Form 440-2965 "Limited Manufactured Structures Dealer License Application" - Oregon

What Is Form 440-2965?

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

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • 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 printable version of Form 440-2965 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-2965 "Limited Manufactured Structures Dealer License Application" - Oregon

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Mail application with payment to:
Limited Manufactured Structures
DCBS Fiscal Services
Dealer License Application
P.O. Box 14610
Oregon Department of Consumer and Business Services
Salem, OR 97309-0445
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
 Approved  Denied
Date:
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
Only persons who own manufactured-dwelling parks may apply for this license. A limited manufactured structures dealer license is
valid for use at a single manufactured-dwelling park and allows the license holder to sell up to 10 used manufactured dwellings in a
Complete all steps before submitting your
calendar year. A limited manufactured structures dealer may not employ a salesperson.
application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Legal name of applicant (sole proprietorship, partnership, corporation, or LLC):
Business name of applicant (DBA/ABN):
Fed. Tax ID No.:
Type of entity:
Sole proprietor
Partnership
Corporation of the state of
LLC
Business mailing address of applicant:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
STEP 2: CONTACT PERSON FOR PARK OWNER
Name of contact person:
Title:
Address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: PARK NAME AND ADDRESS
Legal name of park (sole proprietorship, partnership, corporation, or LLC):
Business name of park (DBA/ABN):
Street address of park:
City:
State:
ZIP:
Continued on next page
The fee for a limited manufactured structures dealer license is $150. The license is valid for two years from the date
issued.
Secure fax payment: 503-947-2333
Visa
MasterCard
Discover
Phone:
Fiscal use only: 12104/0600 92700/93040/1007
Cardholder signature
Amount
Make check or money order payable to Department
of Consumer & Business Services. If paying by credit
Name of cardholder as shown on credit card
card, applicant must sign credit card information box.
$
Do not send cash.
Credit card number
Expiration date
1 of 3
440-2965 (10/19/COM)
Mail application with payment to:
Limited Manufactured Structures
DCBS Fiscal Services
Dealer License Application
P.O. Box 14610
Oregon Department of Consumer and Business Services
Salem, OR 97309-0445
Division of Financial Regulation
DEPARTMENT USE ONLY
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
 Approved  Denied
Date:
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
Signature:
http://dfr.oregon.gov
Only persons who own manufactured-dwelling parks may apply for this license. A limited manufactured structures dealer license is
valid for use at a single manufactured-dwelling park and allows the license holder to sell up to 10 used manufactured dwellings in a
Complete all steps before submitting your
calendar year. A limited manufactured structures dealer may not employ a salesperson.
application and refer to the checklist at the end of this form.
STEP 1: APPLICANT INFORMATION
Legal name of applicant (sole proprietorship, partnership, corporation, or LLC):
Business name of applicant (DBA/ABN):
Fed. Tax ID No.:
Type of entity:
Sole proprietor
Partnership
Corporation of the state of
LLC
Business mailing address of applicant:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
STEP 2: CONTACT PERSON FOR PARK OWNER
Name of contact person:
Title:
Address:
City:
State:
ZIP:
Phone: (
)
Fax: (
)
Email:
STEP 3: PARK NAME AND ADDRESS
Legal name of park (sole proprietorship, partnership, corporation, or LLC):
Business name of park (DBA/ABN):
Street address of park:
City:
State:
ZIP:
Continued on next page
The fee for a limited manufactured structures dealer license is $150. The license is valid for two years from the date
issued.
Secure fax payment: 503-947-2333
Visa
MasterCard
Discover
Phone:
Fiscal use only: 12104/0600 92700/93040/1007
Cardholder signature
Amount
Make check or money order payable to Department
of Consumer & Business Services. If paying by credit
Name of cardholder as shown on credit card
card, applicant must sign credit card information box.
$
Do not send cash.
Credit card number
Expiration date
1 of 3
440-2965 (10/19/COM)
Continued from previous page
STEP 4: PARK OPERATOR INFORMATION
If the applicant is the owner of the manufactured-dwelling park and the owner’s park operator will sell manufactured
structures, complete this section.
Name of park operator:
Email:
Address:
City:
State:
ZIP:
Phone: (
)
Date of birth:
Social Security number (required):
STEP 5: PARK OWNER, PARTNERS OR OFFICERS INFORMATION
Print the names of owners, partners, or corporate officers. A Social Security number is required for each person. If there are
more than four owners or corporate officers, copy this page as needed and attach to the application.
Additional page(s) attached and submitted as part of this application:
Yes
No
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
Name:
Title:
Residence address:
City:
State:
ZIP:
Mailing address (if different):
City:
State:
ZIP:
Phone: (
)
Email:
Percentage of ownership:
Date of birth:
Social Security number (required):
STEP 6: BOND OR LETTER OF CREDIT REQUIREMENT
A bond, in the amount of $15,000 for each year the license is valid, or a letter of credit must be submitted before the Division of
Financial Regulation issues a license. The bond must be submitted on a Division of Financial Regulation surety bond form
(440-2966). Give the form to your insurance agent. When the agent returns the form, sign it and submit the original and power
of attorney with your application.
Continued on next page
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440-2965 (10/19/COM)
Continued from previous page
STEP 7: AFFIDAVIT OF APPLICANT
Read the following statements, check each box, sign, and date.
1. The information on this application is complete and correct.
2. I am authorized to sign this application.
Signature and printed name and title of sole proprietor, partner, corporate officer, or LLC member:
Signature:
Date:
Print name:
Title:
STEP 8: APPLICANT CHECKLIST
1. Application form completed
2. Supplemental pages listing additional owners enclosed, if applicable
3. Signed, original surety bond with power of attorney or letter of credit enclosed
4. Application signed by authorized person
5. Payment of fee enclosed
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440-2965 (10/19/COM)
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