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Get CT K-2 2004-2024

STATE OF CONNECTICUT AUTO CLUB LICENSE DEPARTMENT OF MOTOR VEHICLES K-2 REV. 10-2004 BUREAU OF SAFETY AND ENFORCEMENT DEALERS AND REPAIRERS DIVISION 60 STATE STREET WETHERSFIELD CONNECTICUT 06161 860 263-5049 DMV USE ONLY DATE EXP. LICENSE NO. NEW RENEWAL INSTRUCTIONS 1. Please print clearly. 2. The following documentation must also accompany this application Business License Personnel List K-26 Agent for Service Form - CT Copy of Incorporation papers* 3. Enclose a check made payable to DMV for 250. 00. NAME OF CLUB OR ASSOCIATION LOCATION - NUMBER AND STREET CITY OR TOWN SUITE STATE ZIP CODE AREA CODE PHONE NUMBER MAILING ADDRESS If different PRINCIPAL OFFICER OR MANAGING MEMBER Address Number and Street City or Town State Zip Code ADDITIONAL OWNERS OFFICERS MEMBERS OF AUTO CLUB Please use additional sheet if needed STATE WHERE INCORPORATED Copy of Incorporation Paper must accompany this application SIGNATURE Officer Authorized to Sign Legal Document s on Behalf of Auto Motor Club X WITNESS APPROVED. LICENSE NO. NEW RENEWAL INSTRUCTIONS 1. Please print clearly. 2. The following documentation must also accompany this application Business License Personnel List K-26 Agent for Service Form - CT Copy of Incorporation papers* 3. Enclose a check made payable to DMV for 250. 00. NAME OF CLUB OR ASSOCIATION LOCATION - NUMBER AND STREET CITY OR TOWN SUITE STATE ZIP CODE AREA CODE PHONE NUMBER MAILING ADDRESS If different PRINCIPAL OFFICER OR MANAGING MEMBER Address Number and Street City or Town State Zip Code ADDITIONAL OWNERS OFFICERS MEMBERS OF AUTO CLUB Please use additional sheet if needed STATE WHERE INCORPORATED Copy of Incorporation Paper must accompany this application SIGNATURE Officer Authorized to Sign Legal Document s on Behalf of Auto Motor Club X WITNESS APPROVED. .

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