Wisconsin Department of Transportation
MOTOR VEHICLE SALVAGE DEALER OR RECYCLER Dealer Section
TWO YEAR LICENSE APPLICATION FOR OFFICE USE ONLY PO Box 7909
MV2180 10/2006 Ch. 218 Wis. Stats. Issued Expires Madison, WI 53707-7909
Amending Current License Information
Legal Name Area Code - Telephone Number Dealer License Number
Trade Name(s) or DBAs Federal Employer Identification Number
Business Address Post Office Box Number City State ZIP Code County where business located
Mailing Address - If Different from Business Address E-mail Address
Business Entity Association If Corporation or LLC, State of Incorporation or Organization City Village Township
Date Licensed in Wisconsin
Sole Proprietorship Corporation Name:
Partnership LLC
Address of Additional Salvage or Recycling Location in Same Municipality, which conforms with local zoning requirement
Name and Title of Owner, Partners, Association Members, Corporation Officers and Shareholders, LLC Managers and Members
Complete an Entity/Owner Statement (Form MV2844) for each individual listed.
Completely describe other business, if any, engaged in by your firm Same location? SALES TAX SELLER PERMIT NUMBER
No Yes
NO YES
Was there a licensed dealer at this same location previously this year?
If yes, Name dealer ____________________________________________
Have you, as an individual and your above-named firm, been licensed as a dealer before?
If yes, Same location? No Yes
Has your motor vehicle dealer license ever been denied, suspended or revoked?
If yes, When and what state? _____________________________________ Complete ONE of the following (whichever applicable):
Are you licensed as a motor vehicle dealer at same location? Is business real estate owned by: YES NO
If yes, Give license number _______________________________________ Owner of sole proprietorship If no,
You must submit 2 letters from the WI Dept. of Natural Resources: One One partner of partnership send copy
confirming your coverage under a storm water permit and a second confirming of lease.
Corporate dealership
your registration with the refrigerant recovery program or that you have
certified through another refrigerant recovery compliance method. LLC
Type 4 - Salvage does not need a storm water permit.
Check one of the following statements, which properly explains the minimum type business facilities provided and the extent of this motor vehicle salvage or
recycling operation at main location. If you listed above an additional salvage business address within the same municipality, also check type of facilities and
operation for such additional location, below right.
Business Type
Type 1. Facilites include business office on or adjacent to the salvage yard where motor vehicles are dismantled and/or stored.
Type 2. Facilities are provided and salvage business is conducted strictly within building, in which business office is provided and motor vehicles are
stored and dismantled; there is no adjacent salvage yard.
Type 3. Facilities include business office on or adjacent to the scrap metal recycling operation (shredder, baler, etc.) where salvage motor vehicles and
other scrap metal commodities are reduced in size for shipment to metal producing companies.
Type 4. Facilities do not include a salvage yard, but only a business office for maintenance of required motor vehicle salvage records. Salvage motor
vehicles are purchased from vehicle owners and transported directly to salvage yards or scrap metal recyclers. The vehicle(s) used for
transporting salvage metals shall be parked and stored at the following location, which has been approved by local authorities:
Anticipated Date Business Facilities Will Be Ready
I, the undersigned, certify under penalty of s.946.32 or s.345.17 Wisconsin Statutes,
that the answers and statements on this application are true and correct to the best
of my knowledge.
Submit this application with completed Entity/Owner
Statement, financial statement on form enclosed and $150.00
two year license fee payable to: Registration Fee Trust.
X
See reverse side. (Authorized Dealership Agent, Title) (Date)
Following Applies To First-time Dealer Applicant Or Application For Amended License
Because of Business Relocation or Ownership Change
Proper local officials must sign below, BEFORE submitting this application. All applicants complete section A.
If business is located in a township, complete both sections A and B.
Attention Zoning Authorities: See front of application for type of salvage operation being conducted.
Section A
Business Name / Location Business Type
1 2 3 4
1. Operation of the salvage business, type indicated above, at the location(s) stated above is in accordance with local
zoning, building code and permit requirements.
X
(Print Name) (Signature)
(Official Title) (Municipality)
2. S.175.25 Wisconsin Statutes, requires a permit be issued by (1) the common council or village board, if the
salvage yard is located within the corporate limits of any city or village, OR (2) the town board, if the salvage yard
is located within 2,000 feet outside the corporate limits of a city or village, or within 750 feet of the center line
of any county trunk, state trunk or federal highway, or within 500 feet of the center line of any town road.
Check one box and sign below:
A local permit or license is required and has been issued.
A local permit or license is not required.
X
(Print Name) (Signature)
(Official Title) (Municipality)
Section B
Business Name / Location Business Type
1 2 3 4
County Zoning Approval - required only if business is located in a township.
Operation of the salvage business, type indicated above, at the location(s) stated above is in accordance with local
zoning regulation.
X
(Print Name) (Signature)
(Official Title) (County)
If business address on front does not include a specific street number, furnish directions to your business location,
including highway numbers or letters and distances.
