Wisconsin Department of Transportation
MV2130 4/2017
Division of Motor Vehicles
Dealer and Agent Section
4802 Sheboygan Ave.
P.O. Box 7909
Madison, WI 53707-7909 / Scott Walker, Governor
Dave Ross, Secretary
Internet: wisconsindot.gov
Telephone: 608-266-1425
Facsimile (FAX): 608-267-0323
E-mail:
Ownership Change Addendum
The WI DOT Dealer and Agent Section has received notification you wish to change ownership within your partnership, corporation, business or, LLC. In order to complete this change we require that you verify and sign the statement below.
I, , have examined the original application, or a copy of, dated
(Controlling Interest Legal owner name)
for and verify the information continues to be true and correct with
(Legal business name)
exception to the ownership change taking place on this date, .
My signature below affirms no other changes have been made and I continue to be in full compliance with all licensing requirements necessary to maintain daily business operations.
(Legal owner name) (Legal owner name)
(Legal owner name) (Legal owner name)
Please sign this form, make a copy for your records and return the original to:
WI DOT Dealer and Agent Section
4802 Sheboygan Ave., Box 7909
Madison, WI 53705