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2/5/2013 11:53:36 AM
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2/5/2013 11:53:09 AM
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PWR Application - Fillable
(Original Version)
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\Finance Department\Vehicle Registration and Licensing\Licensing and Registration Forms\MVR
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6. List name, residence address, and date and place of birth of applicant. If partnership or joint <br />venture, list name, residence address, and date and place of birth of each partner or joint <br />venturer. If corporation, list name, residence address, and date and place of birth of each of its <br />officers and directors. <br />Name <br />Residence Address Date /Place of Birth <br />7. List names and addresses of all employees involved in the business for which license(s) is (are) <br />applied. (Attach additional sheet if more space is required.) <br />E-* <br />Have you ever applied for a license under Chapter 289, HRS? <br />If yes, give date of last application: <br />If yes, give date of last license issued: <br />County <br />County <br />Was any license issued to you under Chapter 289 ever revoked <br />orsuspended? <br />If yes, give particulars in Item 15. <br />10. Has any person named in Items 5 or 6 (partners, joint venturers, <br />officers and directors, or employees) been the holder of a <br />license issued under Chapter 289 which was revoked or <br />suspended? <br />If yes, give name(s) of person(s): <br />11. Has any person named in Items 5 or 6 been refused a license <br />under Chapter 286? <br />If yes, give particulars in Item 15. <br />V, <br />OYES KDNO <br />ILI 67� � � <br />
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