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2/5/2013 11:53:36 AM
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PWR Application - Fillable
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\Finance Department\Vehicle Registration and Licensing\Licensing and Registration Forms\MVR
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County of Hawaii <br />Department of Finance <br />Vehicle Registration and Licensing Division <br />101 Pauahi Street, Suite #5 <br />Hilo, Hawai'i, 96720 -4224 <br />(808) 961 -8351 ⢠(808)961 -8330 (Fax) <br />New License, or <br />Renewal <br />For Office use only: Sequence No. <br />New No. Previous No. <br />Application for License(s) to Deal in Used Motor Vehicle Parts or Used Motor Vehicle <br />Accessories; To Engage in the Business of Wrecking, Salvaging, or Dismantling Motor <br />Vehicles; To Rebuild Motor Vehicles <br />FOR THE YEAR ENDING JUNE 30, <br />To the Director of Finance, County of Hawai'i, State of Hawai'i: <br />In accordance with Chapter 289, Hawai'i Revised Statutes, and the Rules and Regulations of the <br />Director of Finance, County of Hawai'i, the undersigned hereby applies for a license to engage in the <br />business of (mark applicable box or boxes): <br />Iā Purchasing or selling used motor vehicle parts or accessories License Fee: $10.00 <br />F1Wrecking, salvaging, or dismantling motor vehicles for the License Fee: $10.00 <br />purpose of reselling the parts or accessories <br />ā Rebuilding wrecked or dismantled vehicles for the purpose of License Fee: $10.00 <br />resale. <br />NOTE: The fee for EACH of the above is $10.00. <br />1. Name of Applicant: <br />2. Business Name: <br />3. Principal place of business <br />4. Mailing address: <br />Phone: <br />5. Address of each place of business other than principal place above: <br />County of Hawaii is an Equal Opportunity Provider and Employer. Complaints of discrimination should be sent to <br />USDA, Director, Office of Civil Rights, Washington, DC 20250-9410 Or call (202) 720 -5964 (Voice and TDD). <br />Last Updated 07/30112 <br />
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