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Fill a Valid Mv 427 Penndot Template

The MV-427 PennDOT form is an essential application used to establish or modify a vehicle inspection station in Pennsylvania. This form ensures that all necessary information is submitted correctly, allowing for the proper licensing of safety and emissions inspections. To get started on your application, please fill out the form by clicking the button below.

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Content Overview

The MV-427 form, administered by the Pennsylvania Department of Transportation (PennDOT), is a crucial document for businesses seeking to establish or modify an inspection station. This form serves multiple purposes, including applications for new inspection stations, changes in ownership, and reappointments after suspensions. It is essential for applicants to carefully compile a complete station information packet, as any omissions can lead to rejection. The packet must include the MV-427 form itself, along with supporting documents like the MV-427A for emission inspections, proof of liability insurance or bond, and a list of certified safety inspectors. Additionally, applicants must provide details about their business, such as the business name, address, and owner information, as well as any necessary documentation related to changes in authority or location. The form also requires a valid Employer Identification Number (EIN) or Social Security Number (SSN), proof of insurance listing PennDOT as the certificate holder, and recent utility bills. Proper completion of the MV-427 form not only facilitates the application process but also ensures compliance with state regulations, ultimately paving the way for safe vehicle inspections in Pennsylvania.

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Similar forms

MV-427A: This form is a supplemental application that must be completed when applying for both safety and emission inspection stations. Similar to the MV-427, it requires separate submissions for safety and emissions, ensuring that each application is distinct and meets specific criteria.
MV-443: This document provides a list of certified safety inspectors, including their inspector numbers. Like the MV-427, it is essential for verifying compliance and ensuring that only qualified individuals are conducting inspections at the station.
Employment Verification Form: To confirm employment status, utilize the important Employment Verification document that provides essential details like position and salary.
MV-500: This form serves as a record for inspection stations, documenting various operational details. It shares the same purpose as the MV-427 in maintaining accurate and up-to-date information about the station's operations and compliance status.
Certificate of Liability Insurance: This document must be attached to the MV-427 form to demonstrate that the inspection station has adequate coverage. Both the certificate and the MV-427 are critical for protecting the station from potential liabilities during inspections.

Document Specifics

Fact Name	Description
Purpose of Form	The MV-427 form is used to apply for a new inspection station or to report changes to an existing station, such as ownership or location changes.
Required Documents	Applicants must submit a complete packet including the MV-427 form, proof of insurance, and other specified documents. Incomplete submissions will be rejected.
Governing Law	This form is governed by the Pennsylvania Vehicle Code, specifically 75 Pa.C.S. Sections 4721, 4723, and 3368.
Application Submission	Completed applications should be sent to the Pennsylvania Department of Transportation, Vehicle Inspection Division, ensuring all required items are included to avoid delays.

Things You Should Know About This Form

What is the MV-427 form used for?
The MV-427 form is an application for establishing a new vehicle inspection station in Pennsylvania or for making changes to an existing station. This includes changes like a new location, ownership transfer, or reappointment after a suspension. Completing this form correctly is essential for obtaining your appointment certificate to operate as an official inspection station.
What items must be included when submitting the MV-427 application?
When submitting the MV-427 application, you must include several documents to ensure your application is complete. These include:
- Completed MV-427 form
- MV-427A form if applying for both safety and emissions inspections
- List of certified safety inspectors (MV-443)
- Proof of liability insurance or bond
- Copy of lease or deed
- Recent utility bills
- Photos of the inspection area and office
- Employer Identification Number (EIN) or Social Security Number (SSN)
- State Sales Tax Number
Incomplete applications will be rejected, and you will receive a notification detailing any deficiencies.
Can I apply for both safety and emissions inspections on the same MV-427 form?
No, you cannot apply for both safety and emissions inspections on the same MV-427 form. You must complete one form for safety and a separate form for emissions. This is to ensure clarity and proper processing of your application.
What happens if my application is incomplete?
If your application is incomplete, it will be rejected. The Pennsylvania Department of Transportation (PennDOT) will send you a letter notifying you of the specific deficiencies. It is crucial to carefully review all required documents before submission to avoid delays.
What type of insurance is required for the inspection station?
You must provide proof of liability insurance or a bond in the amount of at least $10,000. This insurance should cover any damages to vehicles during inspections. A “Garage Keeper’s Legal Liability Policy” is acceptable. Ensure that the insurance documentation includes the station name, physical location, coverage amount, and coverage period.
How should I submit the completed MV-427 application?
You can submit the completed MV-427 application either by mail or email. The application should be sent to:

