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Get WI DoT MV2844 2005-2021

Wisconsin Department of Transportation Dealer Section PO Box 7909 Madison WI 53707-7909 608-266-1425 ENTITY/OWNER STATEMENT MV2844 Clear Form 3/2005 NOTE Complete one form for EACH owner partner corporate officer shareholder of 10 or more of a corporation association member Limited Liability Company - LLC member or LLC manager. Legal Business Name Business / Your Position - Check all that apply. Sole Proprietor Partnership Corporation Officer Shareholder Limited Liability Company Manager Member Association What percentage of the business stock in the corporation or interest in the LLC do you own Your Full Legal Name Residence Address Street or RFD City State ZIP Code Area Code - Telephone Number Residence Birth Date Driver License Number Social Security Number - For identification purposes Provide complete answers to the following questions. List any other business in which you are engaged* List any ownership interests in other dealerships. Have you ever been licensed as a dealer in Wisconsin No Yes - Year Last Licensed Yes - Give State and Year Last Licensed Has your dealer license ever been denied suspended or revoked Yes - List date state charge and court continue on back if needed* Are any criminal charges pending against you List any former names by which you were known* False statements on this application are punishable by law and may result in denial suspension or revocation of your dealer license. The undersigned states that she or he is owner partner officer association member LLC member or LLC manager of the facility named on this application and that the answers contained in this application are true. Legal Business Name Business / Your Position - Check all that apply. Sole Proprietor Partnership Corporation Officer Shareholder Limited Liability Company Manager Member Association What percentage of the business stock in the corporation or interest in the LLC do you own Your Full Legal Name Residence Address Street or RFD City State ZIP Code Area Code - Telephone Number Residence Birth Date Driver License Number Social Security Number - For identification purposes Provide complete answers to the following questions. List any other business in which you are engaged* List any ownership interests in other dealerships. List any other business in which you are engaged* List any ownership interests in other dealerships. Have you ever been licensed as a dealer in Wisconsin No Yes - Year Last Licensed Yes - Give State and Year Last Licensed Has your dealer license ever been denied suspended or revoked Yes - List date state charge and court continue on back if needed* Are any criminal charges pending against you List any former names by which you were known* False statements on this application are punishable by law and may result in denial suspension or revocation of your dealer license. Have you ever been licensed as a dealer in Wisconsin No Yes - Year Last Licensed Yes - Give State and Year Last Licensed Has your dealer license ever been denied suspended or revoked Yes - List date state charge and court continue on back if needed* Are any criminal charges pending against you List any former names by which you were known* False statements on this application are punishable by law and may result in denial suspension or revocation of your dealer license. The undersigned states that she or he is owner partner officer association member LLC member or LLC manager of the facility named on this application and that the answers contained in this application are true. .

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