"Tow Truck Renewal Application Supplement" - New York City

Tow Truck Renewal Application Supplement is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.

Form Details:

  • The latest edition currently provided by the New York City Department of Consumer Affairs;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New York City Department of Consumer Affairs.

ADVERTISEMENT
ADVERTISEMENT

Download "Tow Truck Renewal Application Supplement" - New York City

1396 times
Rate (4.6 / 5) 98 votes
42 Broadway
TOW TRUCK RENEWAL APPLICATION
Lobby
New York, NY 10004
SUPPLEMENT
Dial 311
(212-NEW-YORK)
Business Name:
nyc.gov/consumers
Doing-Business-As (DBA)
or Assumed Name:
Business Address
(No P.O. Boxes):
Business Contact Name:
Telephone Number:
Fax Number:
E-mail Address:
You must answer all questions completely. Failure to provide truthful and/or
complete answers and applicable supporting documentation may result in
denial of your application and/or enforcement action.
Reminder: If any information has changed (e.g., change of officer, address,
business name, etc.), please call the Special Applications Unit for further
instructions at (212) 487-4157 or (212) 487-2353. You must complete required
Change of Information forms.
Please refer to this Key to answer questions:
“Applicant” means any corporation, partnership, or sole proprietor
applying for a license.
“Person” means any officer, owner, director, stockholder with an
interest of 10% or more; partner; or any individual with a beneficial
interest in the applicant.
“Beneficial Interest” means profit, benefit, or advantage resulting
from a business regardless of whether the individuals who enjoy such
profit, benefit, or advantage hold formal ownership or title in the
applicant’s business.
If you answer “Yes” for any of the questions, please provide requested
description. If you need more space, attach additional papers as necessary.
Also attach any supporting documentation.
42 Broadway
TOW TRUCK RENEWAL APPLICATION
Lobby
New York, NY 10004
SUPPLEMENT
Dial 311
(212-NEW-YORK)
Business Name:
nyc.gov/consumers
Doing-Business-As (DBA)
or Assumed Name:
Business Address
(No P.O. Boxes):
Business Contact Name:
Telephone Number:
Fax Number:
E-mail Address:
You must answer all questions completely. Failure to provide truthful and/or
complete answers and applicable supporting documentation may result in
denial of your application and/or enforcement action.
Reminder: If any information has changed (e.g., change of officer, address,
business name, etc.), please call the Special Applications Unit for further
instructions at (212) 487-4157 or (212) 487-2353. You must complete required
Change of Information forms.
Please refer to this Key to answer questions:
“Applicant” means any corporation, partnership, or sole proprietor
applying for a license.
“Person” means any officer, owner, director, stockholder with an
interest of 10% or more; partner; or any individual with a beneficial
interest in the applicant.
“Beneficial Interest” means profit, benefit, or advantage resulting
from a business regardless of whether the individuals who enjoy such
profit, benefit, or advantage hold formal ownership or title in the
applicant’s business.
If you answer “Yes” for any of the questions, please provide requested
description. If you need more space, attach additional papers as necessary.
Also attach any supporting documentation.
1. Are there any other businesses operating at this business address?
Yes
No
If Yes, please complete the information below.
Business Name
Business Type
DCA License Number
(if applicable)
2. Provide information on all general partners and all corporate officers and each shareholder
owning 10% or more of the business. Note: Limited Liability Companies must provide information
1
on all members.
Last and First
Social Security or
Home Address
Title
% Stock
Names
Individual Taxpayer
Identification Number
3. Since your last license was issued, has any employee been convicted of or
charged with any criminal offense which was related to an incident which occurred
on the licensee’s premises or in the course of the licensee’s business?
Yes
No
If Yes, please provide a description of the crime, offense, or violation. NOTE: Description should
include the date of conviction, the nature of the incident, persons involved, and the outcome.
1
Providing Social Security or Individual Taxpayer Identification numbers is voluntary. The City requests this information under
the NYC Charter and Administrative Code. This information will or may be used to allow the City of New York to maintain and
update City databases, to carry out the powers and duties of the Department, and for other purposes necessary to promote the
general welfare.
4. Does any individual listed in “2” or “3” hold a beneficial interest in any other tow
truck company or companies?
Yes
No
If Yes, provide the information below.
Individual’s Name
Name of Other Tow
Address
DCA License
Truck Company
Number
5. Does any individual listed in “2” or “3” have a beneficial interest in any automobile
repair shop(s) or body shop(s)?
Yes
No
If Yes, please provide the information below.
Name of Facility:
DMV Permit:
License Number:
Name of Individual:
Please enter the Federal Employer Identification Number (EIN):
If you do not have an EIN, enter individual’s Social Security Number:
Enter the New York State Sales Tax Identification Number from the Certificate of Authority:
6. My business is a participant in the following
Direct Accident Response Program (DARP)
program(s):
Rotation Tow Program (ROTOW)
None of the above
If your company is in the DARP or ROTOW programs and you store towed vehicles at an
additional location, please provide the address of the additional storage location below.
Corporation Name/Business Name:
Doing-Business-As (DBA) or Assumed Name:
Business Address (No P.O. Boxes):
I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both.
________________________
_____________________________
______________
Signature
Print Name and Title
Date
Page of 3