Pennsylvania Department of Transportation
Vehicle Inspection Division
P O Box 68696
Harrisburg, PA 17106-9003
ATTN: Troy Roadcap, Manager
EMAIL: stationappointments@pa.gov
What if I need to change the ownership of my inspection station?
If there is a change of ownership, you must complete the MV-427 form to reflect this change. This includes listing the new owner(s) and providing any necessary documentation. Make sure to indicate the reason for the application in Section A of the form.

Documents used along the form

When applying for an inspection station, it is essential to ensure that all necessary documents accompany the MV-427 PennDOT form. Each document plays a crucial role in the application process, helping to establish compliance with state regulations. Below is a list of other forms and documents that are often required alongside the MV-427.

MV-427A: This form must be completed when applying for both safety and emissions inspection stations. Separate forms are required for each type of inspection.
Non-disclosure Agreement: Protect confidential information during the application process; ensure you understand the importance of signing an NDA for your business by visiting https://arizonaformpdf.com/.
MV-443: This document lists certified safety inspectors and includes their inspector numbers. It is necessary for verifying the qualifications of personnel conducting inspections.
Letter of Authority: If a person not listed as an owner or corporate officer is responsible for operations, a separate document must provide their name and driver’s license number.
MV-500: This form is used for various administrative purposes related to the inspection station application process.
Certificate of Liability Insurance or Bond: Proof of insurance or a bond of at least $10,000 is required to cover potential damages during vehicle inspections. The document must specify the station name and coverage details.
Lease or Deed: A copy of the lease or property deed is necessary to confirm the physical location of the inspection station.
Utility Bills: Recent copies of utility bills, such as electric and phone bills, are required to verify the business address.
Photos: Images of the inspection area, sticker security area, and office space must be included to demonstrate compliance with safety and operational standards.
Employer Identification Number (EIN) or Social Security Number (SSN): A valid EIN or SSN is necessary for tax purposes and identification of the business.
State Sales Tax Number: A valid sales tax number must be provided to confirm compliance with state tax regulations.

Gathering these documents ensures a smoother application process and helps avoid delays. Each piece of information is vital for the Pennsylvania Department of Transportation to assess your eligibility as an inspection station. Proper preparation will facilitate a more efficient review of your application.

Mv 427 Penndot Preview

Safety Station Application Check List

Upon submission of the station information packet, all items below must be included. If information is incomplete, the packet will be rejected. A letter will be sent to the applicant, notifying them of the deficiency. Additionally, included in the packet is an instruction sheet detailing how to complete form MV-427.

☐MV-427 (If applying for a safety and emission inspection, station must complete one form for safety and a separate form for emission. (Do NOT check both safety and emissions on the same form. One form should only specify SAFETY and the other form, if necessary, should only specify EMISSIONS).

☐MV-427A (must complete two separate forms if applying for a safety and emission inspection station).

☐MV-443 list of certified safety inspectors (include inspector number).

☐If you have completed section E Letter of Authority on form MV-427 and the person listed in section E is not listed on the form MV-427 as owner or is not listed as an owner/corporate officer on form MV-427A, you must include a separate document to provide that person’s name and driver’s license number with the packet. (If you are providing an out-of-state driver’s license number, you must also provide date-of-birth with the information.)

☐MV-500

☐Certificate of liability insurance or bond: Attach proof of insurance or a bond, in the amount

of at least $10,000.00, providing compensation for any damage to a vehicle during an inspection. A

“ Garage Keeper’s Legal Liability Policy” is acceptable. This proof of insurance or bond MUST include station name, physical location, and amount of coverage and period of coverage.

