Form Tc-301 - Bonded Motor Vehicle Business Application Page 2
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4TC-301, page 2 of 4
Owner(s), partner(s) or corporate officers information
Attach additional sheet(s) if necessary.
You must apply in person at MVED (210 N 1950 W, Salt Lake City, Utah) if:
1. you are applying for dealer license as any entity type and any of the owners are not U.S. citizens; or
2. you are a sole proprietor who is not a U.S. citizen and you are applying for any of the following licenses: body shop, crusher, distributor,
dismantler, manufacturer, factory branch, distributor branch, remanufacturer or transporter.
Bring proof that you and/or any of the owners who are not U.S. citizens are in the United States lawfully under 8 USC 1641. Also bring your/their
employment authorization card(s) and documentation showing the I-94 (arrival/departure) number(s) and Alien Registration Number(s) issued by the
U.S. Citizenship and Immigration Service.
Owner #1 name
Title
Home phone
Home address
Social Security Number
Driver’s license number and state
City
State
ZIP Code
Date of birth
Hair color
Eye color
Height
Weight
Gender
Male
Female
Place of birth
Race
Under state and federal law we cannot issue a license to any person who does not provide the following information.
Check one (Providing false information subjects the signer to the penalties of perjury.):
I am a U.S. citizen.
SSN: _ __ _ _ _ __ _ _ __ _ ___ _ _ __ _ _ _
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94#*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
Alien #*: _ __ _ __ _ __ _ _ __ _ _ __ _ _ __ __
Employment authorization card #*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
Owner #2 name
Title
Home phone
Home address
Social Security Number
Driver’s license number and state
City
State
ZIP Code
Date of birth
Hair color
Eye color
Height
Weight
Gender
Male
Female
Place of birth
Race
Under state and federal law we cannot issue a license to any person who does not provide the following information.
Check one (Providing false information subjects the signer to the penalties of perjury.):
I am a U.S. citizen.
SSN: _ __ _ _ _ __ _ _ __ _ ___ _ _ __ _ _ _
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94#*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
Alien #*: _ __ _ __ _ __ _ _ __ _ _ __ _ _ __ __
Employment authorization card #*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
Owner #3 name
Title
Home phone
Home address
Social Security Number
Driver’s license number and state
City
State
ZIP Code
Date of birth
Hair color
Eye color
Height
Weight
Gender
Male
Female
Place of birth
Race
Under state and federal law we cannot issue a license to any person who does not provide the following information.
Check one (Providing false information subjects the signer to the penalties of perjury.):
I am a U.S. citizen.
SSN: _ __ _ _ _ __ _ _ __ _ ___ _ _ __ _ _ _
I qualify under 8 U.S.C. 1641 and I am present in the U.S. lawfully.
I-94#*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
Alien #*: _ __ _ __ _ __ _ _ __ _ _ __ _ _ __ __
Employment authorization card #*: _ __ _ __ _ _ __ _ __ _ ____ ___ __
* The Alien Registration Number (A#), I-94 (arrival/departure) number and employment authorization card are issued by the U.S. Citizenship and Immigration Service.
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Parent category: Financial