Form K-91 "Application for Connecticut Motor Vehicle Junkyard License" - Connecticut

What Is Form K-91?

This is a legal form that was released by the Connecticut Department of Motor Vehicles - a government authority operating within Connecticut. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on June 1, 2002;
  • The latest edition provided by the Connecticut 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 K-91 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Motor Vehicles.

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Download Form K-91 "Application for Connecticut Motor Vehicle Junkyard License" - Connecticut

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APPLICATION FOR CONNECTICUT
DMV USE (License No.)
STATE OF CONNECTICUT
MOTOR VEHICLE JUNKYARD LICENSE
DEPARTMENT OF MOTOR VEHICLES
K-91 REV. 6-2002
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS:
1. The applicant must complete Part A and attach newspaper clipping of Advance Public Notice to this application.
2. The Local Approving Authority must complete Part B.
TO: DEPARTMENT OF MOTOR VEHICLES, DEALERS & REPAIRERS SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161
PART A - APPLICANT INFORMATION
NAME UNDER WHICH BUSINESS OF APPLICANT IS TO BE CONDUCTED
FULL ADDRESS OF LOCATION FOR WHICH LICENSE IS REQUESTED (Use separate application for each location)
MAILING ADDRESS (If different from above address)
IS LOCATION VISIBLE FROM A STATE HIGHWAY?
ROUTE NUMBER
IS LOCATION VISIBLE FROM INTERSTATE HIGHWAY?
ROUTE NUMBER
YES
NO
YES
NO
TYPE OF OWNERSHIP
IF INCORPORATED OR LLC, UNDER LAWS OF WHAT STATE?
INDIVIDUAL
PARTNERSHIP
CORPORATION
LLC
IF APPLICANT FIRM IS OWNED BY INDIVIDUAL OR PARTNERSHIP, ENTER DATA BELOW FOR ALL OWNERS. IF APPLICANT IS A
CORPORATION, ENTER DATA FOR PRINCIPAL OFFICERS. IF APPLICANT IS A LLC, ENTER MANAGING MEMBER(S) OR MANAGER.
NAME OF OWNER, PARTNER, PRINCIPAL
DATE OF
TITLE
HOME ADDRESS
OFFICER, OR MANAGING MEMBERS
BIRTH
I declare that the statements made by me in this application, or in any documents attached hereto, are true and
complete to the best of my knowledge and belief.
SIGNATURE OF OWNER OR AUTHORIZED OFFICER
DATE SIGNED
X
CERTIFICATION
PLACE SWORN
DATE SIGNED
Subscribed and sworn
to be before me:
SIGNATURE OF NOTARY PUBLIC, JUSTICE OF PEACE, COMMISSIONER OF SUPERIOR COURT
DATE COMMISSION EXPIRES OR JURIS NO.
X
PART B - CERTIFICATE OF APPROVAL FOR PROPOSED LOCATION
The firm or individual named above is granted approval to conduct a motor vehicle junk yard business as referred to in Sections 14-67g and 14-67i of the Connecticut General Statutes.
A public hearing on this application has been held as indicated and as provided by the Section 14-67k, C.G.S. It is hereby certified that the applicant is deemed suitable to establish,
maintain or operate a junk yard business and to receive a license.
In issuing this certification and, at time of hearing referred to below, the following requirements of Section 14-67k, C.G.S., were considered and no basis or sufficient reason was found for
:
disapproval of this application. The board has taken into consideration
1. That the location is not in an established district restricted against such use as provided in Section 14-67s, C.G.S.
2. The nature and development of surrounding property.
3. The proximity of churches, schools, hospitals, public buildings or other places of public gatherings.
4. The sufficiency in number of other such dismantlers or businesses in the vicinity.
