Taxicab Operator License Application Form - Department Of Inspections And Permits - Anne Arundel County Maryland

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Licensing Division, MS 6006
Department of Inspections and Permits
2664 Riva Road, Annapolis, MD 21401
Telephone: (410) 222-7788
Fax: (410) 222-4488
PROVISIONAL TAXICAB OPERATOR LICENSE APPLICATION
The fee for a Provisional Taxicab Operators License is $100.00. A minimum of $25.00 and a complete
State of Maryland motor vehicle driving record must accompany this application. Proof of fingerprinting
is due within 20 days. $75.00 and a physician verification form are due within 45 days.
Name _______________________________________________________________________________
First
Middle
Last
Current Residence _____________________________________________________________________
Number
Street
_____________________________________________________________________________________
City
State
Zip
Home Telephone Number _______________________ Cell Phone Number _______________________
Home addresses for the previous five years
Dates
Street Address
City
State
Zip
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Date of Birth ________________
Place of Birth ___________________________________________
Month-Day-Year
City
State/Country
Race _______________________
Height ____________
Weight __________
Age ____________
Hair color______________________________
Eye color_________________________
How long have you lived in Maryland?___________
E-mail___________________________________
U.S. Citizen? ___YES
___NO
Social Security No.____________ - ____________ - ____________
If NO, a copy of your INS Employment Authorization or Alien Registration card must be submitted with
this application.
If YES and you were not born in the U. S., a copy of your US Passport or Certificate of Naturalization is
required.
List your employment history for the past six years:
Dates
Employer & Address
Position/Job Title
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
OVER►

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