☐Must have a valid insurance policy with PennDOT listed as the Certificate Holder, using the address below

☐Copy of lease or deed

☐Copies of utility bills (most recent electric and phone bill)

☐Photos of the interior and exterior of the inspection area, sticker security area, and office area.

☐Must have a valid Employer Identification Number (EIN) or Social Security Number (SSN)

☐Must have a valid State Sales Tax Number

The completed packet should be mailed/emailed to:

Pennsylvania Department of Transportation

Vehicle Inspection Division

P O Box 68696

Harrisburg, PA 17106-9003

ATTN: Troy Roadcap, Manager

EMAIL: stationappointments@pa.gov

MV- 4 2 7

I NSPECTI ON STATI ON APPLI CATI ON

I NSTRUCTI ONS

USE: This application should be completed when applying for a new inspection station, and when any changes occur to an existing station, such as; change of location, change of ownership, and reappointment after a suspension, etc.

COMPLETI ON OF FORM: When properly completed and approved, this application will serve as your appointment certificate. Please use black ink and print clearly or type. PROVI DI NG FALSE, I NACCURATE, OR I NCOMPLETE I NFORMATI ON WI THI N THE APPLI CATI ON AUTOMATI CALLY I NVALI DATES THI S CERTI FI CATE.

Section A: I ndicate the reason for this application.

•New inspection station: A business which is not currently an inspection station.

•Reappoint After Cancel: A previously cancelled station reopens. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) NOT APPLI CABLE FOR PREVI OUS ENHANCED EMI SSI ON STATI ONS.

•Reappointment after Suspension: A business that had its inspection privileges suspended and wishes to reopen as an inspection station after the suspension has been served.

•Change of Location: An existing inspection station that is moving to a new location or is remodeling the existing location to provide additional space.

•Change of Ownership: When a new owner(s) takes over an existing inspection station or when a corporation changes President and the person was never listed as a Corporate Officer in the past. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” )

•Change of Authority: When a person in charge of an inspection station changes, but the ownership of the company remains the same. ( Section E should be completed at this time.)

•Change of Mailing Address: When a business wants to update an existing mailing address that is different than the physical location.

•Add Mailing Address: When a business wants its mail to be delivered to an address other than the physical location of the garage. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Delete Mailing Address: when a business wants to delete an existing mailing address other than its physical location. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Change of address by Post Office: When the business address of the station is being changed by the United States Post Office, or other agency.

•Company to Corporation: A sole proprietorship or partnership incorporates. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Change of Trade Name: An existing inspection station making a name change only. (See Company to Corporation above it the station is incorporating) .

•Adding or changing a station type: When a general station adds motorcycle, a fleet station changes to a general station and vice versa. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

•Add or Drop Partner: When a business adds or drops a partner(s) . (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Section B: Complete this section with the following information.

•Business name: I ndicate the name under which you will operate. (list both names is you trade under a

different name; ie. Smith’s Garage, inc. T/ A Mike Smith Automotive.

•Business address: I ndicate the actual location of the business. Must be a street address, no post office boxes in this space. I f you want to use a PO Box, complete the mailing address box in this section.

•Telephone number: Provide the business telephone number including area code.

• Ow ner’s name: List the owner of the business. I f business is a partnership list on partner. I f the business is a corporation, list a corporate officer. A regional or district manager is also acceptable.

•Driver License# : Provide the owner’s driver’s license number. I f license is issued from a state other than

Pennsylvania, please list the correct state abbreviation after the operator number: e.g., 123038483949 NJ (for operator number from New Jersey) .

•Mailing address ( if different from the business address) : May be indicated in the space provided. I f you wish to receive mail from the Department at your business address, the mailing address segment of Section B should remain blank.

Section C: This section provides additional information about your business.

•I ndicate if you are the sole proprietor, a partnership, or a corporation. (Commonwealth stations should check corporation) .