5. The health, safety, and general welfare of the public.
DATE OF HEARING
LOCATION OF HEARING
HEARING
DATA
CERTIFYING AUTHORITY OR OFFICIAL
ZONING COMMISSION
MAYOR
BOROUGH WARDEN
MAJORITY OF BOARD OF SELECTMAN
SIGNATURE
TITLE
SIGNATURE
TITLE
X
X
LOCATION
SIGNATURE
TITLE
SIGNATURE
TITLE
APPROVAL BY
AUTHORIZED
X
X
OFFICIALS
SIGNATURE
TITLE
SIGNATURE
TITLE
X
X
APPLICATION FOR CONNECTICUT
DMV USE (License No.)
STATE OF CONNECTICUT
MOTOR VEHICLE JUNKYARD LICENSE
DEPARTMENT OF MOTOR VEHICLES
K-91 REV. 6-2002
DEALERS AND REPAIRERS SECTION
On The Web At ct.gov/dmv
INSTRUCTIONS:
1. The applicant must complete Part A and attach newspaper clipping of Advance Public Notice to this application.
2. The Local Approving Authority must complete Part B.
TO: DEPARTMENT OF MOTOR VEHICLES, DEALERS & REPAIRERS SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161
PART A - APPLICANT INFORMATION
NAME UNDER WHICH BUSINESS OF APPLICANT IS TO BE CONDUCTED
FULL ADDRESS OF LOCATION FOR WHICH LICENSE IS REQUESTED (Use separate application for each location)
MAILING ADDRESS (If different from above address)
IS LOCATION VISIBLE FROM A STATE HIGHWAY?
ROUTE NUMBER
IS LOCATION VISIBLE FROM INTERSTATE HIGHWAY?
ROUTE NUMBER
YES
NO
YES
NO
TYPE OF OWNERSHIP
IF INCORPORATED OR LLC, UNDER LAWS OF WHAT STATE?
INDIVIDUAL
PARTNERSHIP
CORPORATION
LLC
IF APPLICANT FIRM IS OWNED BY INDIVIDUAL OR PARTNERSHIP, ENTER DATA BELOW FOR ALL OWNERS. IF APPLICANT IS A
CORPORATION, ENTER DATA FOR PRINCIPAL OFFICERS. IF APPLICANT IS A LLC, ENTER MANAGING MEMBER(S) OR MANAGER.
NAME OF OWNER, PARTNER, PRINCIPAL
DATE OF
TITLE
HOME ADDRESS
OFFICER, OR MANAGING MEMBERS
BIRTH
I declare that the statements made by me in this application, or in any documents attached hereto, are true and
complete to the best of my knowledge and belief.
SIGNATURE OF OWNER OR AUTHORIZED OFFICER
DATE SIGNED
X
CERTIFICATION
PLACE SWORN
DATE SIGNED
Subscribed and sworn
to be before me:
SIGNATURE OF NOTARY PUBLIC, JUSTICE OF PEACE, COMMISSIONER OF SUPERIOR COURT
DATE COMMISSION EXPIRES OR JURIS NO.
X
PART B - CERTIFICATE OF APPROVAL FOR PROPOSED LOCATION
The firm or individual named above is granted approval to conduct a motor vehicle junk yard business as referred to in Sections 14-67g and 14-67i of the Connecticut General Statutes.
A public hearing on this application has been held as indicated and as provided by the Section 14-67k, C.G.S. It is hereby certified that the applicant is deemed suitable to establish,
maintain or operate a junk yard business and to receive a license.
In issuing this certification and, at time of hearing referred to below, the following requirements of Section 14-67k, C.G.S., were considered and no basis or sufficient reason was found for
:
disapproval of this application. The board has taken into consideration
1. That the location is not in an established district restricted against such use as provided in Section 14-67s, C.G.S.
2. The nature and development of surrounding property.
3. The proximity of churches, schools, hospitals, public buildings or other places of public gatherings.
4. The sufficiency in number of other such dismantlers or businesses in the vicinity.
5. The health, safety, and general welfare of the public.
DATE OF HEARING
LOCATION OF HEARING
HEARING
DATA
CERTIFYING AUTHORITY OR OFFICIAL
ZONING COMMISSION
MAYOR
BOROUGH WARDEN
MAJORITY OF BOARD OF SELECTMAN
SIGNATURE
TITLE
SIGNATURE
TITLE
X
X
LOCATION
SIGNATURE
TITLE
SIGNATURE
TITLE
APPROVAL BY
AUTHORIZED
X
X
OFFICIALS
SIGNATURE
TITLE
SIGNATURE
TITLE
X
X