Free DATE - Michigan

PLEASE NOTE: This form can only be processed 45 days prior to the current expiration date.
AR-0064 (03/06) By Authority of Public Act 300 of 1974 DEPARTMENT USE ONLY

MOTOR VEHICLE REPAIR FACILITY REGISTRATION RENEWAL
PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING ALL ITEMS. LINE OUT INCORRECT INFORMATION AND PRINT IN CORRECT INFORMATION. FACILITY NUMBER COUNTY CURRENT EXPIRATION

APPROVED BY

DATE

Clear Form

OWNERS, PARTNERS, OR CORPORATE OFFICERS NOTE: If there are changes, see instructions for Ownership Change on back.

List Owners, Partners, or Corporate Officers

THIS IS YOUR ONLY NOTICE. RENEW NOW!
Enter Facility Name, Address, City, State & Zip Code

1. FACILITY TELEPHONE

2. OWNERSHIP TYPE

3. NUMBER OF MECHANICS ­

Enter the number of persons who diagnose, repair, or maintain motor vehicles. This includes even persons who do lubrication work, tire installation, and body shop collision repairs.

4. NAME OF PERSON IN CHARGE

5. BUSINESS DAYS AND HOURS

6. Email Address

7. FEE SCHEDULE ­ IMPORTANT ­ READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS ITEM. CHECK APPROPRIATE CATEGORY. GROSS ANNUAL REVENUE A. B. C. D. E. F. G. Under $5,000................... $5,001 to $15,000............ $15,001 to $25,000........... $25,001 to $40,000........... $40,001 to $60,000........... $60,001 to $80,000........... $80,001 to $100,000......... FEE $25.00 $50.00 $75.00 $100.00 $125.00 $150.00 $175.00 H. I. J. K. L. M. N. GROSS ANNUAL REVENUE $100,001 to $120,000..... $120,001 to $140,000.... $140,001 to $160,000.... $160,001 to $180,000.... $180,001 to $200,000.... $200,001 to $220,000... $220,001 to $240,000... FEE $200.00 $225.00 $250.00 $275.00 $300.00 $325.00 $350.00 O. P. Q. R. S. T. GROSS ANNUAL REVENUE $240,001 to $260,000... $260,001 to $280,000... $280,001 to $300,000... $300,001 to $320,000..... $320,001 to $340,000..... Over $340,000................ FEE $375.00 $400.00 $425.00 $450.00 $475.00 $500.00

8. Enter the fee that was checked above........................................................................................................................... $_______________ 9. If you checked fee category A through S, list your gross annual revenue for repairs covered by the Motor Vehicle Service and Repair Act as reported on your most recent federal income tax return. 10. Give your Federal Identification Number or Social Security Number: ____________________________________________________ 11. If this renewal application is being submitted after the expiration date shown at the top of this form, enter 50% (one half) of Item 7 $________________ 12. Total Items 8 and 11. PLEASE SUBMIT THIS AMOUNT. MAKE CHECKS PAYABLE TO STATE OF MICHIGAN......................$________________ 13. DOES YOUR REPAIR FACILITY PERFORM BODY OR COLLISION WORK? NO YES $________________________

14. ARRESTS OR CONVICTIONS. Has any person listed on this application been arrested or convicted of a crime other than a traffic violation in any state within the past 12 months? NO YES If YES, complete "ARRESTS OR CONVICTIONS" on the back of this form. 15. CERTIFICATION AND AUTHORIZED SIGNATURE (Must be signed by an owner, partner, or corporate officer.) On this ______day of _______________, ____________, I certify to the truth and accuracy of all statements and representations made in this application, including all statements attached hereto, and authorize the release of all criminal history information that pertains to me on file at the Michigan State Police Central Records Division or at any court of record. ANY MISLEADING, INCOMPLETE, OR FALSE STATEMENT, OR FAILURE TO NOTIFY THE DEPARTMENT OF STATE OF MATERIAL CHANGES, MAY BE GROUNDS FOR SUSPENSION, REVOCATION, OR DENIAL OF THIS REGISTRATION. 16. HOME ADDRESS (STREET) (CITY) (STATE) (ZIP+4)

17. PRINT NAME OF OWNER, PARTNER, OR OFFICER

18. TITLE

19. SIGNATURE

20. WE ARE OUT OF BUSINESS

21. OUR LOCATION HAS BEEN TAKEN OVER BY (OWNER NAME)

22. NEW FACILITY NAME

Motor Vehicle Service and Repair Act training (basic regulatory requirements) is now available to repair facility owners, managers, and other personnel at no charge! To register, call (517) 373-6993.

