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Auto Body Repair Facility License Application Form. This is a New Jersey form and can be use in Motor Vehicle Commission Statewide.
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Tags: Auto Body Repair Facility License Application, New Jersey Statewide, Motor Vehicle Commission
New Jersey
Motor Vehicle Commission
Business Licensing Services Bureau
Auto Body Unit, P.O. Box 172
Trenton, New Jersey 08666-0172
(888) 486-3339 ext.5014 toll-free in NJ
(609) 292-6500 ext.5014
PLEASE READ CAREFULLY
Enclosed is the application for an auto body repair facility initial license which must be completed and
returned to this office.
In accordance with recently adopted regulations, each applicant shall have an established place of
business at the time such license is issued. The establishment must be in conformance with the
requirements of the municipality in which it is located.
The municipal or zoning board clerk must complete the approval certificate contained on the reverse side
of the Application for License. We will, however, accept a photocopy of a certificate of occupancy in lieu
of the completed approval certificate.
Please return the completed application to this office with documents below:
1. Statement advising if your facility will be performing painting services.
2. Two (2) certified checks/money orders for: $350.00 (license fee) and $20.00 (non-refundable
application fee).
3. Copy of receipt for fingerprints.
4. Color photographs of each applicant.
5. Copy of driver license for each applicant.
6. Photographs of the auto body repair facility showing signs and other advertising media.
7. Federal Tax Identification Number. (Attach copy of certificate).
8. NJ Sales Tax Identification Number. (Attach copy of certificate).
9. Workers’ compensation insurance or a statement advising no employees. Please note that if
employees are hired after the license has been issued, you must submit workers’ compensation
insurance at that time.
10. Current certificate of inspection from the fire marshal for the building and spray booth.
11. Garage keepers’ liability insurance (min. $300,000), certificate holder must read:
New Jersey Motor Vehicle Commission
Auto Body Unit
P.O. Box 172
Trenton, NJ 08666-0172
12. A copy of your Corporate Certificate (Inc) or formation papers for LLC, Partnerships and sole
Proprietors.
13. Evidence of completion from a recognized auto body class; at least one class must be taken
within one (1) year preceding issuance of the initial license.
14. Stack permit or letter of exemption from DEP for spray booth.
15. Provide signed agreement (sample enclosed) if the below listed services will be performed by a
facility other than yourself.
( ) structural repairs
( ) vehicle four-wheel alignment
( ) air conditioner servicing
( ) mechanical repair as a result of collision damage.
16. If your auto body repair facility will not be spray painting, please contact this office for additional
forms. Prior to your Auto Body Repair Facility license being issued, a site inspection will be
conducted. An investigator from this Commission will contact you.
Enclosures
BLC-25 (R 01/08)
On the Road to Excellence
www.njmvc.gov
New Jersey is an Equal Opportunity Employer
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Business Licensing Services Bureau
PO Box 172
Trenton, New Jersey 08666-0172
Motor Vehicle
Commission
APPLICATION FOR LICENSE
FOR OFFICE USE ONLY
License No.
Date
Reg. No.
Email
Approved by
The undersigned hereby applies for the license(s) checked in Part 3 and submits the following certified statement:
Corp Code
1.
Business phone
Name of Business (if corporation, corporate name)
____________________________________________________________________
Trade Name
2. Please Check
[ ] Corporation
Street Address
County
All applicants please provide the following information and attach copies
of proof thereof:
A. NJ Sales Tax Identification Number
B. NJ Unemployment Registration Number
C. Federal Employer Identification Number
4.
Complete the following for proprietor, partners, or corporate officers:
Title
Name
5.
3. Please Check appropriate Box for License:
[
[
[
[
[
[
] Leasing Company
] Driving School
] Moped Dealer
] Junkyard
] Private Inspection Facility
] Fleet Fleet Inspection Facility
[ ] Other
Home Address
[ ] New & Used Motor Vehicle Dealer
[✘] Auto Body Repair Facility
[ ] Used Motor Vehicle Dealer
[ ] Fleet DEIC
[ ] DElC
Telephone Number
Have the owners, partners, or officers ever been arrested, charged or convicted of a criminal or disorderly persons offense in this or any other state?
[ ] Yes
[ ]N o
6
[ ]Proprietorship
[ ] Other
Zip Code
City
[ ] Partnership
if yes, explain:
Do you knowingly intend to employ a person who has been convlcted of the above, or any other crime or who was previously licensed as any
in this or any other state and was subject to license suspension or revocation?
