Application For Motor Vehicle Repair Business Form - Miami-Dade County Page 3
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3Other Repairs:
Please list all your Certified Technicians & Apprentices: (Attach a separate sheet if necessary)
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Mechanic Name:
License No:
Complete the following checklist including those items attached or enclosed with this application:
- Renewal Applications Need Only Include the Underlined Items Below -
Completed Application
County Local Business Tax Receipt
License Fees(See attachment)
DERM Permit
Certified Mechanic(s) for all Repairs Applied For
Federal Employer Identification Document from IRS
Articles of Incorporation or Fictitious Name Reg.
State Sales Tax Registration Certificate
City Local Business Tax Receipt, if applicable
Garage Liability & Garage Keepers Insurance Cert.(See attachment)
Vehicle Registration (Mobile Businesses Only)
Copy of Owner’s Drivers License
I, _______________________________, the undersigned, under penalties of perjury, declare that I have read the
foregoing application and verify that the facts stated in it are true and complete. I will abide by the provisions of the
Code of Miami-Dade County and all other applicable laws. I understand that civil penalties may be imposed for
violations of the Miami-Dade County Code. I acknowledge that, persuant to Article VII of Chapter 8A of the Coder of
Miami-Dade County, the license number appearing on the license certificate must appear in all advertisement. This
requirement pertains to all media to include: free and paid listings in telephone directories, business forms, business
cards, flyers, raid television and internet ads, commerical vehicle adds, signs announcements and displays. I affirm that
motor vehicle repairs requiring certification shall be inspected and approved in writing by the certified technicians
disclosed on this application. I acknowledge that omissions or false statements will be grounds for suspension,
revocation or non-issuance of a license or permit. I further acknowledge that all license fees are non-refundable and
that incomplete applications shall be immediately denied.
______________________________________________________
________________________________________________
APPLICANT SIGNATURE
DATE
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