•I ndicate your Federal I D number and Sate Sales Tax number in the appropriate boxes. I f you have submitted applications to these agencies and have not received your identification numbers, you may write “ APPLI ED FOR” in the appropriate boxes, and then submit your number(s) to the Department when they are received.

•I ndicate the size of the I nspection area where inspection are performed (ie. 22ft x 28 ft or if more than one bay, e.g., Bay 1 22ft x 28 ft Bay 2 22ft X 62 ft, etc.)

•I ndicate the one category most appropriate for your business.

•I ndicate the type(s) of station you wish to operate which should coincide with the type(s) of vehicles you will be inspecting. I f applying for a safety station and an emission station you must complete a separate application for each type. (Do not mark safety and emission on the same application) .

•I ndicate the type(s) of station you wish to operate and check the appropriate box(es) for any type(s) of vehicles you will be inspecting at your business.

Section D: First section should be completed when you own another inspection station. Second section should be completed when you need to cancel a previous inspection station.

•First Section – Provide the station number(s) of other station(s) you own.

•Second Section – Provide the current station number and/ or name of station being cancelled due to change of location, change of ownership or change of station type, ie. Fleet to General.

Section E: This section should be completed by the owner or a corporate officer ONLY when a person OTHER THAN an owner or a corporate officer is responsible for operating the business in the owner/ corporate officer’s behalf.

I MPORTANT: PRI NT ALL PARTS OF SECTI ON E, EXCEPT for the signature of the owner/ corporate officer.

Section F: DO NOT WRI TE I N THI S SPACE.

Section G: The application must be signed by the owner/ corporate officer at the time of application submission. I N THOSE CASES WHERE SECTI ON E HAS BEEN COMPLETED, THE PERSON AUTHORI ZED BY THE OWNER/ CORPORATE OFFI CER MUST SI GN THE APPLI CATI ON.

MV-427 (2-08)

INSPECTION STATION

FORDEPARTMENTUSEONLY

PLEASE TYPE OR PRINT CLEARLY.

CERTIFICATE OF

INCIDENT# ____________________________

THIS APPLICATION WILL SERVE AS

APPOINTMENT

YOUR CERTIFICATE

CHECK ✔ THE PROPER BLOCK:

❑New Inspection Station

❑Re-appointment after suspension

❑Change of Location

❑ Change ofAuthority within a Company or a Corporation

❑Change of MailingAddress

❑Change ofAddress by Post Office

❑ Change of Trade Name

❑ Other

NAME AND ADDRESS OF BUSINESS

Name of Business

Business StreetAddress

City

County

State

Zip Code

Telephone #

Owner’s Name

Driver’s License #

MailingAddress (if different than above)

City

County

State

Zip Code

BUSINESS INFORMATION

CHECK ✔ OWNERSHIP CLASS:

❑Sole Proprietorship (A)

❑ Partnership (B) ❑Corporation (C)

Federal ID #

State Sales Tax #

Size of InspectionArea

Category ✔ Check One:

❑Garage (A)

❑Manufacturer (E)

❑Gas Station (B)

❑New Dealer (C)

❑Used Dealer (D)

Station Type: ❑Motorcycle (A)

❑Fleet (C)

❑General (E)

❑Enhanced Safety

❑Commonwealth (F)

❑Emission (X)

❑Trailer (D)

Inspection (J)

Type of vehicles you will be inspecting:

❑Passenger Cars

❑Light Trucks

❑Trailers 10,000 lbs or less

❑Trucks over 17,000 lbs.

❑ Buses

❑Motorcycles

❑Trailers over 10,000 lbs.

❑Trucks 17,000 lbs. or less

Station number of other Station(s) presently owned:

Station number and/or name of current Inspection Station:

LETTER OF AUTHORITY

CERTIFICATION

Thisletterauthorizes_______________________________________

Certificate ofAppointment as an Official Inspection Station

(Print Name of person signing the application)

Pursuant to the provisions of the Vehicle Code, 75 Pa.C.S. Sections 4721,

4723 or 3368,Act of June 17, 1976, No. 81, as amended.