Of
the above
[ ] Yes
[ ]No
7
Give name and address of person
Have the owners, partners or corporate officers ever held any of the above licenses?
[ ] Yes
[ ]N o
If yes, please explain the type of license and license numbers
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8.
Was the license ever suspended or revoked?
[ ]Yes
[ ]N o
If yes, explain:
Have the owners, partners or corporate officers, agents or employees of your organization ever used an alias or been known by any other name
9.
[ ]Yes
If yes, explain:
[ ]N o
10.
Does any stockholder own more than 10% of the corporation's stock?
If yes, give name, address and holding
[ ] Yes
[ ]N o
11
Attach copy of the Certificate of Incorporation/Formation which has
been filed with the N.J. Secretary of State. Foreign Corporations must
submit a copy of their Authorization to do business in New Jersey as
a Foreign Corporation in addition to a copy of their corporate/formation
papers.
Place of Incorporation/Formation
Date of Incorporation/Formation
Date of authorization to do business in New Jersey
12
The applicant certifies all information contained herein is true and agrees any untruthful representation and any violation of the applicable statutes and regulations
promulgated by the Commission shall be reasonable and proper grounds for license suspension or revocation. He further agrees to notify the Commission
immediately of any change in the status of the business or of any other information which would change the answers and statements in this application or
supplement thereto.
13
The individual(s) signing this application certify that they have read the applicable statutes and are thoroughly familiar with the details and penalties provided.
I, the undersigned, hereby certify that I _________________of the above business previously named____________________________________________
Owner, Partner, Officer, Member
and that the information I have submitted is true to the best of my knowledge.
_______________________________________________________________
Print Name of Applicant
Signature and Title of Applicant
the undersigned, hereby certify that I am Secretary/Member/Partner of the above Corporation and have witnessed the signature of__________________________
who is
of said corporation.
President, Vice-President or Member
Signatureof Secretary/Member/Partner
APPROVAL CERTIFICATE
Clerk of the Municipality of
County of
(Print Name)
State of New Jersey, hereby certify that the Municipal Governing Body or Zoning Commission has approved
the location. establishment and maintenance of the business checked below:
[ ] Leasing Company
[ ] Fleet DElC
[ ] Driving School
[ ] New & Used Motor Vehicle Dealer
[ ] Moped Dealer
[✘] Auto Body Repair Facility
[ ] Other
[ ] Junkyard
[ ] Private Inspection Facility
[ ] Used Motor Vehicle Dealer
[ ] Fleet Inspection Facility
[ ] DElC
located at
Complete Address
_____________________________________________________
Print Name of Municipal or Zoning Board Clerk
BLC-183 (R12/04)
Signature of Municipal or Zoning Board Clerk
Date
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BUSINESS LICENSE SERVICES
SUPPLEMENTARY APPLICATION
BUSINESS NAME
BUSINESS PHONE #
1. FULL NAME INCLUDING MIDDLE NAME AND SUFFIX, IF ANY
2. STREET ADDRESS
CITY
STATE
HOME PHONE #
3. HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS?
4. LIST THE CITIES, STATES OR FOREIGN COUNTRIES WHERE YOU LIVED BEFORE AND HOW LONG YOU W E R E IN EACH STATE OR COUNTRY.
5. DATE OF BIRTH (MO. DAY, YEAR)
7. SEX
6. PLACE OF BIRTH: (CITY, STATE OR FOREIGN COUNTRY)
8. HEIGHT
11. SOCIAL SECURITY NUMBER
10. COLOR OF EYES
9. WEIGHT
12. DRIVER LICENSE NUMBER (STATE)
13. HAVE YOU, IN THIS OR ANY OTHER STATE OR COUNTRY EVER BEEN ARRESTED, CHARGED OR CONVICTED OF A CRIME, DISORDERLY PERSONS OFFENSE,
VIOLATION OF CONSUMER PROTECTION LAWS OR REGULATIONS?
YES
NO
IF YES, ATTACH EXPLANATION DESCRIBING NATURE OF OFFENSE, DATE, CITY AND STATE WHERE OFFENSE OCCURRED, IDENTIFY COURT OR ADMINISTRATIVE
TRIBUNAL BEFORE THE CASE WAS TRIED, DATE AND SENTENCE.
14.
