- Form MV-700 - Application for Sales Away from Premises - New York
- Form PD-1 - Request for Dealer Boat Registration - New York
- Form VS1-PROV - Provisional Dealer Registration Application - New York
- Form MV-463 - Application for Dealer Plate Issuance Program - New York
- Form MV-950 - Affirmation of Repossession and Bill of Sale - New York
- Form PD-7 - Plate Surrender Application Form - New York
Fillable Printable Form MV-253G - Request for Business Amendment/Duplicate Certificate - New York
Fillable Printable Form MV-253G - Request for Business Amendment/Duplicate Certificate - New York
Form MV-253G - Request for Business Amendment/Duplicate Certificate - New York
1.
2
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3
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4.
5.
6.
Inspection Stations or Dealers
a) Change in business type (for example, Fleet to Public, Wholesale to Retail, etc.):
To: From:
b) Change in groups approved for inspection (check the box(es) for the group(s) you want to inspect):
VEHICLE GROUPS
GROUP (Weights shown are maximum gross weights)
2a All motor vehicles that have a seating capacity over fourteen passengers, and all motor vehicles and trailers that have an
MGW over 18,000 pounds.
2b All semi-trailers.
3 All motorcycles.
DL Diesel Emissions Testing for all non-exempt vehicles registered in the New York Metropolitan Area.
1b All trailers, except semi-trailers, that have an MGW under 18,001 pounds.
1a All motor vehicles that have a seating capacity under fifteen passengers, and all motor vehicles, except trailers and
motorcycles, that have an MGW under 18,001 pounds.
Name Certification Number Expiration Date
_________________________________________________________________________ _________________________________________________ _________________________
_________________________________________________________________________ _________________________________________________ _________________________
_________________________________________________________________________ _________________________________________________ _________________________
Number and Street County
Business address change:
New Address
Manufacturer’s Name
____________________________________________________________________________
Model Number
____________________________________________________________________________
Business(es) requesting amendment/duplicate certificate(s) — check all that apply:
Repair Shop Dealer Dismantler Itin. Veh. Collector Salvage Pool Transporter
Inspection Station Boat Dealer Scrap Collector Scrap Processor Mobile Car Crusher Other
Business name change to:
City State Zip Code
Number and Street County
City State Zip Code
New York State Department of Motor Vehicles
REQUEST FOR BUSINESS AMENDMENT/DUPLICATE CERTIFICATE
Present Facility Number Present Facility Name Facility Phone Number
( )
c) If you will perform diesel emissions inspections, print the manufacturer’s name and the model number of the testing equipment here.
This information is required in order to process your request.
d) Please provide the name(s) and certification number(s), including expiration date, of your Certified Inspector(s). Use additional sheet(s)
if necessary. This information is required in order to process your request.
MV-253G (2/11)
PAGE 1 OF 2
www.dmv.ny.gov
Old Address
Requested change: Amendment Duplicate Reason: __________________________________________________________________
INSTRUCTIONS Use this form to tell DMV about an amendment or to request a duplicate Business Certificate (you must fill out an original
application if you are acquiring a business). There is no fee for amendments or duplicate certificates. If you are making a change, please call (518)
474-0919 for information about required documentation
. Failure to provide all documentation will delay processing of your request.
D
UPLICATE CERTIFICATE CUSTOMERS: Complete items 1, 2, 3, 9 and 10 and the “Certification” section at the bottom of page 2.
A
MENDMENT CUSTOMERS: Complete items 1, 2, 3, 9 and 10 and the “Certification” section at the bottom of page 2. Also, complete items 4 - 8
only if they apply to the change you are making.
DOCUMENTATION REQUIREMENTS FOR AMENDMENT CUSTOMERS ONLY
DISMANTLERS: All dismantlers must provide a letter of zoning approval with this request. New York City Only - all “Secondhand Dealer - General”, and
“Secondhand Dealer - Auto”, amendment requests MUST INCLUDE a Fire Department permit and an NYC Department of Consumer Affairs License.
CUSTOMERS MAKING LOCATION CHANGES: If you are changing location, complete Form VS-19 (“Statement of Ownership and/or Permission to
Use Place of Business”) and submit it with this request. Repair shops must also provide a Certificate of Occupancy, local license or town
letter as proof of zoning approval. If the new location was previously registered as a Repair Shop, please tell us the Facility number or Facility
name of that shop. This can be used as proof of zoning.
D
EALERS
: All dealers (excluding those who are exempt under the law) are required to have a bond. If you are a dealer requesting an
amendment, please call (518) 474-0919 to determine if you have to provide a revised bond with your request. If you are a franchised dealer
requesting an address change, you must provide franchise papers showing the new address.
RETURN THIS COMPLETED REQUEST, AND ANY REQUIRED DOCUMENTATION, TO:
Bureau of Consumer and Facility Services, Application Unit, PO Box 2700, Albany NY 12220-0700
I certify that I am the owner, partner or officer of the business named in this request form, and that the information contained in it is true.
NOTE: For partnerships, each partner must sign this form.
Name (Please Print Full Name) Business Phone Number
( )
Signature (Full Name) Title Date
Partner’s Signature (Full Name) Partner’s Signature (Full Name)
Name
Date of Birth
Conviction Date Penalty
Deletions to Owners, Partners, Corporate Officers and/or Stockholders holding more than 10% of stock. Use additional sheet(s) if necessary.
Additions to Owners, Partners, Corporate Officers and/or Stockholders holding more than 10% of stock. Use additional sheet(s) if necessary.
7.
8.
9.
10.
a) Have you, or has any person named in this application, ever been an individual owner, partner, interested party, officer, corporation
director or stockholder having more than ten percent of the stock in a business for which a DMV license, registration or certification
was denied, suspended or revoked in New York State, including matters now on appeal? Yes No
b) Are you, or is anyone named in this application, scheduled for a hearing which could result in the suspension, revocation or denial of a
DMV business license, registration or certification? Yes No
c) If (a) or (b) is “YES ”, provide name and address of the person(s), business type, date and action taken against the business or reason
for the hearing.
Has the owner, any member of the partnership, interested party, officer or director of the corporation been convicted of, or forfeited bail for,
any misdemeanor or felony? Yes No If “YES ”, give the following information:
MV-253G (2/11)
Court Nature of Offense
CERTIFICATION
(a) Name (First, MI, Last) Date of Birth Title
Please Sign Name in Full
Driver License Identification Number Social Security Number
Residence Address Apt. No. Residence Phone
( )
(b) Name (First, MI, Last)
Please Sign Name in Full
Residence Address Apt. No. Residence Phone
( )
(c) Name (First, MI, Last)
Please Sign Name in Full
Residence Address Apt. No. Residence Phone
( )
(a) Name (First, MI, Last)
Please Sign Name in Full
Residence Address Apt. No. Residence Phone
( )
(b) Name (First, MI, Last)
Please Sign Name in Full
Residence Address Apt. No. Residence Phone
( )
(c) Name (First, MI, Last)
Please Sign Name in Full
Residence Address Apt. No. Residence Phone
( )
% of Stock or Ownership
Date of Birth Title
Driver License Identification Number Social Security Number
% of Stock or Ownership
Date of Birth Title
Driver License Identification Number
Social Security Number
% of Stock or Ownership
Date of Birth Title
Driver License Identification Number Social Security Number
% of Stock or Ownership
Date of Birth Title
Driver License Identification Number Social Security Number
% of Stock or Ownership
Date of Birth Title
Driver License Identification Number Social Security Number
% of Stock or Ownership
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