ࡱ> g xbjbjJJ p(ub(ub,LMZZ$$$$$$$$$PJ%6'$+\v3(333y4m5|5@$cRe$)6y4y4)6)6$$33>;;;)6F$3$3;)6;;.Hd3޹ºo62Ѓ@zW<T8ddF$)6)6;)6)6)6)6)6%:f)6)6)6)6)6)6)6)6)6)6)6)6)6)6)6)6ZB #: OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES MOTOR VEHICLE SALVAGE DEALER, SALVAGE MOTOR VEHICLE AUCTION, SALVAGE MOTOR VEHICLE POOL APPLICATIONFailure to complete ANY portion of this application will delay the processing of the license. By completing, signing, and submitting this application with all required documentation, as applicable, you are affirming that the established place of business meets all the requirements of Chapter 4738 of the Ohio Revised Code (R.C.) and Chapter 4501:1-4 of the Ohio Administrative Code (O.A.C.) FORMCHECKBOX  YES  FORMCHECKBOX  NOAre you or your spouse a veteran or member of the armed forces or a surviving spouse of a veteran or member of the armed forces? (NOTE: a completed application with the required documentation of military status qualifies the applicant for an expedited application process, upon receipt.) If yes, please provide a copy of you or your spouses DD214, an official military ID for verification, separation documentation, or other official military documentation approved by the board.INITIALNote: The issuance of a Motor Vehicle Salvage Dealers License, Salvage Motor Vehicle Auction or Salvage Motor Vehicle Pool does not supersede local zoning. The State of Ohio (BMV) Dealer Licensing Section is the regulator of motor vehicle dealers, but does not pre-empt the enforcement by local authorities of zoning, health, safety codes, or laws. It is recommended that each applicant check zoning regulations applicable to the proposed facility with their local authority prior to making application.INITIALI affirm that I have completed the I-9 Employment Eligibility Verification form that is required to be on file with the employer under the Immigration Reform and Control Act of 1986, 8 USC 1324a (with the exception of sole proprietors).INDICATE SALVAGE LICENSE TYPE (check ONLY one) FORMCHECKBOX  *Motor Vehicle Salvage Dealers License For salvage license that deals primarily in motor vehicle parts. FORMCHECKBOX  *Salvage Motor Vehicle Auction For salvage license that engages in the business of auctioning salvage motor vehicles to authorized purchasers. FORMCHECKBOX  Motorcycle / Motor Scooter / APV Salvage Dealers For salvage license that deals exclusively in motorcycles / motor scooters / APVs parts. (NOTE: If any motor vehicle parts will be sold, you must apply for a Salvage Motor Vehicle Dealers License and meet the requirements.) FORMCHECKBOX  *Salvage Motor Vehicle Pool For salvage license that engages in the business of storing, displaying, and offering for sale, salvage motor vehicles to authorized purchasers.SALVAGE DEALER, SALVAGE AUCTION, OR SALVAGE POOL INFORMATIONEXACT BUSINESS NAME  FORMTEXT      BUSINESS PHONE #  FORMTEXT      ALTERNATE PHONE #  FORMTEXT      REGISTERED DBA OR TRADE NAME  FORMTEXT      FAX #  FORMTEXT      COUNTY  FORMTEXT      BUSINESS STREET ADDRESS  FORMTEXT      E-MAIL ADDRESS  FORMTEXT      CITY  FORMTEXT      STATE  FORMTEXT      ZIP CODE  FORMTEXT      FEDERAL TAX ID OR EIN #  FORMTEXT      VENDOR S #  FORMTEXT      rEGISTERED DBA OR TRADE NAME  FORMTEXT      HOURS OF OPERATIONOPENCLOSEOPENCLOSEMONDAY FORMTEXT       FORMTEXT      SATURDAY FORMTEXT       FORMTEXT      TUESDAY FORMTEXT       FORMTEXT      SUNDAY FORMTEXT       FORMTEXT      WEDNESDAY FORMTEXT       FORMTEXT      THURSDAY FORMTEXT       FORMTEXT      FRIDAY FORMTEXT       FORMTEXT       IMPORTANT INFORMATIONApplications for a license may be denied for reasons which include:Having been convicted of, judicial finding of guilt of, or plea of guilty to a disqualifying offense as determined under section  HYPERLINK "https://codes.ohio.gov/ohio-revised-code/section-9.79" 9.79 of the R.C. For a complete list of disqualifying offenses, visit our website at www.OhioAutoDealers.com. OWNERSHIP INFORMATION (R.C. 4738.04, 4738.07 and O.A.C. 4501:1-4-02, 4501:1-24)All Ohio residents who are listed on this application MUST be electronically fingerprinted. Applicants must request that the results be sent electronically to direct copy BMV Dealer Licensing at the web check locations in order for them to be forwarded to the BMV Dealer Licensing Section. (For a complete list of electronic fingerprinting locations in Ohio, visit  INCLUDETEXT P:\\Printing Services\\PSS-Electronic Design\\ODPS FORMS & PUBLICATIONS\\BOOKMARKING\\WEBSITES.doc AGWEB \* MERGEFORMAT  HYPERLINK "http://www.OhioAttorneyGeneral.gov" www.ohioattorneygeneral.gov.)All