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County of Hawaii DEPARTMENT OF FINANCE Vehicle Registration & Licensing Division 101 Pauahi Street, Suite No. 5, Hilo, Hawaii 96720 -4224 (808) 961 -8351 • (808) 961 -8330 (FAX) County of Hawai’i is an Equal Opportunity Provider and Employer. Complaints of discrimination should be sent to: USDA, Director, Office of Civil Rights, Washington, DC 20250 -9410. Or call (202) 720 -5964 (Voice and TDD). Last Updated 10/17 /12 Certificate of Motor Vehicle Dealer of Used Parts and Accessories Form The undersigned Motor Vehicle Dealer of Used Parts and accessories in the County of Hawai`i do es hereby certify that there have been no changes since the last filing of an application for Motor Vehicle Dealer of Used Parts and Accessories License in respect to: 1) Personnel of owners, partners, officers or directors 2) Location of offices, or principal place of business 3) That no proceeding is pending f or the suspension or revocation of the licensee’s existing license Business Name Owner Signature Date Print Owner Name For Office Use Only: Sequence No. _________ New No. Issued:_________ Previous No.___________