Form VS-95 "Public Emissions Inspection Station Buy/Sell Agreement" - New York

What Is Form VS-95?

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 May 1, 2015;
  • 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 VS-95 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 VS-95 "Public Emissions Inspection Station Buy/Sell Agreement" - New York

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PUBLIC EMISSIONS INSPECTION
STATION BUY/SELL AGREEMENT
*Enclose this form with the Original Facility Application submitted by the purchaser*
In order for DMV to accept for review a buy/sell agreement for an official public emissions group 1a inspection station, the
selling facility and the purchasing facility must be in the same county or within five miles of each other. Additionally, the selling
facility must be in “good standing” at the time of sale. “Good standing” means that:
- the facility license is valid and is not suspended or revoked,
- the facility does not owe any outstanding civil penalties,
- the facility has no hearings or appeals pending before the DMV, and
- the facility has no litigation pending in which the DMV is named as a party.
The selling facility must also be able to account for all unused inspection certificates (stickers).
If inspection certificates are missing, there may be long delays in processing the buy/sell agreement, denial of the
application, or possible administrative action.
Selling Facility Information:
Facility Number:
County:
Facility Name:
Facility Address:
Daytime Contact Phone: (
)
-
Alternate Contact Phone: (
)
-
NYVIP Unit Number : NY
A copy of your current inspection license issued by DMV must be attached.
I/we understand that if DMV approves the original facility application for a public emissions inspection station that was
submitted by the purchaser, the inspection license for the selling facility will be placed out of business. If the
purchasing facility is approved at the same location as the selling facility, all business types for the selling
facility will be placed out of business. After being placed out of business, if I/we wish to become a public emissions
inspection station in the future, I/we would be required to submit an original application. If I/we apply to become a
public emissions inspection station, the application will be for a new license and, as such, may be subject to placement
on a waitlist, as required by 15 NYCRR 79.7 (f).
I/we, the undersigned, sold or agree to sell the facility below.
I/we understand that
(name of purchaser)
is applying to DMV to acquire approval to operate a public emissions group 1a inspection station.
Date of agreement/sale:
/
/
(mm)
(dd)
(yyyy)
ALL principals of the selling facility on record with DMV must sign below (attach additional notarized sheet(s) if necessary):
IMPORTANT: This form must be notarized within 90 days prior to receipt by DMV.
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
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PUBLIC EMISSIONS INSPECTION
STATION BUY/SELL AGREEMENT
*Enclose this form with the Original Facility Application submitted by the purchaser*
In order for DMV to accept for review a buy/sell agreement for an official public emissions group 1a inspection station, the
selling facility and the purchasing facility must be in the same county or within five miles of each other. Additionally, the selling
facility must be in “good standing” at the time of sale. “Good standing” means that:
- the facility license is valid and is not suspended or revoked,
- the facility does not owe any outstanding civil penalties,
- the facility has no hearings or appeals pending before the DMV, and
- the facility has no litigation pending in which the DMV is named as a party.
The selling facility must also be able to account for all unused inspection certificates (stickers).
If inspection certificates are missing, there may be long delays in processing the buy/sell agreement, denial of the
application, or possible administrative action.
Selling Facility Information:
Facility Number:
County:
Facility Name:
Facility Address:
Daytime Contact Phone: (
)
-
Alternate Contact Phone: (
)
-
NYVIP Unit Number : NY
A copy of your current inspection license issued by DMV must be attached.
I/we understand that if DMV approves the original facility application for a public emissions inspection station that was
submitted by the purchaser, the inspection license for the selling facility will be placed out of business. If the
purchasing facility is approved at the same location as the selling facility, all business types for the selling
facility will be placed out of business. After being placed out of business, if I/we wish to become a public emissions
inspection station in the future, I/we would be required to submit an original application. If I/we apply to become a
public emissions inspection station, the application will be for a new license and, as such, may be subject to placement
on a waitlist, as required by 15 NYCRR 79.7 (f).
I/we, the undersigned, sold or agree to sell the facility below.
I/we understand that
(name of purchaser)
is applying to DMV to acquire approval to operate a public emissions group 1a inspection station.
Date of agreement/sale:
/
/
(mm)
(dd)
(yyyy)
ALL principals of the selling facility on record with DMV must sign below (attach additional notarized sheet(s) if necessary):
IMPORTANT: This form must be notarized within 90 days prior to receipt by DMV.
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
VS-95 (5/15)
Page 1 of 2
Facility Name:
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
Print Name
Title(s)
Date of Birth
Signature
/
/
Notary Stamp Below
Sworn to and signed before me this
day,
in the year of
.
(Notary Public)
*This form must be notarized within 90 days prior to receipt by DMV.
Purchaser Information:
Name:
Daytime Contact Phone: (
)
-
Contact Address:
Facility Number (if applicable):
Computerized Vehicle Inspection System (CVIS):
In addition to transferring the facility licenses and certificates, every official public emissions station needs to have a CVIS.
The current provider of the CVIS in New York State is Opus Inspection. Please contact them regarding transferring equipment
or an original equipment purchase at (866) 623-8378 or at www.nyvip.org.
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