out-of-state applicants, or those who qualify for electronic exemption that are listed on this application, MUST submit a fingerprint card (supplied by Dealer Licensing or Ohio Attorney Generals Office), exemption form, and fingerprint card processing fee with the application for license. Contact the Dealer Licensing Section at  INCLUDETEXT P:\\Printing Services\\PSS-Electronic Design\\ODPS FORMS & PUBLICATIONS\\BOOKMARKING\\PHONEFAX.doc DEALERLICENSEPHONE \* CharFormat \* MERGEFORMAT (614) 752-7636 to request that a fingerprint card and exemption form be mailed to youAll individuals listed on this application are required to complete a criminal history record through the Bureau of Criminal Identification and Investigation (BCI). A Federal Bureau of Investigation (FBI) criminal history record is not acceptable in place of a BCI criminal history record.NOTE: Some background checks could take BCI up to thirty (30) days for processing. BUSINESS ENTITY INFORMATION (Mark one and complete ownership information) FORMCHECKBOX  Sole Proprietor  FORMCHECKBOX  Corporation (President, Vice President, Treasurer, Secretary)  FORMCHECKBOX  Limited Liability (Members) FORMCHECKBOX  Partnership (Partners)  FORMCHECKBOX  Business Trust (Trustee)  FORMCHECKBOX  Other Registered Entity* FORMTEXT      *Must include a copy of the registered business entity that has been filed with the Secretary of State. You may be required to show the registered ownership structure. OWNERSHIP INFORMATION FAILURE TO COMPLETE ANY PORTION WILL DELAY THE PROCESSING OF THIS APPLICATIONAPPLICANT NAME OR CORPORATION NAME  FORMTEXT      TITLE  FORMTEXT      HOME OR CORPORATION ADDRESS  FORMTEXT      SSN / FEIN  FORMTEXT      CITY, STATE, ZIP  FORMTEXT      TELEPHONE #  FORMTEXT      OWNERSHIP % (if member)  FORMTEXT      ELECTRONIC FINGERPRINTS COMPLETED?  FORMCHECKBOX  YES  FORMCHECKBOX  NO  FORMCHECKBOX  NOT APPLICABLE DATE COMPLETED FORMTEXT      APPLICANT NAME (first, middle, last, suffix)  FORMTEXT      TITLE  FORMTEXT      HOME ADDRESS  FORMTEXT      SSN  FORMTEXT      CITY, STATE, ZIP  FORMTEXT      TELEPHONE #  FORMTEXT      OWNERSHIP % (if member)  FORMTEXT      ELECTRONIC FINGERPRINTS COMPLETED?  FORMCHECKBOX  YES  FORMCHECKBOX  NO  FORMCHECKBOX  NOT APPLICABLE DATE COMPLETED FORMTEXT       APPLICANT NAME (first, middle, last, suffix)  FORMTEXT      TITLE  FORMTEXT      HOME ADDRESS  FORMTEXT      SSN  FORMTEXT      CITY, STATE, ZIP  FORMTEXT      TELEPHONE #  FORMTEXT      OWNERSHIP % (if member)  FORMTEXT      ELECTRONIC FINGERPRINTS COMPLETED?  FORMCHECKBOX  YES  FORMCHECKBOX  NO  FORMCHECKBOX  NOT APPLICABLE DATE COMPLETED FORMTEXT       APPLICANT NAME (first, middle, last, suffix)  FORMTEXT      TITLE  FORMTEXT      HOME ADDRESS  FORMTEXT      SSN  FORMTEXT      CITY, STATE, ZIP  FORMTEXT      TELEPHONE #  FORMTEXT      OWNERSHIP % (if member)  FORMTEXT      ELECTRONIC FINGERPRINTS COMPLETED?  FORMCHECKBOX  YES  FORMCHECKBOX  NO  FORMCHECKBOX  NOT APPLICABLE DATE COMPLETED FORMTEXT      Any additional persons please list on a separate sheet of paper and attach to this application. Provisional Motor Vehicle Salvage License: It is understood that a physical inspection will be performed by BMV Investigations and if passes the initial inspection; a 180 day provisional permit may be issued.INITIALNinety (90) days after the issuance of the provisional permit, a notice will be sent to the permit holder, which indicates that the business will be re-inspected near the end of the 180 day provisional period, and that the business must pass the inspection at that time.INITIALIf the licensed location fails to meet any of the listed requirements, the permit will be immediately revoked R.C. 4738.071. The revocation will be verbal at first, by the investigator, but shall be followed-up in writing by the Registrar of Motor Vehicles.INITIALIf the applicant passes the second inspection, it may simply continue in business as regulated by R.C. 4738. Shortly after the second inspection is approved, you will receive a permit and new registration cards and stickers, if plates were ordered.To the best of my knowledge and belief, I, the applicant(s) acknowledge responsibility for any misrepresentation of the foregoing information and the subsequent statements in this application and any additional documents, as applicable. FORMCHECKBOX  YES  FORMCHECKBOX  NODoes the business listed on this application have a net worth of at least twenty thousand ($20,000) dollars? No dealer shall be issued a motor vehicle salvage dealers license, salvage motor vehicle auction