Form DOS-1798 "Application for Renewal of Installer Certification" - New York

What Is Form DOS-1798?

This is a legal form that was released by the New York State Department of State - 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 June 1, 2008;
  • The latest edition provided by the New York State Department of State;
  • 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 DOS-1798 by clicking the link below or browse more documents and templates provided by the New York State Department of State.

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Download Form DOS-1798 "Application for Renewal of Installer Certification" - New York

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Print Form
New York State Department of State
Manufactured Housing Unit
DIVISION OF
One Commerce Plaza, Suite 1160
CODE ENFORCEMENT
99 Washington Ave.
&
Albany, NY 12231
ADMINISTRATION
518.474.4073 phone
518.486.4487 fax
A
R
I
C
PPLICATION FOR
ENEWAL OF
NSTALLER
ERTIFICATION
STATE.NY.US
Instructions: Complete all parts of this application by checking the applicable box(es) and filling in the blank spaces as
required. Show any required explanation or additional information on attached sheets. Sign and date the completed application
and submit, with $200.00 fee, to the above
address.
Provide current information in this application. If any information provided in
this application differs from the information provided in your application for initial certification, check this box
and describe the
change(s) in an attached sheet.
A
I
PPLICANT
S
NFORMATION
Check applicable box:
Applicant is a
Individual
General Partnership
Corporation
LLC
LP Specify state of formation:
Applicant’s Name:
Applicant’s Certification No.
DBA (if any):
Telephone:
(
)
Street Address:
Fax
(
)
City, State, Zip:
Email:
Mailing Address if different than above:
Individuals listed below have certification as a Limited Installer and are in the employ of the applicant (if applicable).
Certification No.
Certification Expiration Date
Name
Financial Security in the form of
Surety Bond
Deposit Account Control Agreement
Letter of Credit in
the amount of $10,000 satisfying the requirements of 19 NYRR 1210.06(a) remains in effect.
The undersigned
hereby applies to the New York State Department of State for the renewal of certification as a
Applicant
Installer and certifies that the information herein is correct to the best of
knowledge, information and belief and
Applicant’s
this renewal application is filed pursuant to 19 NYCRR 1210, Manufactured Homes.
Signature of Applicant or Authorized Representative
Title
Printed Name of Applicant or Authorized Representative
Daytime telephone
(
)
WWW.DOS.STATE.NY.US/CODE/MANUF.HTML
DOS-1798 (06-08)
Print Form
New York State Department of State
Manufactured Housing Unit
DIVISION OF
One Commerce Plaza, Suite 1160
CODE ENFORCEMENT
99 Washington Ave.
&
Albany, NY 12231
ADMINISTRATION
518.474.4073 phone
518.486.4487 fax
A
R
I
C
PPLICATION FOR
ENEWAL OF
NSTALLER
ERTIFICATION
STATE.NY.US
Instructions: Complete all parts of this application by checking the applicable box(es) and filling in the blank spaces as
required. Show any required explanation or additional information on attached sheets. Sign and date the completed application
and submit, with $200.00 fee, to the above
address.
Provide current information in this application. If any information provided in
this application differs from the information provided in your application for initial certification, check this box
and describe the
change(s) in an attached sheet.
A
I
PPLICANT
S
NFORMATION
Check applicable box:
Applicant is a
Individual
General Partnership
Corporation
LLC
LP Specify state of formation:
Applicant’s Name:
Applicant’s Certification No.
DBA (if any):
Telephone:
(
)
Street Address:
Fax
(
)
City, State, Zip:
Email:
Mailing Address if different than above:
Individuals listed below have certification as a Limited Installer and are in the employ of the applicant (if applicable).
Certification No.
Certification Expiration Date
Name
Financial Security in the form of
Surety Bond
Deposit Account Control Agreement
Letter of Credit in
the amount of $10,000 satisfying the requirements of 19 NYRR 1210.06(a) remains in effect.
The undersigned
hereby applies to the New York State Department of State for the renewal of certification as a
Applicant
Installer and certifies that the information herein is correct to the best of
knowledge, information and belief and
Applicant’s
this renewal application is filed pursuant to 19 NYCRR 1210, Manufactured Homes.
Signature of Applicant or Authorized Representative
Title
Printed Name of Applicant or Authorized Representative
Daytime telephone
(
)
WWW.DOS.STATE.NY.US/CODE/MANUF.HTML
DOS-1798 (06-08)