New York > Statewide > Department Of Motor Vehicles
Request For Business Amendment Or Duplicate Certificate MV-253G - New York
| Request For Business Amendment Or Duplicate Certificate Form. This is a New York form and can be used in Department Of Motor Vehicles Statewide . |
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New York State Department of Motor Vehicles REQUEST FOR BUSINESS AMENDMENT/DUPLICATE CERTIFICATE INSTRUCTIONS Use this form to tell DMV about an amendment or to request a duplicate Business Certificate (you must fill out an original application if you are acquiring a business). There is no fee for amendments or duplicate certificates. If you are making a change, please call (518) 474-0919 for information about required documentation. Failure to provide all documentation will delay processing of your request. DUPLICATE CERTIFICATE CUSTOMERS: Complete items 1, 2, 3, 9 and 10 and the "Certification" section at the bottom of page 2. AMENDMENT CUSTOMERS: Complete items 1, 2, 3, 9 and 10 and the "Certification" section at the bottom of page 2. Also, complete items 4 - 8 only if they apply to the change you are making. DOCUMENTATION REQUIREMENTS FOR AMENDMENT CUSTOMERS ONLY DISMANTLERS: All dismantlers must provide a letter of zoning approval with this request. New York City Only - all "Secondhand Dealer - General", and "Secondhand Dealer - Auto", amendment requests MUST INCLUDE a Fire Department permit and an NYC Department of Consumer Affairs License. CUSTOMERS MAKING LOCATION CHANGES: If you are changing location, complete Form VS-19 ("Statement of Ownership and/or Permission to Use Place of Business") and submit it with this request. Repair shops must also provide a Certificate of Occupancy, local license or town letter as proof of zoning approval. If the new location was previously registered as a Repair Shop, please tell us the Facility number or Facility name of that shop. This can be used as proof of zoning. DEALERS: All dealers (excluding those who are exempt under the law) are required to have a bond. If you are a dealer requesting an amendment, please call (518) 474-0919 to determine if you have to provide a revised bond with your request. If you are a franchised dealer requesting an address change, you must provide franchise papers showing the new address. RETURN THIS COMPLETED REQUEST, AND ANY REQUIRED DOCUMENTATION, TO: Bureau of Consumer and Facility Services, Application Unit, PO Box 2700, Albany NY 12220-0700 Amendment Duplicate Reason: __________________________________________________________________ 1. Requested change: Present Facility Number Present Facility Name Facility Phone Number ( ) 2. Business(es) requesting amendment/duplicate certificate(s) -- check all that apply: Repair Shop Dealer Dismantler Itin. Veh. Collector Salvage Pool Transporter 3. Inspection Station Boat Dealer Scrap Collector Scrap Processor Mobile Car Crusher Other Business name change to: 4. Business address change: Number and Street New Address County Old Address Number and Street County 5. City State Zip Code City State Zip Code Inspection Stations or Dealers 6. a) Change in business type (for example, Fleet to Public, Wholesale to Retail, etc.): To: From: b) Change in groups approved for inspection (check the box(es) for the group(s) you want to inspect): VEHICLE GROUPS GROUP (Weights shown are maximum gross weights) 1a All motor vehicles that have a seating capacity under fifteen passengers, and all motor vehicles, except trailers and motorcycles, that have an MGW under 18,001 pounds. 1b 2a 2b 3 DL All trailers, except semi-trailers, that have an MGW under 18,001 pounds. All motor vehicles that have a seating capacity over fourteen passengers, and all motor vehicles and trailers that have an MGW over 18,000 pounds. All semi-trailers. All motorcycles. Diesel Emissions Testing for all non-exempt vehicles registered in the New York Metropolitan Area. c) If you will perform diesel emissions inspections, print the manufacturer's name and the model number of the testing equipment here. This information is required in order to process your request. Manufacturer's Name ____________________________________________________________________________ Model Number ____________________________________________________________________________ d) Please provide the name(s) and certification number(s), including expiration date, of your Certified Inspector(s). Use additional sheet(s) if necessary. This information is required in order to process your request. Name _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ MV-253G (2/11) Certification Number _________________________________________________ _________________________________________________ _________________________________________________ Expiration Date _________________________ _________________________ _________________________ www.dmv.ny.gov PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com 7. Deletions to Owners, Partners, Corporate Officers and/or Stockholders holding more than 10% of stock. Use additional sheet(s) if necessary. (a) Name (First, MI, Last) Date of Birth Title % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( (b) Name (First, MI, Last) Date of Birth Title ) % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( (c) Name (First, MI, Last) Date of Birth Title ) % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( ) 8. Additions to Owners, Partners, Corporate Officers and/or Stockholders holding more than 10% of stock. Use additional sheet(s) if necessary. (a) Name (First, MI, Last) Date of Birth Title % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( (b) Name (First, MI, Last) Date of Birth Title ) % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( (c) Name (First, MI, Last) Date of Birth Title ) % of Stock or Ownership Please Sign Name in Full Driver License Identification Number Social Security Number Residence Address Apt. No. Residence Phone ( ) 9. a) Have you, or has any person named in this application, ever been an individual owner, partner, interested party, officer, corporation director or stockholder having more than ten percent of the stock
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