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County of Hawaii <br />DEPARTMENT OF FINANCE <br />Vehicle Registration & Licensing Division <br />101 Pauahi Street, Suite No. 5, Hilo, Hawaii 96720 -4224 <br />(808) 961 -8351 • (808) 961 -8330 (FAX) <br />Date: <br />Business Name: <br />Address of Sales Location: <br />Mailing Address: <br />Type of License: <br />State of Hawaii GE Tax No.: <br />Owner Name(s): <br />Phone: <br />Email: <br />W - <br />Print Applicant Name <br />Applicant Signature <br />NOTICE: Issuance of this license does not relieve applicant from securing any necessary <br />approvals from other applicable government agencies, including the Hawai'i County <br />Planning Department. <br />I (We) do solemnly swear that the statements <br />contained in the foregoing application are true and correct and that I, as an individual or as an <br />officer of the corporation, or we, as members of the partnership or joint venture, have authority to <br />sign this application and to make the statements contained herein on behalf of the applicant. <br />Subscribed and sworn to before me this <br />day of 120 <br />Notary Public, State of Hawaii <br />My commissions expires <br />For Office Use Only: <br />Auctioneer's Bond <br />Firearms Supplement <br />Purchasing, Wrecking, Rebuilding Supplement <br />SEQUENCE No. New No. Issued <br />County of Hawai'i 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 11/07/12 <br />