Ar-0191 - Salvage Vehicle Agent Application For Corrected Or Dupilcate License

Download a blank fillable Ar-0191 - Salvage Vehicle Agent Application For Corrected Or Dupilcate License in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Ar-0191 - Salvage Vehicle Agent Application For Corrected Or Dupilcate License with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

AR-0191 (12/2015) by Authority of PA 300 of 1949, as amended
MICHIGAN DEPARTMENT OF STATE
DEPARTMENT USE ONLY:
BUREAU OF DRIVER & VEHICLE PROGRAMS
SALVAGE VEHICLE AGENT APPLICATION
BUSINESS LICENSING SECTION
Approved: _____________
LANSING, MI 48918
FOR CORRECTED OR DUPILCATE LICENSE
888-767-6424
By: ___________________
Please read carefully and complete the appropriate sections. All applicants must complete sections 1 and 4 and Section 2 or
Section 3. The application must be signed by both the agent and the employing dealer. If the license has been lost, damaged, or
destroyed, a duplicate may be obtained for a $50.00 fee. A corrected license at no fee may be obtained for one of the following
reasons: unacceptable photograph, agent name change, agent address change, or change in dealer’s name or d/b/a.
NOTE: A change of employing dealer requires an original agent application.
When requesting either a duplicate or corrected license, the current license (unless lost or stolen) must be surrendered at the
Secretary of State branch office when your new photograph is taken.
Clear Form
_______________________________________________________________________________________________________
Section 1 – CURRENT LICENSE INFORMATION (As it appears on your license)
Name ___________________________________________________________ Agent License Number ___________________
Dealer ___________________________________________________________ Dealer Number _________________________
_______________________________________________________________________________________________________
Section 2 – CORRECTED LICENSE (No fee is required)
 Agent Name Change
New Name ___________________________________________________________________________________________
New Driver License Number and Issuing State _______________________________________________________________
(Note: A name change also requires your driver license to be changed.)
 Agent Address Change
New Address _________________________________________________________________________________________
(Street)
(City)
(County)
(State)
(Zip Code)
 Dealer Name Change or D/B/A Change
New Dealer Name _____________________________________________________________________________________
(Note: Dealers must first complete and attach a Vehicle Dealer License Application Change of Name and/or Change of
Address Form. A corrected agent license will not be approved unless the dealer license is also corrected.)
 Unacceptable Photograph (Explain) ________________________________________________________________________
 Other (Explain) ________________________________________________________________________________________
Section 3 – DUPLICATE LICENSE (Fee is required)
A duplicate license will show the same information as the original license. If any information has changed, complete Section 2.
 Lost
 Damaged
 Destroyed
 Stolen
Reason for duplicate license:
The fee for a duplicate license is $50.00. Make check payable to “State of Michigan.”
_______________________________________________________________________________________________________
Section 4 – CERTIFICATION AND SIGNATURES
I/we certify that the statements contained in this application are true. I/we understand that any misleading, incomplete, or false
statement may be grounds for denial of this application or suspension or revocation of the license issued.
Agent’s Printed Name
Agent’s Signature
Telephone Number
Date
Dealer’s Printed Name
Dealer’s Signature
Telephone Number
Date

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go