev. 08/13)

Form D-17a - Application For A Vehicle Dealer License Page 3

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