________________________________________________________

(Title)

residing at _______________________________________________

(home street address)

________________________________________________________

(NOT VALID WITHOUT SEAL)

(city/town)

(county)

(state)

(zip)

to be responsible for all inspection operations performed at the above

station.

_______________________________________ _______________

This certificate may be suspended or cancelled at any time if the provisions

of the Vehicle Code or the inspection regulations are not being complied

(Signature of owner or officer)

(Date)

with or if the business is being improperly conducted.

_______________________________________

Any change at a designated Official Inspection Station automatically

(Title)

invalidates this Certificate.

Application Date:

Appointment Date:

Inspection

Station #

Iverifythatthefactssetforthonthisapplicationwerecheckedafterthecompletionoftheformandaretrueandcorrect.Thisverificationismadesubject

to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. § 4904) relating to Unsworn falsification to authorities.

Applicant Signature:

Title

Department Investigator:

Troop/Station

Badge #

WHITE - Business Copy

YELLOW - Bureau of Motor Vehicles Copy

PINK - Investigator Copy

MV-427A (4-12)

Station Application

Supplemental Information

For Department Use Only

ATTACHMENT 1

PLEASE TYPE OR PRINT CLEARLY

A.STATION NAME: _____________________________________________________________________________________

B.INSURANCE ACKNOWLEDGEMENT:

I understand that a bond or certificate of insurance in the amount of $10,000 is required for each inspection station. I also understand that failure to maintain this bond or insurance will result in cancellation of my inspection station.

Yes ______ No ______

C.ADDITIONAL INFORMATION:

1.LIST ALL OWNERS, PARTNERS OR CORPORATE OFFICERS (NOTE: Individuals should list thier PA Driverʼs License (PA DL) or Photo ID# in the space provided. Business should list their Business ID# (Bus.ID) where indicated (i.e. E.I.N.)

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

NAME	TITLE	PA DL/PHOTO ID#	DATE OF BIRTH

STREET ADDRESS	CITY	STATE	ZIP

2.Has this business or the owners, partners or officers thereof ever been a dealer, miscellaneous motor vehicles business, messenger service, inspection station or issuing agent in this or any other state?

Yes _____ No _____

If yes, list name(s), location(s), and identification number(s).

_________________________________________________________________________________________________

3.Is this application for a change of ownership or was this location previously an inspection station?

Yes _____ No _____

If yes, list previous station name(s), address(s) and identification number(s).

_________________________________________________________________________________________________

4.Is this inspection station being sold, transferred or leased while the station is suspended or restored pending appeal?

Yes _____ No _____

If yes, were you ever affiliated with this station or are you related in any way to the owner(s)? Yes _____ No _____

5.Have any owners, partners or corporate officers of this business been affiliated with a dealership, miscellaneous motor vehicle business, messenger service, inspection station or issuing agent whose privilege to conduct business as such was suspended, cancelled or revoked or is currently under investigation or received notice to attend a Departmental or court hearing or is awaiting a decision by a hearing officer or a Court?

Yes _____ No _____

If yes, list name, location, and identification number and explain situation.

_________________________________________________________________________________________________

6.Does any owner, partner, corporate officer or any business with which they were previously affiliated, have any outstanding liabilities which are due and owing to the Commonwealth, including but not limited to, taxes, fees, monetary penalties or outstanding paperwork?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

7.Have any owners, partners or corporate officers of this business ever been convicted or administratively sanctioned for violations of Department regulations Chapter 175 or 177 or Chapter 47 of the Vehicle Code?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

8.Have any owners, partners or corporate officers of this business ever remitted uncollectible checks payable to the Department of Transportation or the Commonwealth of Pennsylvania?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

9.Are all owners, partners, officers and management/supervisory employees aware of their responsibilities and obligations relating to the operation of an official inspection station, including but not limited to, record keeping, supervision of employees and customer relations?

Yes _____ No _____

If no, explain

_________________________________________________________________________________________________

I hereby verify that the information set forth above is true and correct to the best of my knowledge, information and belief. This verification is made subject to the penalties of 18 PA. C.C.§4904, relating to unsworn falsification of authorities.