I CERTIFY THAT THE INFORMATION PROVIDED HEREIN AND ATTACHMENTS, IF ANY, IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
SIGNATURE:
DATE
1. FULL NAME INCLUDING MIDDLE NAME AND SUFFIX. IF ANY
2. STREET ADDRESS
CITY
STATE
3. HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS?
HOME PHONE #
4. LIST THE CITIES, STATES OR FOREIGN COUNTRIES WHERE YOU LIVED BEFORE AND HOW LONG YOU WERE IN EACH STATE OR COUNTRY.
5 DATE OF BIRTH (MO. DAY, YEAR)
7. SEX
11. SOCIAL SECURITY NUMBER
6. PLACE OF BIRTH: (CITY. STATE OR FOREIGN COUNTRY)
8. HEIGHT
9. WEIGHT
10. COLOR OF EYES
12. DRIVER LICENSE NUMBER (STATE)
13. HAVE YOU, IN THIS OR ANY OTHER STATE OR COUNTRY EVER BEEN ARRESTED, CHARGED OR CONVICTED OF A CRIME, DISORDERLY PERSONS OFFENSE,
VIOLATION OF CONSUMER PROTECTION LAWS OR REGULATIONS?
YES
NO
IF YES, ATTACH EXPLANATIONDESCRIBING NATURE OF OFFENSE, DATE, CITY AND STATE WHERE OFFENSE OCCURRED, IDENTIFY COURT OR ADMINISTRATIVE
TRIBUNAL BEFORE THE CASE WAS TRIED, DATE AND SENTENCE.
14. I CERTIFY THAT THE INFORMATION PROVIDED HEREIN AND ATTACHMENTS, IF ANY, IS TRUE AND COMPLETE TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
SIGNATURE:
BLC-205B (12/03)
DATE
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Business Licensing Services Bureau
P.O. Box 171
Trenton, New Jersey 08666-0171
(609) 292-6500 #5014
_______________________________________________________________________________________
CHILD SUPPORT CERTIFICATION FORM
_________________________________________
Business Name
_________________________________________
Applicant’s Name (Print)
__________________
Date of Birth
_________________________________________
Social Security Number
Under the provisions of N.J.S.A. 2A:17-56.7 et seq., responses to the questions listed below are
required. Misstatements will be just cause to take administrative action including, but not limited
to, denial of licensure, immediate suspension or revocation of the license.
1. Do you have a child support obligation?
Yes
No
2. If yes, do the arrearage amounts equal or exceed the amount of child support
payable for six months?
Yes
No
3. Are you subject to a child-support warrant?
Yes
No
I certify that the foregoing responses made by me are true and I am aware that the making of
false statements may subject me to contempt of court.
______________________________________________
__________________
Signature
Date
BLS-43 (R 9/09)
On the Road to Excellence
www.njmvc.gov
New Jersey is an Equal Opportunity Employer
American LegalNet, Inc.
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New Jersey
Motor Vehicle Commission
Trenton, New Jersey 08666
STATE OF NEW JERSEY
Business Licensing Services Bureau
PO Box 168
(609) 292-6500 ext.5014
I,____________________________________,owner of _______________________________
(Subcontractor)
located at _______________________________________________ hereby certify that I have
entered into an agreement with _____________________________________________ located
(Autobody Licensee)
at__________________________________________________________ to perform the below
listed service:
[ ]
Four-Wheel Alignment
[ ]
Air Conditioner Servicing
[ ]
Mechanical Repairs
[ ]
Structural Repairs (Frame Machine)
[ ]
All of the above services are preformed in house
I understand that this document will be attached to his/her New Jersey Full Service Auto Body Repair
Facility License.
_______________________________
Signature Subcontractor
_____________________________
Signature Licensee
_______________________________
Date
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New Jersey Department of Environmental Protection
Office of Local Environmental Management
Minor Source Compliance Investigations
P.O. Box 407
Trenton, NJ 08625-0407
To Whom It May Concern:
I have been informed that an air pollution permit is no longer required by the
Department as established in N.J.A.C. 7:27-8.2(a) (Eleventh Amendment
operative June 12, 1998) since my coating application will NEVER EXCEED ½
GALLON PER HOUR AND MY Spray booth DOES NOT contain a heating
device with a rating of 1,000,000 BTU’s or greater. As such, I am requesting
deletion of the following surface coating permit(s) /certificat(s) and hereby certify
under penalty of law that I believe the information provided in this document is
true, accurate, and complete.
I understand that if at any time our coating rate does exceed the applicability
threshold of ½ gallon in any one hour or the heating device does equal or
exceeds 1 million BTU’s, it is my responsibility to apply for the necessary
permit(s) and certificate(s).
