"Michigan Repair Facility Closeout Statement" - Michigan

Michigan Repair Facility Closeout Statement is a legal document that was released by the Michigan Department of State - a government authority operating within Michigan.

Form Details:

  • Released on February 1, 2021;
  • The latest edition currently provided by the Michigan Department of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Michigan Department of State.

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Clear Form
MICHIGAN REPAIR FACILITY CLOSEOUT STATEMENT
I, ___________________________________________ as ______________________________
(Name)
(Position/Title)
of _________________________________________, hereby certify that I have discontinued
(Name of Repair Facility)
business as a Michigan Repair Facility, _________________________________,
(Repair Facility Registration Number)
effective, ___________________.
(Date)
Office of Investigative Services Representative ___________________________ on ____________.
(Representative Name)
(Date)
I certify that all statements I have made herein are true and accurate to the best of my
knowledge. I understand that, according to Section 6 [MCL 257.1306] of the Motor Vehicle
Service and Repair Act [MVSRA; MCL 257.1301 et seq.] that I cannot lawfully operate a
motor vehicle repair facility in Michigan without a registration. I further certify that I will
surrender or dispose of the repair facility registration certificate issued by the Michigan
Department of State.
______________________________________
__________________
(Signature and Title)
(Date)
This form must be signed by an Owner/Officer of record for the facility.
O F F I C E O F I N V E S T I G A T I V E S E R V I C E S
R I C H A R D H . A U S T I N B U I L D I N G
4 T H F L O O R
4 3 0 W . A L L E G A N
L A N S I N G , M I C H I G A N 4 8 9 1 8
( 5 1 7 ) 3 3 5 - 0 2 1 8
F A X ( 5 1 7 ) 3 3 5 - 3 2 4 1
w w w . M i c h i g a n . g o v / s o s
Revised February 2021
Clear Form
MICHIGAN REPAIR FACILITY CLOSEOUT STATEMENT
I, ___________________________________________ as ______________________________
(Name)
(Position/Title)
of _________________________________________, hereby certify that I have discontinued
(Name of Repair Facility)
business as a Michigan Repair Facility, _________________________________,
(Repair Facility Registration Number)
effective, ___________________.
(Date)
Office of Investigative Services Representative ___________________________ on ____________.
(Representative Name)
(Date)
I certify that all statements I have made herein are true and accurate to the best of my
knowledge. I understand that, according to Section 6 [MCL 257.1306] of the Motor Vehicle
Service and Repair Act [MVSRA; MCL 257.1301 et seq.] that I cannot lawfully operate a
motor vehicle repair facility in Michigan without a registration. I further certify that I will
surrender or dispose of the repair facility registration certificate issued by the Michigan
Department of State.
______________________________________
__________________
(Signature and Title)
(Date)
This form must be signed by an Owner/Officer of record for the facility.
O F F I C E O F I N V E S T I G A T I V E S E R V I C E S
R I C H A R D H . A U S T I N B U I L D I N G
4 T H F L O O R
4 3 0 W . A L L E G A N
L A N S I N G , M I C H I G A N 4 8 9 1 8
( 5 1 7 ) 3 3 5 - 0 2 1 8
F A X ( 5 1 7 ) 3 3 5 - 3 2 4 1
w w w . M i c h i g a n . g o v / s o s
Revised February 2021