Signature: _________________________________________________________________________________________

Print Name as it Appears Above: _______________________________________________________________________

Title: ________________________________________________________________________________________________

Date: _______________________________________________________________________________________________

MV-443 (3-06)

Commonwealth of Pennsylvania

DEPARTMENT OF TRANSPORTATION

OFFICIAL INSPECTION STATION NUMBER _____________________________

CURRENT LIST OF CERTIFIED

SAFETY INSPECTION MECHANICS

	OPERATOR’S	MECHANIC
NAME	LICENSE	CERTIFICATION	CLASS
NAME			CLASS
	EXPIRATION	EXPIRATION
	DATE	DATE

1.____________________________________________________________________________________

2.____________________________________________________________________________________

3.____________________________________________________________________________________

4.____________________________________________________________________________________

5.____________________________________________________________________________________

6.____________________________________________________________________________________

7.____________________________________________________________________________________

8.____________________________________________________________________________________

9.____________________________________________________________________________________

10.___________________________________________________________________________________

11.___________________________________________________________________________________

12.___________________________________________________________________________________

13.___________________________________________________________________________________

14.___________________________________________________________________________________

15.___________________________________________________________________________________

16.___________________________________________________________________________________

17.___________________________________________________________________________________

MV-500 (11-10)

www.dot.state.pa.us

Bureau of Motor Vehicles

Vehicle Inspection Division

P.O. 68697 • Harrisburg, PA 17106-8697

Pennsylvania Department of Transportation Authorized Agents for Purchasing Stickers

r NEW

r REVISED (PLEASE CHECK ONE)

	PRINT NAME AS LISTED ON ID		OPERATOR NUMBER		SOCIAL SECURITY#
	OR DRIVER’S LICENSE				(IF NON-PA DRIVER’S LICENSE)
	OR DRIVER’S LICENSE
1.	_____________________________	1.	_____________________________	1.	_____________________________
2.	_____________________________	2.	_____________________________	2.	_____________________________
3.	_____________________________	3.	_____________________________	3.	_____________________________
4.	_____________________________	4.	_____________________________	4.	_____________________________
5.	_____________________________	5.	_____________________________	5.	_____________________________

I hereby authorize the above listed person(s) to sign sticker requisitions and receive Certificates of Inspection for the following Official Inspection Station:

__________________	__________________________________	________________________
(Station Number)	(Station Name)		(Telephone #)
______________________________________________________________			____________________
(Signature of Station Owner or Authority) - Station Owner or Authority must be listed in one of the five lines above.			(Title)
______________________________________________________________			____________________
(Print Name As It Appears Above)			(Date)

REVIEW INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING.

THIS FORM MAY NOT BE COPIED OR FAXED

•Official Inspection Stations must use this form to authorize purchaser(s) to sign Form MV-436A, "Inspection Sticker and Insert Order Form."

•You may submit up to five names to be placed in a computerized signature file for your station. (NO MORE THAN FIVE (5) NAMES ARE PERMITTED). Each name submitted must include, driver’s license number (or government issued photo identification card number) and Social Security number (if non-PA driver’s license).

•If the station owner or authority (as listed in sections B or E of the certificate of appointment Form MV-427) or corporate officer, partner, etc. (listed on Form MV-427A) intends to sign Form MV-436A to purchase inspection stickers, his/her name, operator number, and Social Security Number

(if applicable) must also be listed on one of the five (5) designated spaces.

•If the REVISED box is checked, you will need to list all persons whom you have previously authorized and wish to remain authorized. Any names that are not on this form will be deleted from the computerized signature file.

•Stations which are appointed to perform both safety and emission inspections may submit only one (1) authorization form. The authorized purchasers for these stations will be able to sign Form MV-436A for both safety and emission stickers.

•Bonded messengers and members of the Legislature cannot be listed on this form as authorized purchasers.

•Return this form to: Bureau of Motor Vehicles, Vehicle Inspection Division, P.O. Box 68697, Harrisburg, PA 17106-8697. If you have questions please call (717) 787-2895.