I further understand that if I exceed these thresholds and fail to apply for the
necessary permit(s) and certificate(s) I may be subject to an enforcement action
which may include civil and criminal penalties, including the possibility of fine or
imprisonment or both, for submitting false, inaccurate or incomplete information.
Signature: _________________________________
Title: _____________________________________
Name of Facility: ____________________________
Address: __________________________________
Phone#: __________________________________
Program Interest ID#:________________________
Activity Number ID#: ________________________
Date: _________________
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Motor Vehicle
Commission
PO Box 172
Trenton, New Jersey 08666-0172
SIGNATURE CARD
Business Type:
MV Dealer
Autobody Repair
The undersigned Licensee hereby authorizes the person(s) whose signatures appear below to execute and sign Title Papers and/or estimates
on behalf of the licensee:
(AGENT'S NAME - PRINT IN FULL)
(SIGNATURE)
(ADDRESS)
- PRINT IN FULL)
(SIGNATURE)
(ADDRESS)
(AGENT'S NAME - PRINT IN FULL)
(SIGNATURE)
(ADDRESS)
(AGENT'S NAME - PRINT IN FULL)
(SIGNATURE)
(ADDRESS)
(AGENT'S NAME
(AGENT'S NAME - PRINT IN FULL)
(SIGNATURE)
(ADDRESS)
BUSINESS NAME & LICENSE NO. (Print in full)
LICENSEE'S SIGNATURE
(OWNER, PARTNER OR CORPORATE OFFICER)
DATE
Signature card or cards must be filed for all persons authorized to sign title papers and/or estimates. If you authorize any other person
to sign title papers and/or estimates or if you revoke the authority of any person to sign such papers, you shall notify this Bureau immediately
and re-submit current signature card or cards, covering all persons in authority to sign title papers and/or estimates.
All signature cards prior to the most current are invalid.
BLC-9 (R12/04)
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Motor Vehicle
Commission
Trenton, New Jersey
STATE OF NEW JERSEY
BUSINESS LICENSING SERVICES BUREAU
TO ALL MOTOR VEHICLE AUTO BODY REPAIR FACILITIES
The New Jersey Motor Vehicle Commission has now established a live fingerprint scan process
to streamline criminal background checks required as a condition of certification as a licensed
Motor Vehicle Auto Body Facility.
As part of the Business License application process, it is required that all proprietors, partners
and corporate officers schedule an appointment with the State fingerprint scan vendor
MorphoTrak (formerly Sagem Morpho, Inc.)
All you need do is call this toll free number 1-877-503-5981 (English or Spanish Operators) or
TTY-1-800-673-0353 (HEARING IMPAIRED Modem Required) to arrange an appointment to
be scanned at an established site. When scheduling your appointment, you will be asked to
provide certain personal information including your driver’s license and social security
number. Please make sure you have this information available when scheduling your
appointment. In addition, you will be asked to provide the following Motor Vehicle identification
numbers:
ORIGINATING AGENCY REFERRAL NUMBER (ORI)
NJ920530Z
AGENCY CASE NUMBER (Your Driver License Number)
CATEGORY
MVS
DOCUMENT TYPE
RS1
STATUTE
39:13-7 AUTO BODY REPAIR FACILITIES
Please complete the applicant information form contained on the back of this letter. Though
certain information is already filled in, you will need to supply certain personal information in
blocks 9 thru 26 as well as your driver’s license number in block 7 which will be used as your
agency case number. Please have this form filled in present it when you appear for your
appointment along with the proper photo identification as noted on the back of this letter
After supplying this information you will be scheduled for an appointment at one of the electronic
scan sites. You will be required to pay a one-time fee in the amount of $51.00 incorporating all
required background checks. Payment must be made at the time of scheduling your
appointment. AT THE TIME OF SCANNING YOU WILL RECEIVE A RECEIPT FROM THE
STATE’S VENDOR. PLEASE SUBMIT THIS RECEIPT OR A COPY THEREOF AS PART OF
YOUR BUSINESS LICENSE APPLICATION PACKAGE.
