OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES APPLICATION FOR ADDRESS, NAME/DBA, OR DEALER LICENSE TYPE CHANGE Change of Address Applicants, complete Sections I & II, VII &VIII Change of Business Name Applicants , complete Sections I, III, VII & VIII Add or Remove a DBA Name, complete Sections I, IV, VII & VIII Add or Remove a P.O. Box, complete Sections I, V, VII & VIII Change Dealer License Type, complete Sections I, VI, VII & VIII COMPLETE ALL SECTIONS THAT APPLY SECTION I CURRENT INFORMATION BUSINESS NAME PERMIT # DBA OR FICTITIOUS NAME BUSINESS TELEPHONE # BUSINESS STREET ADDRESS PO BOX CITY SECTION II STATE ZIP CODE COUNTY CHANGE OF ADDRESS PROPOSED NEW BUSINESS STREET ADDRESS CITY PLATE # BUSINESS PHONE, IF DIFFERENT THAN ABOVE STATE ZIP CODE COUNTY 1) FRANCHISE MOTOR VEHICLE DEALERS: Indicate below each NEW make to be sold and submit Statements of Contract, BMV 4319, for each new make of vehicle to be offered for sale, showing the new business address. ____________________________________________________________________________________________________________________ 2) Contact your County Auditor to determine if a new vendor’s number is required. If yes, enter new vendor number. _____________________ 3) Are you or do you intend on sharing the proposed business location with another licensed motor vehicle dealer? YES NO If yes, indicate the business name and, if available, the permit number of the other dealer and submit a Certificate of Compliance form, BMV4347. BUSINESS NAME PERMIT NUMBER 4) Was the proposed business location previously occupied by another motor vehicle dealer? If yes, indicate the business name, if available. YES NO BUSINESS NAME 5) Submit photographs of the proposed business location’s lot, office (inside and outside), and business sign(s). The sign must be in the exact name of the business, as indicated on the application, including any registered trade names, permanent, prominently displayed and properly maintained. Letters on the sign must be at least six inches (6") high. Photographs, in jpg format only, may be e-mailed to DEALERPHOTOS@DPS.STATE.OH.US. Please include your business name and permit number in the subject of your email. BMV 4443 1/11 Page 1 of 3 www.OhioAutoDealers.com American LegalNet, Inc. www.FormsWorkFlow.com SECTION III CHANGE OF BUSINESS NAME 1) NEW BUSINESS NAME 2) FRANCHISE MOTOR VEHICLE DEALERS: Indicate below each NEW make to be sold and submit Statements of Contract, BMV4319 for each new make of vehicle to be offered for sale, showing the new business name. ____________________________________________________________________________________________________________________ 3) Submit photographs of the new business sign. The sign must be in the exact name of the business, as indicated on the application, permanent, prominently displayed and properly maintained. Letters on the sign must be at least six inches (6") high. Photographs, in jpg format only, may be emailed to DEALERPHOTOS@DPS.STATE.OH.US. Please include your business name and permit number in the subject of your email. SECTION IV ADD OR REMOVE A DBA NAME 1) DBA OR FICTITIOUS NAME ADD REMOVE ADD REMOVE ADD REMOVE 2) DBA OR FICTITIOUS NAME 3) DBA OR FICTITIOUS NAME 4) Submit photographs of the new business sign(s). The sign must be in the exact name of the business, as indicated on the application, including any registered trade names, permanent, prominently displayed and properly maintained. Letters on the sign must be at least six inches (6") high. Photographs, in jpg format only, may be emailed to DEALERPHOTOS@DPS.STATE.OH.US. Please include your business name and permit number in the subject of your email. SECTION V ADD OR REMOVE P.O. BOX 1) P.O. BOX ADD REMOVE ADD REMOVE 2) P.O. BOX NOTE: P.O. BOX MUST BE IN THE SAME ZIP CODE AS THE BUSINESS PHYSICAL ADDRESS. SECTION VI 1) CHECK ONE: CHANGE DEALER LICENSE TYPE USED MOTOR VEHICLE DEALER TO NEW MOTOR VEHICLE DEALER NEW MOTOR VEHICLE DEALER TO USED MOTOR VEHICLE DEALER 2) FRANCHISE MOTOR VEHICLE DEALERS: Indicate below each NEW make to be sold and submit Statements of Contract, BMV4319, for each new make of vehicle to be offered for sale. 3) If your primary business will be selling Motorcycles, APV’s and/or Off-Highway Motorcycles, what size of Dealer License Plates would you prefer? (Select only one size) REGULAR SIZE LICENSE PLATES MOTORCYCLE SIZE LICENSE PLATES NOTE: * Only one size of dealer plate may be requested/issued. BMV 4443 1/11 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com SECTION VII FEES PAYABLE TO “OHIO TREASURER JOSH MANDEL” DO NOT SEND CASH MOTOR VEHICLE DEALER PERMIT (REQUIRED) @ $2.00 = SALVAGE DEALER, POOL OR AUCTION ONLY PERMIT (REQUIRED) @ $2.00 = AMENDED REGISTRATION CARDS (REQUIRED, IF ISSUED LICENSE PLATES) MASTER PLATE + ADDITIONAL PLATES @ $1.00 each = Registration Fees do not apply to DBA Name or P.O. Box change. TOTAL FEES DUE = NOTE: Only ONE fee is required for multiple changes. I.E. If you request a name change and address change on the same application you only need to pay ONE permit fee and ONE set of amended registration card fees, not two sets of fees. FEES ARE NON-REFUNDABLE SECTION VIII READ, SIGN AND DATE FINANCIAL RESPONSIBILITY YOU WILL LOSE YOUR DRIVER LICENSE FOR AT LEAST 90 DAYS IF YOU DRIVE WITHOUT INSURANCE OR OTHER ACCEPTABLE PROOF OF FINANCIAL RESPONSIBILITY COVERAGE In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage. It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage. PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket At all vehicle inspection stops Upon traffic court appearances and Upon random checks by the Registrar of Motor Vehicles. ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license for 90 DAYS on first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of $100.00 for first offense, $300.00 for second offense, $600.00 for third and subsequent offenses Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS. ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS. IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied). THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: AN INSURANCE POLICY showing automobile liability insurance of at least $12,500 bodily injury per person, $25,000 injury two or more persons, and $7,500 property damage AN INSURANCE IDENTIFICATION CARD (same coverage) A SURETY BOND OF $30,000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles. I AFFIRM THAT ALL INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT AND THAT I, AS PROPRIETOR, PARTNER, OFFICER, MEMBER OR TRUSTEE HAVE AUTHORITY TO SIGN THIS APPLICATION. X SIGNATURE (OWNER, PARTNER, OFFICER, MEMBER, OR TRUSTEE) DATE PRINT NAME OF SIGNER INCOMPLETE INFORMATION WILL RESULT IN THE DELAY OF PROCESSING YOUR APPLICATION. Upon receipt of a completed application for change of address or dealer license type change, a physical inspection of the proposed new location will be requested. Please allow four to six weeks for processing. Applications for name/dba or PO Box change only do not require an inspection. Notice of change of status is required, in writing, within 15 days of the change [O.R.C. 4517.23 & 4738.08]. Return completed application, all supporting documents and fees to: Ohio Bureau of Motor Vehicles, Attn: Dealer Licensing Section, P.O. Box 16521, Columbus, Ohio, 43216-6521 BMV 4443 1/11 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com