Form PSP-1 "Application for Registration Processing by Private Partners" - New York

What Is Form PSP-1?

This is a legal form that was released by the New York State Department of Motor Vehicles - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2016;
  • The latest edition provided by the New York State Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PSP-1 by clicking the link below or browse more documents and templates provided by the New York State Department of Motor Vehicles.

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Download Form PSP-1 "Application for Registration Processing by Private Partners" - New York

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APPLICATION FOR REGISTRATION
PROCESSING BY PRIVATE PARTNERS
INSTRUCTIONS: Complete all sections in this application.
SECTION 1
Facility Number or License Number assigned by NYS DMV, if any
Business Name
(as filed with the New York State Department of State)
Business Address
(street and number where registrations will be processed)
Telephone #
(
)
City
State
Zip Code
County
Business Contact Name
Email Address
Telephone #
Fax #
(
)
(
)
Type of Business
(check all that apply)
o
o
o
o
o
o
Rental
Dealer
Leasing
Fleet Management
Private Service Bureau
Other
(explain)
Owner/Corporation Name
(if different from business name)
Owner/Corporation Address
Telephone #
(
)
City
State
Zip Code
County
1. If this is an INDIVIDUAL
ownership, complete (a) below. If a PARTNERSHIP, complete a section for each partner. If a CORPORATION, complete a section for each officer or
director. If additional space is needed, attach a separate page.
a) Name
Date of Birth
Title
Residence Address
b) Name
Date of Birth
Title
Residence Address
c) Name
Date of Birth
Title
Residence Address
2. If you are required by law to collect sales tax, provide your NYS Sales
Tax Number:
3. What is your Federal Employer Identification Number (required by New York State Tax Law if you have employees)?
Yes
No
4. Are you participating in the NYS Dealer Plate Issuance Program?
SECTION 2
1. List all names and facility numbers of any businesses licensed by
DMV, of which you are or have been an owner, principle, officer, member or partner.
Name
Facility Number
2. How many years has the owner or one principle in the company been in business?
3. Have you had any businesses licensed by the Department of Motor
Vehicles that had their licenses suspended or revoked, or that are currently pending
or under appeal?
No
PSP-1 (5/21)
Page 1 of 4
APPLICATION FOR REGISTRATION
PROCESSING BY PRIVATE PARTNERS
INSTRUCTIONS: Complete all sections in this application.
SECTION 1
Facility Number or License Number assigned by NYS DMV, if any
Business Name
(as filed with the New York State Department of State)
Business Address
(street and number where registrations will be processed)
Telephone #
(
)
City
State
Zip Code
County
Business Contact Name
Email Address
Telephone #
Fax #
(
)
(
)
Type of Business
(check all that apply)
o
o
o
o
o
o
Rental
Dealer
Leasing
Fleet Management
Private Service Bureau
Other
(explain)
Owner/Corporation Name
(if different from business name)
Owner/Corporation Address
Telephone #
(
)
City
State
Zip Code
County
1. If this is an INDIVIDUAL
ownership, complete (a) below. If a PARTNERSHIP, complete a section for each partner. If a CORPORATION, complete a section for each officer or
director. If additional space is needed, attach a separate page.
a) Name
Date of Birth
Title
Residence Address
b) Name
Date of Birth
Title
Residence Address
c) Name
Date of Birth
Title
Residence Address
2. If you are required by law to collect sales tax, provide your NYS Sales
Tax Number:
3. What is your Federal Employer Identification Number (required by New York State Tax Law if you have employees)?
Yes
No
4. Are you participating in the NYS Dealer Plate Issuance Program?
SECTION 2
1. List all names and facility numbers of any businesses licensed by
DMV, of which you are or have been an owner, principle, officer, member or partner.
Name
Facility Number
2. How many years has the owner or one principle in the company been in business?
3. Have you had any businesses licensed by the Department of Motor
Vehicles that had their licenses suspended or revoked, or that are currently pending
or under appeal?
No
PSP-1 (5/21)
Page 1 of 4
SECTION 3
1. If your business is regulated by any other government agency in NYS, is your license or registration valid and in
effect at this time?
Yes
No
Yes
No
Has your New York business license or business registration ever been suspended or revoked in the past five years?
If “Yes”, give dates and details:
2. If your business is regulated by a government agency in a state other than New
York, identify the state and provide your license or registration number, if any.
State
License or Registration Number
3. Has any
owner, partner or officer of this company had any business license, registration or certification denied, suspended or revoked in New York State, including matters
Yes
No
now on appeal?
Yes
No
If “Yes”, has it been at least one year since your case was resolved with New York State DMV?