If you have any questions concerning this procedure, please contact the following area:
NEW JERSEY MOTOR VEHICLE COMMISSION
BUSINESS LICENSING SERVICES BUREAU
AUTO BODY REPAIR FACILITY LICENSING SECTION
(609) 292-6500 ext.5014
PLEASE BRING THIS LETTER AND PHOTO IDENTIFICATION WITH YOU WHEN YOU
APPEAR TO BE FINGERPRINTED
REV 9/09
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Formerly Sagem Morpho Inc
(1) Originating Agency Number (ORI #)
(2) Category
NJ920530Z
(3) Statute Number
MVS
39:13-7
(4) Reason for Fingerprinting
(5) Document Type
AUTO BODY REPAIR FACILITY
$51
RS1
(7) Contributor’s Case # (Unique Identifier)
(6) Payment Information
(8) Miscellaneous
DL#
(9) First Name
(10) MI
(12)Daytime Phone Number
(
)
(13) Social Security
Number
(11) Last Name
(14) Date of Birth
(15) Height
(16) Weight
-
(17) Maiden Name (if married female)
(18) Place of Birth (U.S. State –for US Citizen;
Country for all others)
(19) Country of Citizenship
(20) Home Address
Address
(21) Gender (Select one)
(22) Hair Color (Indicate most
predominant color, one only)
Male ( )
Female ( )
Both ( )
(25) Occupation
City
(23) Eye Color
State
Zip
(24) Race (Select One)
A Asian/ Pacific Islander ( includes Asian Indian)
B Black
W White ( Includes Hispanic/ Spanish Origin)
U Unknown
I American Indian / Alaska Native
(26) Employer (Name)
Employer Address
City
State
Zip
APPLICANT INFORMATION – READ THIS FORM CAREFULLY AND FOLLOW ALL INSTRUCTIONS TO COMPLETE THE FINGERPRINT
PROCESS. You MUST present this completed form at your appointment to be FINGERPRINTED. NO EXCEPTIONS ALLOWED. Applicants
without forms or with incomplete forms will not be printed.
IDENTIFICATION IS REQUIRED- ACCEPTABLE ID REQUIREMENTS –ID MUST include Photo, Name, Address (Home/ Employer) and
Date of Birth. Acceptable ID MUST be issued by a Federal, State, County or Municipal entity for Identification purposes. Examples of
acceptable ID are: 1) Valid Photo Drivers License or Valid Photo ID issued by any State DMV or NJ MVC, 2) Passport. Acceptable ID
MUST meet all of the underlined requirements above and MUST be present on one (1) ID. Combinations of documents are NOT
acceptable. If acceptable ID is not presented you will not be fingerprinted.
For applicants who are required to pay for their own fingerprinting fees, payment is required at the time of scheduling. Payment may be made with a
credit card or electronic debit from a checking account. Remember your account will automatically be debited. An $11 fee is charged to cover the cost
of a scheduled appointment for applicants who do not cancel/reschedule by noon on the business day prior to your scheduled appointment (Saturday
noon for Monday appointments). All appointments can be canceled/rescheduled via the web without penalty if cancellation requirements are met. The
$11 fee will also apply for applicants who are turned away from the printing sites due to the inability to present proper ID, who fail to present this
completed Universal Fingerprint Form provided to you by your requesting agency or employer, or who are turned away because information on this
form does not match the information provided during the scheduling process. You will be refunded State and Federal search fees only.
Appointment scheduling is available via the web at www.bioapplicant.com/nj, 24 hours per day, 7 days per week. For applicants who do not
have web access, appointments can be made by contacting us toll free at (877) 503-5981 on a first call, first served basis Monday through Friday,
8:00 AM to 5:00 PM EST and Saturday, 8:00 AM to 12 noon EST. English and Spanish speaking operators are available. Hearing impaired
scheduling is available at (800) 673-0353. ONLY applicants who schedule through the call center can make payment by money order at the fingerprint
site. No other form of payment is accepted at the fingerprint site.
Your APPLICANT ID, Site, Date, Time of your appointment, and payment authorization will be confirmed by the call center agent or web confirmation
when scheduling is complete. You must record this information in the appropriate blocks below while speaking with the operator. If you appear for
fingerprinting at a site where you are not scheduled or on a different date and time, you will be turned away and not fingerprinted. If applicable, you
may incur the $11 appointment fee.
Your PCN number will be recorded when your fingerprinting has been completed. You MUST retain a copy of the form and a copy of the receipt
provided to you by the Fingerprint Technician for your records. NO RECEIPTS WILL BE PROVIDED AFTER THE DATE OF PRINTING.
Applicant ID No.
Scheduled Site/ Date/ Time
Agency Information #1
PYMT Authorization
PCN
Agency Information #2
APPLICANTS MUST NOT ALTER, SHARE, OR REUSE THIS FORM
FORM NO. NJAPS2, Version 4.0
September 1, 2009
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