Form DMV-101-LS "Application for License Service to Process and Issue Registration Decals" - West Virginia

What Is Form DMV-101-LS?

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

Form Details:

  • Released on September 1, 2021;
  • The latest edition provided by the West Virginia 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 DMV-101-LS by clicking the link below or browse more documents and templates provided by the West Virginia Department of Transportation.

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Download Form DMV-101-LS "Application for License Service to Process and Issue Registration Decals" - West Virginia

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DMV-101-LS
Rev. 09/2021
West Virginia Department of Transportation
Division of Motor Vehicles
DEALER SERVICES
304-926-0705
dmv.wv.gov/dealers
Application for License Service to Process and Issue Registration Decals
LICENSE CERTIFICATE NUMBER:
Name of rm or trade name under which the license service operates:
Mailing Address:
STREET ADDRESS
CITY
STATE
ZIP
Principal Business Address:
STREET ADDRESS
Phone: (
)
-
CITY
COUNTY
STATE
ZIP
Address and telephone number of any additional locations in this state where you do business:
Phone: (
)
-
STREET
CITY
STATE
ZIP
Phone: (
)
-
STREET
CITY
STATE
ZIP
Phone: (
)
-
STREET
CITY
STATE
ZIP
Will you keep and maintain in a permanent form all records required by §17-A-6B of the Motor Vehicle Code and Legislative
□ □
Rules and Regulations?
YES
NO
Name, address and telephone number of local agent of the company issuing bond:
NAME
Phone: (
)
-
STREET
CITY
STATE
ZIP
DMV USE
/
/
Checked and approved by:
NAME
DATE
Notary Certi cation
State of West Virginia, County of
, to wit:
Before the undersigned authority this day personally appeared
,
who, being rst duly sworn upon his/her oath deposes and says that he/she is the applicant, if the applicant be an individual, or a
partner, if the applicant be a co-partnership, or an o cer, if the applicant be a corporation, or a member, if the applicant be a limited
liability company, or said Code; that all statements contained in this application are true and correct to the best of his/her knowledge
and belief, and that he/she understands that fraudulent or misleading statements contained herein may be considered cause for the
immediate suspension or revocation of the license certi cate issued pursuant to such application.
Taken, subscribed and sworn before me this
day of
20
(X)
SIGNATURE
/
/
My commission expires
.
DATE
DMV-101-LS
Rev. 09/2021
West Virginia Department of Transportation
Division of Motor Vehicles
DEALER SERVICES
304-926-0705
dmv.wv.gov/dealers
Application for License Service to Process and Issue Registration Decals
LICENSE CERTIFICATE NUMBER:
Name of rm or trade name under which the license service operates:
Mailing Address:
STREET ADDRESS
CITY
STATE
ZIP
Principal Business Address:
STREET ADDRESS
Phone: (
)
-
CITY
COUNTY
STATE
ZIP
Address and telephone number of any additional locations in this state where you do business:
Phone: (
)
-
STREET
CITY
STATE
ZIP
Phone: (
)
-
STREET
CITY
STATE
ZIP
Phone: (
)
-
STREET
CITY
STATE
ZIP
Will you keep and maintain in a permanent form all records required by §17-A-6B of the Motor Vehicle Code and Legislative
□ □
Rules and Regulations?
YES
NO
Name, address and telephone number of local agent of the company issuing bond:
NAME
Phone: (
)
-
STREET
CITY
STATE
ZIP
DMV USE
/
/
Checked and approved by:
NAME
DATE
Notary Certi cation
State of West Virginia, County of
, to wit:
Before the undersigned authority this day personally appeared
,
who, being rst duly sworn upon his/her oath deposes and says that he/she is the applicant, if the applicant be an individual, or a
partner, if the applicant be a co-partnership, or an o cer, if the applicant be a corporation, or a member, if the applicant be a limited
liability company, or said Code; that all statements contained in this application are true and correct to the best of his/her knowledge
and belief, and that he/she understands that fraudulent or misleading statements contained herein may be considered cause for the
immediate suspension or revocation of the license certi cate issued pursuant to such application.
Taken, subscribed and sworn before me this
day of
20
(X)
SIGNATURE
/
/
My commission expires
.
DATE