or salvage motor vehicle pool license or permitted to operate under a license unless there is a net worth (Net Worth = Assets minus Liabilities) in the sum of $20,000, and must be verifiable upon request of the Registrar. Net worth must be maintained during the entire period for which the license is held. FORMCHECKBOX  YES  FORMCHECKBOX  NOAre you or any person listed in the ownership information section on this application, listed under another motor vehicle business entity? FORMCHECKBOX  YES  FORMCHECKBOX  NOHave you or any person listed in the ownership information section on this application, previously applied for a motor vehicle dealers license, leasing license, distributors license, auction owners license, motor vehicle salvage dealership, motor vehicle salvage auction, motor vehicle salvage pool, construction equipment auction license or salespersons license? (If yes please list below; submit any additional information on a separate sheet of paper.)BUSINESS NAME APPLIED IN  FORMTEXT      DATE  FORMTEXT      TYPE OF LICENSE  FORMTEXT      PERMIT # - IF ISSUED  FORMTEXT       FORMCHECKBOX  YES  FORMCHECKBOX  NOHave you or any person listed in the ownership information section on this application, ever had their motor vehicle salvage dealer, salvage motor vehicle auction or salvage motor vehicle pool license suspended or revoked? FORMCHECKBOX  YES  FORMCHECKBOX  NOHas any person listed on this application ever been convicted of, judicial finding of guilt of, or plea of guilty to a disqualifying offense as determined under section  HYPERLINK "https://codes.ohio.gov/ohio-revised-code/section-9.79" 9.79 of the R.C. in this state or any other state? For a complete list of disqualifying offenses, visit our website at www.OhioAutoDealers.com. If answered yes, please provide the following certified documents and information: A certified copy of a conviction or journal entry; A certified copy of the sentencing entry; and A certified copy of the indictment or complaint. If in another state, list the state(s): ______________________________ FORMCHECKBOX  YES  FORMCHECKBOX  NOHave you or any person listed in the ownership information section on this application, ever had a civil judgment rendered against you that resulted from a transaction of business as a motor vehicle salvage dealer, salvage motor vehicle auction or salvage motor vehicle pool and remains unsatisfied? If answered yes please provide the following certified documents and information: The courts journal entry showing the final disposition of the judgment. The court of jurisdiction that decided the civil judgment. That courts case number. The date the civil judgment was issued. FORMCHECKBOX  YES  FORMCHECKBOX  NOAre you or do you intend on sharing the proposed business location with another licensed motor vehicle salvage dealer? * If  yes , give the business name  FORMTEXT       *A Certificate of Compliance form (BMV 4347) must be submitted with this application. FORMCHECKBOX  YES  FORMCHECKBOX  NOTo your knowledge, was the proposed business location previously occupied by another licensed motor vehicle salvage dealer, salvage motor vehicle auction or salvage motor vehicle pool? If yes, give the business name, if available  FORMTEXT       PHYSICAL REQUIREMENTS Below are listed the physical requirements for application. Affirm that each requirement meets exactly as intended at the time of application and shall remain in compliance the entire time the license is held.INITIAL Motor Vehicle Salvage Dealer License (primarily motor vehicle parts): A minimum area of a contiguous fifty thousand (50,000) square feet.INITIAL Motorcycle / Motor Scooter / APV Dealer License (exclusive to motorcycle / motor scooter / APV parts): A minimum area of a contiguous five thousand (5,000) square feet.INITIAL Area must be shielded by a fence meeting the following requirements, except in very limited instances and not in violation of the relevant provisions of sections R.C. 4737.07 and 4737.09: Fencing shall be a minimum height of six feet and a maximum of ten feet. Fencing shall shield the salvage place of business from ordinary view. All inventory of the business shall be stored behind the fence or enclosure to promote and preserve a positive visual impact of the salvage yard's business on the surrounding neighborhood. (A living hedge of equal or greater height and sufficient density year round to prevent view of the salvage place of business may be substituted for the fence.)INITIAL An office in which business will be transacted, in a building not less than two hundred