Fillable Printable Form VS-19 - Statement of Ownership and/or Permission - New York
Fillable Printable Form VS-19 - Statement of Ownership and/or Permission - New York
Form VS-19 - Statement of Ownership and/or Permission - New York
VS-19 (6/08)
www.nysdmv.com
New York State Department of Motor Vehicles
STATEMENT OF OWNERSHIP AND/OR PERMISSION
TO USE PLACE OF BUSINESS
(Please Print)
YOUR BUSINESS
Business
Name (DBA)
Business
Address
City
Phone No. (Include Area Code)
( )
State Zip Code
Name of Property
Owner
Owner Mailing
Address
City
Print the name
the lease is in
Business
Address
Number of Years or Months Owned? Is this property zoned for business use?
Yes No
Phone No. (Include Area Code)
( )
Phone No. (Include Area Code)
( )
Must
have at least six-month lease
Expiration Date / /
Full Last Name of Applicant (Please Print)
Residence Street Address (Include Street Number and Name, Rural Delivery, Box and/or Apartment Number)
City State Zip Code
Signature of Applicant
(Sign name in Full) ±
Title of
Applicant
Date
First M.I.
Date of Birth (Month/Day/Year)
/ /
State Zip Code
OWNER OF PROPERTY (This section must be filled out)
LEASING INFORMATION (If you are leasing, please complete the following section)
If any of the leases will expire in the next six months, you must provide a letter from the owner or lessor stating the intention to
renew that lease. If you do not provide this information with your application, the application will be denied.
Do you own your business property?
Yes No
Print the name
the sub-lease is in
Business
Address
Must
have at least six-month lease
Expiration Date / /
SUB-LEASING INFORMATION (If you are sub-leasing, please complete the following section)
PLEASE ATTACH ADDITIONAL PAGES, IF NEEDED.
CERTIFICATION (To be completed by owner/partner/officer)
False statements on this application are punishable by law and may result in denial, suspension or revocation of your
business certificate(s), as authorized by Regulations of the Commissioner of Motor Vehicles. I certify that I am the
owner, partner, officer or agent of the business named on this application, and that the information in this application is true.
PLEASE NOTE:
Whether you own or are leasing your business property, it is your responsibility to be in compliance with all state and local laws
and regulations, while being considered for registration and while conducting your business.