If “Yes”, provide the person’s name and address and the type of business. Also, specify the action that was taken against the business and the date the action was taken:
4. Has any
owner, any member of the partnership, or an officer or director of the corporation been convicted of, or forfeited bail for, a misdemeanor or felony,
at any time?
Yes
No
If “Yes”, provide the person’s name and date of birth, the conviction date, penalty, nature of the offense and name of the court:
5. Has any licensing or certification
organization, including government agency, ever determined that you committed misconduct, unprofessional conduct, or negligence, that
resulted in criminal charges?
Yes
No
If “Yes”, explain:
6. Have you ever been denied an application and/or license by NYS DMV?
Yes
No
If “Yes”, give reason and date:
Yes
7. Have you ever been convicted of a criminal
offense (felony or misdemeanor)?
No
If “Yes”, explain:
8. Do you have an arrest or criminal accusation currently pending against you?
Yes
No
If “Yes”, explain:
PSP-1 (5/21)
Page 2 of 4
SECTION 4
1. We need the following information to help determine the number of plates, stickers and registration documents you will need. To establish a plate inventory, provide an
estimate of the number of registrations (for each appropriate type below) for which you issue a plate during a one-month period.
o
o
o
Passenger
Commercial
Trailer
(PAS multiples of 25)
(COM multiples of 25)
(TRL multiples of 25)
o
o
o
Light Trailer
Motorcycle
Boat
(LTR multiples of 25)
(MOT multiples of 25)
(BOT multiples of 25)
o
ATV
(ATV multiples of 25)
(Month/Day/Year)
3. To establish an inventory of security documents, including registration stickers, please estimate how many registration transactions using windshield registration stickers
you expect to have in a month. Remember to include renewals and duplicate registrations where you do not issue a plate. (multiples of 100)
Trailer, light trailer, ATV and motorcycle registrations, and renewals of dealer and transporter plates, require a plate sticker. How many of these registration transactions
do you expect to have in a month?
4. How many of the following documents/plates do you expect to use in a typical month?
FS-6T (multiples of 50):
In-transit Permits (multiples of 25):
SECTION 5
CERTIFICATION
The person signing this application certifies to being the owner, partner or officer of the facility named on this application (or has signature authority
for the organization), and that the information contained in this application is true.
To knowingly make a false statement or conceal a material fact in
this application is a criminal offense, and will result in the revocation of your Private Service Bureau license. False statements are punishable
under Section 210.45 of the Penal Code.
Pursuant to Vehicle and Traffic Law Section 392, any person knowingly making a false statement in an application for any document issued by
the Department or in any proof or statement in writing in connection with such an application shall be guilty of a misdemeanor.
I affirm that all statements made by me on this form are true, complete and correct to the best of my knowledge. I understand all statements made by
me in connection with this application are subject to investigation and verification, and that falsification or omission of information is cause for denial
of this application.
Name of Applicant (Please Print)
Date of Birth
Residence Address
X
Signature of Applicant (Sign Name in Full)
Title
Date
Section 206 of the New York State Vehicle and Traffic Law allows the Commissioner of Motor Vehicles to appoint, deny or cancel the appointment
of agents, without a hearing, at any time.
Return the completed application to:
Partnering Programs
New York State Department of Motor Vehicles
6 Empire State Plaza Room 322
Albany, NY 12228
If you have any questions about this application, please call the Partnering Unit at (518) 474-7147.
PSP-1 (5/21)
Page 3 of 4
SECTION 6
CHECKLIST OF REQUIREMENTS TO APPLY TO BE A PRIVATE SECTOR PARTNER:
o
Did you complete the application?
o
Remember to provide a copy of the New York State Department of State Filing Receipt that allows you to conduct
business in New
York (not necessary if your business has a Facility Number issued by NYS DMV).
o
If you have a Facility Number issued by DMV’s Vehicle Safety Division, your company name, address and the
officers listed on this application MUST match those on DMV’s Facility File. If you are not sure what owner information is
listed on your dealer license, contact the Freedom of Information
office at (518) 473-0967.
o
DMV’s Division of Field Investigation (DFI) staff will review security plans for plates and documents at your business before
your application is approved. Please review the enclosed list of DFI security standards to ensure that you
comply before you
submit your application.
o
A copy of the driver’s license (NY or out of state) of the owner/officers of the company listed above.
o
Has it been at least one year since any cases, violations, appeals or hearings have been resolved with DMV?
PSP-1 (5/21)
Page 4 of 4
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