twenty-five (225) square feet, consisting of the following: A clearly identifiable area devoted to sales transactions.INITIAL The business hours must be maintained and legibly posted in a conspicuous place near the entrance of the office.INITIAL Each motor vehicle salvage dealer, salvage motor vehicle auction, or salvage motor vehicle pool licenses shall be posted in a conspicuous place in each place of business establishment.INITIAL A permanent, properly maintained, and prominently displayed sign showing the exact name of the business as it appears on the application and, any registered trade names in letters, in letters that shall be no less than six (6) inches high.INITIAL No salvage motor vehicle dealer may operate at the same 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location showing; the salvage business location for which the license is being sought, to include area behind shielding that is designated for inventory storage area in front of the shielding the sign with the business name, including any registered trade names. inside of the office showing designated parts counter outside of the office area PHOTOS MAY BE SUBMITTED BY MAIL WITH THE APPLICATION OR BY E-MAIL (JPEG format) TO  HYPERLINK "mailto:dealerphotos@dps.ohio.gov" dealerphotos@dps.ohio.gov.(If submitted by e-mail, please include dealership name and county in the subject line.)FEES ARE NON-REFUNDABLE Make check payable to Ohio Treasurer of State. Fees are as follows: (DO NOT SEND CASH)Motor Vehicle Salvage DealerPermit$ 100.00Salvage Motor Vehicle AuctionMaster Plate (Optional)$ 50.25Salvage Motor Vehicle PoolPostage$ 4.50SUBTOTAL FEE$ 154.75*Additional Plate(s) (Optional) $10.25 x  FORMTEXT      $  FORMTEXT       GRAND TOTAL FEE$  FORMTEXT        FORMTEXT  =254.75+Platetotal 254.75254.75 INITIALA reasonable number of additional plates may be requested to support the motor vehicle salvage license. Plates may not be used contrary to uses as specified in the R.C. 4503.31. I understand that plates used for any other purpose may be reduced or may be subject to confiscation. (Motor Vehicle Salvage Dealer, Salvage Pool, Salvage Auction ONLY)FEE FOR THE FOLLOWING LICENSEMotorcycle / Motor Scooter / APV Salvage DealerPermit$100.00GRAND TOTAL FEE$  FORMTEXT       It is understood that at the discretion of the Registrar, a physical inspection will be performed by BMV Investigations prior to or after the issuance of the license and at any given time during the period which the license is held.I understand that if the licensed location fails to meet any of the requirements or fails to maintain compliance, it will immediately be referred to the Motor Vehicle Salvage Dealers Licensing Board for possible suspension or revocation of the license.I understand that the Registrar of motor vehicles must be notified if there is a change of status at the licensed location, including but not limited to, personnel of ownership, relocation of the place of business, posted business hours, and telephone number.I understand that this application may be denied if any individual listed under the ownership has been convicted of, judicial finding of guilt of, or plea of guilty to a disqualifying offense as determined under section  HYPERLINK "https://codes.ohio.gov/ohio-revised-code/section-9.79" 9.79 of the R.C. Notification of an administrative hearing shall be given to the applicants in a timely manner upon notification to the Board of such a conviction.I affirm that the motor vehicles owned by this business will be insured or have other financial responsibility coverage, will not be operated without financial responsibility coverage, and will not be used as commercial vehicles unless so registered.I, as an authorized representative of the business entity or sole proprietor, acknowledge that all information in the foregoing application and in any additional documentation is true and correct.PRINTED OR TYPED NAME OF SIGNER  FORMTEXT      TITLE  FORMTEXT      SIGNATURE (OWNER, PARTNER, PRESIDENT, MEMBER, TRUSTEE, OR PRINCIPAL OWNER) XDATE OF APPLICATION  FORMTEXT      NOTARY Subscribed and sworn to before me this day of , in the county of State of Ohio. 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Box 16521 Columbus, Ohio 43216-6521 For additional information and laws visit our Web site at  INCLUDETEXT P:\\Printing Services\\PSS-Electronic Design\\ODPS FORMS & PUBLICATIONS\\BOOKMARKING\\WEBSITES.doc DEALERWEB \*CharFormat \* MERGEFORMAT  HYPERLINK "http://www.ohioautodealers.com/" www.ohioautodealers.com.     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