Fillable Printable Dealer Property Lease Verification Form

Dealer Property Lease Verification Form

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

DRIVER AND VEHICLE SERVICES

445 Minnesota Street, Suite 186

Saint Paul, MN 55101-5186

Phone: (651) 201-7800 Fax: (651) 297-1480

Web: dvs.dps.mn.gov Email: [email protected]

OFFICE USE ONLY

DEALER NUMBER:____________________

DATE RECEIVED:____________________

INITIALS: ____________

Verification of Property Lease

According to Minnesota Statue 168.27, Subd.10 - Place of Business, all licensees under this section (New, Used, Lessor,

Wholesaler, Auction, Used Limited, DSB) shall have an established place of business, which shall include owned or a minimum

lease term of one year by the licensee.

Note: If Owned - Proof of Property Ownership is required. Example: Property Tax Statement.

Name of Dealership:

State of Minnesota County of:

(Owner of Property)

, being first duly sworn, depose and say

that I am the owner of the property located at

(Street Address)

(City)

(State and Zip Code)

, and certify that I have leased the above property to

Name of the Lessee/Dealer Owner

from

(Effective Date)

(Termination Date)

PS2407-09 (07/15)

Signature of Property Owner

Date

Subscribed and sworn to before me this

_______ day of ______ 20 _____

NOTARY PUBLIC

COUNTY:

MY COMISSION EXPIRES:

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