INSTRUCTIONS FOR COMPLETING RENEWAL APPLICATION Facility Name and Address ­ The correct name and address of the business. Ownership Change ­ If your facility has changed ownership, an Original Repair Facility Registration Application must be submitted. Ownership changes include: a new individual owner, adding or dropping a partner, becoming a partnership, incorporating or changing from a corporation to a partnership or individual owner. If your facility is a corporation that has added new corporate officers, directors, or stockholders, a Motor Vehicle Repair Facility Registration Change of Officer, Director, Stockholder Application must be submitted. This form is not necessary to delete corporate officers. Instead, on the front of this form, draw a line through each name being deleted. If you have questions, need an original application or corporate officer change form, please telephone the Licensing Unit at 1-888-SOS-MICH (1-888-767-6424). Name of Person in Charge ­ List the name of the person in charge of this facility Number of Mechanics ­ The number of uncertified and certified persons who diagnose, repair, or maintain motor vehicles. This includes even persons who do lubrication work, tire installation, and body shop collision repairs. Business Days and Hours ­ The days of the week and hours of the day your business is open. Fee Schedule ­ Gross annual revenue is the total amount you received in payment for services or repairs provided, before expenses of any kind were subtracted, for the most recent federal income tax year. To calculate your gross annual revenue, include all parts, labor, and materials used in performing repairs. Parts such as tires, oil filters, windshield wiper blades, sheet metal parts, etc., are to be included. Labor must always be included even if parts are not used. Repairs covered by a warranty that reimburses you for repairs performed must also be included in your gross annual revenue. Parts sold over the counter but not installed by your facility and motor fuel and lubricants sold at the service station pump are NOT to be included. Do not include revenue from repairs to vehicles not required to be registered and titled under Michigan law (such as farm tractors and off-road construction vehicles). When you have found the correct revenue category, place a check mark next to the fee to be paid. Enter this fee in Item 8. Late Renewals ­ All renewals received by the Department of State after the expiration of the current registration must include a registration fee of 1½ times the regular fee. Take 50% or ½ of the amount shown in Item 8 and insert in Item 11. Add Items 8 and 11, which is the total to be submitted. For example, if your regular fee would ordinarily be $100.00 (you checked fee category "D"), add $50.00 (½ of $100.00) for a total fee of $150.00 Arrests or Convictions ­ Name(s) of Person(s) Arrested or Convicted__________________________________________________ ________________________________________________________________________________________________________________ Details__________________________________________________________________________________________________________ ______________________________________________________________________________________________________ Date(s) of Arrest(s) or Conviction(s)_________________________________________________________________________________ Court(s) of Record________________________________________________________________________________________________ City and State____________________________________________________________________________________________________ ATTACH ADDITIONAL SHEET, IF NECESSARY. Certification and Signature ­ The application must be dated and signed by an owner, partner, or corporate officer. Out of Business ­ If your facility is out of business, check the box provided in Item 19. In addition, fill in the name(s) of the new owner(s) and the new name of the facility, if it has changed, and return this form to the address listed below. When you have completed the application, attach a check or money order (MADE PAYABLE TO STATE OF MICHIGAN) and submit to: Michigan Department of State Bureau of Regulatory Services Licensing Unit Lansing, Michigan 48918 If you have questions, telephone 1-888-SOS-MICH (1-888-767-6424)
NOTE: MAIL YOUR RENEWAL APPLICATION AND FEE AT LEAST 30 DAYS PRIOR TO THE EXPIRATION OF YOUR CURRENT REGISTRATION TO ALLOW FOR PROCESSING OF YOUR RENEWAL APPLICATION. REMEMBER, IF YOUR APPLICATION IS NOT RECEIVED PRIOR TO THE EXPIRATION DATE, YOU MUST SUBMIT THE LATE FEE.