Form 46-0106 "Add or Delete Individual on a License" - Arizona

What Is Form 46-0106?

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

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Arizona Department of Transportation;
  • 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 46-0106 by clicking the link below or browse more documents and templates provided by the Arizona Department of Transportation.

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Download Form 46-0106 "Add or Delete Individual on a License" - Arizona

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Mail Drop 552M
ADD OR DELETE INDIVIDUAL
Dealer Licensing
PO Box 2100
ON A LICENSE
Phoenix AZ 85001-2100
azdot.gov
46-0106 R04/18
Clear
Arizona law requires a licensee to notify the Motor Vehicle Division when any officer, director, partner or agent is
added or removed on a dealer license, within 30 days.
Business Name
MVD Dealer License Number
Doing Business As (DBA)
Business Address
City
State
Zip
Phone Number
Fax Number
County
(
)
(
)
I request that the following individual be:
Added
Removed
Name (first, middle, last)
Title
Residence Address
City
State
Zip
Residence Phone Number
Stock Percentage (if applicable)
Date of Birth
(
)
The following must be completed by the individual to be added to the license, (if applicant owns 20% or more of
the entity the following must be submitted.
1. Authorization to Release Information/Statement of Personal History form
2. One completed fingerprint card and technician form in envelope sealed by fingerprint technician
3. Cashier’s check or money order for $22.00 made payable to the Arizona Department of Public Safety for a
criminal records check
If a corporation is adding or deleting an individual, also submit a copy of the corporation minutes or a copy of
amended articles indicating the addition or deletion of the individual
I certify that the information contained on this application is true and correct to the best of my knowledge.
Principal or Duly Authorized Officer Name (Officer currently on license)
Title
Principal or Duly Authorized Officer Signature
Date
Notary or MVD Agent Signature
Acknowledged before me this date.
Date
County
State
Commission Expires
Mail Drop 552M
ADD OR DELETE INDIVIDUAL
Dealer Licensing
PO Box 2100
ON A LICENSE
Phoenix AZ 85001-2100
azdot.gov
46-0106 R04/18
Clear
Arizona law requires a licensee to notify the Motor Vehicle Division when any officer, director, partner or agent is
added or removed on a dealer license, within 30 days.
Business Name
MVD Dealer License Number
Doing Business As (DBA)
Business Address
City
State
Zip
Phone Number
Fax Number
County
(
)
(
)
I request that the following individual be:
Added
Removed
Name (first, middle, last)
Title
Residence Address
City
State
Zip
Residence Phone Number
Stock Percentage (if applicable)
Date of Birth
(
)
The following must be completed by the individual to be added to the license, (if applicant owns 20% or more of
the entity the following must be submitted.
1. Authorization to Release Information/Statement of Personal History form
2. One completed fingerprint card and technician form in envelope sealed by fingerprint technician
3. Cashier’s check or money order for $22.00 made payable to the Arizona Department of Public Safety for a
criminal records check
If a corporation is adding or deleting an individual, also submit a copy of the corporation minutes or a copy of
amended articles indicating the addition or deletion of the individual
I certify that the information contained on this application is true and correct to the best of my knowledge.
Principal or Duly Authorized Officer Name (Officer currently on license)
Title
Principal or Duly Authorized Officer Signature
Date
Notary or MVD Agent Signature
Acknowledged before me this date.
Date
County
State
Commission Expires