Vehicle For Hire Application Form - City Of Auburn, Alabama Page 2
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2
3CITY OF AUBURN, AL
VEHICLE FOR HIRE APPLICATION
Page 2
SECTION 2: DRIVER INFORMATION
Name: _____________________________________________________________________________________________________
Address: _________________________________________________________, _____________________, _______ ___________
Home Address
City
State
Zip Code
Will you garage (keep) the vehicle at this address? Yes No
If so, a Home Occupation Permit must be obtain from the Planning
Department [171 N Ross St, Auburn, AL] and Section 2 on Page 3 must be completed.
SSN: _______________________ DOB: _______________________ DL#/STATE: _______________________
Phone # _________________________
Alternative Phone # ____________________________
SECTION 2A: EMPLOYER INFORMATION (Provide the employer name, address, and phone number.)
Name: _______________________________________________________________________________________ ______________
Address: _________________________________________________________, _____________________, _______ ___________
Street Address
City
State
Zip Code
Phone # ___________________________
Fax # __________________________
STATE OF ALABAMA—COUNTY OF LEE
Under the provisions of Section 23-31 of the Code of Auburn, Alabama, regulating the licensing of vehicle for hire drivers, and the
operations of said vehicles on the streets of the City of Auburn, I hereby make application to the City of Auburn, Alabama, for a
Municipal Vehicle for Hire Business License and upon oath make the following statements:
o
I am physically and mentally able to safely operate a motor vehicle with no restrictions which cannot be reasonably and legally
accomodated.
o
I am _________ years of age and my date of birth is _____/______/______.
o
I have had ________ years experience in operating automobiles.
o
I am familiar with the ordinances of the City governing the use and operations of vehicles, vehicles for hire, and the use of public
streets.
I have attached a copy of my current vehicle operator’s license (driver’s license) to this application.
o
o
I have attached certified copies of my official Criminal and Driving/Accident Histories obtained through the Alabama Criminal
Justice Information Center—Information Integrity Division and the Alabama Department of Public Safety. I understand that
crimes or moral turpitude, crimes involving recklessness, and serious driving infractions/accidents may cause my application for
this license to be denied.
o
I have attached two passport sized photos taken within sixty (60) days of the application.
Under penalties of perjury, I declare that I have examined this form and to best of my knowledge and belief, it is true, correct, and
complete. My signature indicates that I take full responsibility for the information presented on this form and any tax liability that might
occur.
________________________________________
____________________________________________________
PRINT NAME
SIGNATURE OF APPLICANT and DATE
st
th
st
st
st
– Jun 30
– Dec 31
LICENESE FEES: $105 (Start Date Jan 1
) or $55 (Start Date Jul 1
). Licenses expire on Dec 31
and are
nd
th
th
th
– Feb 15
renewable between Jan 2
. If renewed after Feb 15
, a 15% penalty will be added. If renewed after Mar 15
(30-days
after delinquent date), a 30% penalty plus 1% interest for each month delinquent will be added.
PAYMENT OPTIONS: Cash, Check, Money Order, or Credit Card (Visa/MasterCard ONLY)
Credit card payments may be made in person at the Revenue Office or by phone by calling (334) 501-7239. To process a
phone payment, a copy of the registration form and applicable documents must be faxed to (334) 501-7297.
____________________________________________________________
Approved
Denied
(Circle One)
(Chief of Police Signature and Date)
____________________________________________________________
Approved
Denied (Circle One)
(City Manager Signature and Date)
Mail Completed Form To: City of Auburn-Revenue Office at 144 Tichenor Avenue∙Suite 6∙Auburn, AL 36830
Office: (334) 501-7239 ∙ Fax: (334) 501-7297 ∙ Website:
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