Free Michigan Vehicle Dealer Close Out Statement (Temporary Location) - Michigan

Bureau of Regulatory Services Michigan Department of State Lansing, Michigan 48918

Clear Form

MICHIGAN VEHICLE DEALER CLOSEOUT STATEMENT
(Temporary Location)

(Please type or print legibly)

Dealer Number: _________________________
(Street Address) (Street Address)

Temporary Dealer Number : ____________________
(City) (City) (ZIP Code) (ZIP Code)

Primary Licensed Location: ___________________________________________________________________________________ Temporary Licensed Location: ________________________________________________________________________________ Date(s) of Sale: From ______________ To: ______________

I, ________________________________________________________________ as _________________________________________
(Name) (Name of Dealership) (Title)

of _________________________________________________________ , do certify that I will discontinue doing business as a Michigan Vehicle Dealer at the above temporary location, effective ___________________ .
(Date)

I certify that I will surrender my temporary license to: The Secretary of State branch office located at ____________________________ on _______________ .
(Location) (Date)

OR
The Bureau of Regulatory Services, Lansing, Michigan on _________________ .
(Date)

I further certify that I have disposed of vehicles that were in our inventory at the temporary location, or have moved the vehicles to my primary licensed location. My dealer records, including those from my temporary location, will be available for inspection at my primary licensed location: .

_______________________________________________________________________
(Street Address) (City) (ZIP Code)

I certify that all the statements I have made herein are true and accurate to the best of my knowledge, and that untrue or misleading information may be grounds for administrative action against my primary dealer license.

Signed, X _________________________________________________________________
(Signature and Title)

_____________________
(Date)

(Rev. 9/2003)