Texas Department of Public Safety |
• MUST USE MOST CURRENT FORM |
VEHICLE INSPECTION |
Regulatory Services Division |
• TYPED PREFERRED OR PRINT CLEARLY |
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• MAKE SURE ENTIRE CIRCLE IS FILLED |
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www.dps.texas.gov |
EXAMPLE: Yes |
No |
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0029- |
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0030- |
VEHICLE INSPECTION STATION APPLICATION |
7130- |
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FOR DPS USE ONLY |
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STATION INFORMATION |
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Station Name |
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County: |
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Federal / Tax ID # or Social Security Number: |
(DBA): |
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Corporation or Business Name: |
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Station Website: |
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Station Email Address: |
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Phone Number: |
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Fax Number: |
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Station |
Address: |
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Physical |
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City: |
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State: |
ZIP + 4: |
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Address |
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Station |
Address: |
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Mailing |
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City: |
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State: |
ZIP + 4: |
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Address |
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Business Hours |
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Monday through Friday _____ a.m. to _____ p.m. |
Saturday _____ a.m. to _____ p.m. |
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Sunday _____ a.m. to _____ p.m. |
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Business Type: |
Corporation |
Partnership |
Sole Proprietor |
Government |
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Change: |
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Name |
Location |
Add Owner |
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For Corporations, I certify that: |
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My corporate franchise taxes owed to the State of Texas under Tax Code Chapter 171, are current. |
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The corporation is exempt from, or not subject to, the Texas Franchise Tax. |
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____________________________________________________________ |
______________________________________________________ |
___________________ |
Name of Business Owner (if applicable) |
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Email Address |
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Phone Number |
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Date of Birth: |
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Driver License # |
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DL State: |
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DL Expiration: |
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Residence |
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Address: |
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/Physical |
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City: |
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State: |
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ZIP + 4: |
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County: |
Address |
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Mailing |
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Address: |
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Address |
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City: |
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State: |
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ZIP + 4: |
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County: |
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Phone Number: |
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Alternate Phone Number: |
Cell |
Home |
Work |
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Cell |
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Home |
Work |
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Email:
If you have been previously licensed as an official vehicle inspection station,provide the following:
____________________________________________________________ |
______________________________________________________ |
___________________ |
Station Name |
City, State |
Date |
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I verify the information provided below is true and correct, and I understand any required fee is non-refundable and non-transferrable. I also understand this is an official government record and any missing information and/or false statement made on this document or any other supplement provided to DPS
may result in denial of application and/or criminal prosecution.
____________________________________________________________ |
_________________________ |
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Signature of Owner #1 (No Stamped Signatures) |
Date |
Printed Name and Title |
VI-2 (Rev. 9/2017) |
Page 1 of 2 |
Date of Birth: |
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Driver License # |
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DL State: |
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DL Expiration: |
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Residence |
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Address: |
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/Physical |
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City: |
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State: |
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ZIP + 4: |
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County: |
Address |
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Mailing |
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Address: |
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Address |
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City: |
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State: |
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ZIP + 4: |
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County: |
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Phone Number: |
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Alternate Phone Number: |
Cell |
Home |
Work |
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Cell |
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Home |
Work |
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Email:
If you have been previously licensed as an official vehicle inspection station,provide the following:
____________________________________________________________ |
______________________________________________________ |
___________________ |
Station Name |
City, State |
Date |
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I verify the information provided below is true and correct, and I understand any required fee is non-refundable and non-transferrable. I also understand this is an official government record and any missing information and/or false statement made on this document or any other supplement provided to DPS
may result in denial of application and/or criminal prosecution.
____________________________________________________________ |
_________________________ |
_______________________________________________ |
Signature of Owner #2 (No Stamped Signatures) |
Date |
Printed Name and Title |
FOR DPS USE ONLY
FOR DPS USE ONLY
____________________________________________________________ |
_________________________ |
_______________________________________________ |
Check # or Money Order # |
Amount Paid |
Deposit / Payment Date |
Privacy Policy
Sec. 559.003. RIGHT TO NOTICE ABOUT CERTAIN INFORMATION LAWS AND PRACTICES
(a)Each state governmental body that collects information about an individual by means of a form that the individual completes and files with the governmental body in a paper format or in an electronic format on an Internet site shall prominently state, on the paper form and prominently post on the Internet site in connection with the electronic form, that:
(1)with few exceptions, the individual is entitled on request to be informed about the information that the state governmental body collects about the individual;
(2)under Sections 552.021 and 552.023 of the Government Code, the individual is entitled to receive and review the information; and
(3)under Section 559.004 of the Government Code, the individual is entitled to have the state governmental body correct information about the individual that is incorrect.
(b)Each state governmental body that collects information about an individual by means of an Internet site or that collects information about the computer network location or identity of a user of the Internet site shall prominently post on the Internet site what information is being collected through the site about the individual or about the computer network location or identity of a user of the site, including what information is being collected by means that are not obvious.
Please visit: http://www.statutes.legis.state.tx.us/docs/GV/htm/GV.559.htm
VI-2 (Rev. 9/2017) |
Page 2 of 2 |