Form Rwm 10.04 - Taxi Driver Permit Application
ADVERTISEMENT
1City of Newport
TAXI DRIVER PERMIT APPLICATION
New
Renewal
Temporary Permit
(Please Print)
PERSONAL DATA
Last Name
First Name
Middle
Home Phone
Message Phone
(
)
(
)
Address
City
State
Business Phone
(
)
Social Security Number
Date of Birth
Driver License Number/State
Are you currently under investigation or indictment or have you been convicted of any crime?
(NOTE: A conviction will not necessarily bar you from receiving a permit. A conviction will be judged on its own merits with respect to time, circumstances & seriousness.)
If Yes, please explain _____________________________________________________________________
Attach the following documents to this application:
1. Copy of Driver License
2. Two (2) recent passport size photograph of applicant
3. FBI "Applicant" Fingerprint card (not required for renewal or temp. permit application)
4. Copy of fee receipt
5. Check for $12.00 payable to Oregon State Police (not required for renewal or temp. permit)
6. Proof of insurance (For temp. permit $500,000)
Temporary permit
vehicle information:
Make:
Make:
Model:
Model:
Color:
Year:
Year:
Color:
License #
License #
APPLICANTS MUST BE 21 YEARS OF AGE OR OLDER.
By my signature below, I certify that all answers to the questions and statements on the application have been
provided voluntarily and are true and complete to the best of my knowledge. I understand that a background
check will be conducted and that I am required to submit my fingerprints. I understand that should the City learn,
at any time, of any untruthful or misleading answers, my application may be rejected and/or Taxi Permit revoked.
I agree to hold harmless the City of Newport and it's employees for any claims arising out of this application
process or the City's reliance on any information provided by the applicant.
Attach the following documents to this application:
Signature:___________________________________________ Date:_______________________________
NOTE: APPLICATIONS MAY TAKE UP TO TEN WORK DAYS TO PROCESS.
Application received: ___________________________ By: ____________________________________
FOR POLICE DEPARTMENT USE ONLY
[ ] - Signed and dated application
[ ] - Photographs (2)
[ ] - Fingerprint cards
[ ] - $12.00 check payable to Oregon State Police (not required for renewal or temp. permit)
[ ] -
$25.00
fee paid to City of Newport
[ ] - Proof of Insurance
[ ] - LEDS check
[ ] - Criminal History File
[ ] - Alliance
[ ] - DMV
[ ] - Field Interview Card Completed
169 SW Coast Highway
Newport, Oregon 97365
RWM 10.04 (Revised 2/11)
541-574-3348
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business