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APPLICATION FOR PERMISSION TO OPERATE A TAXICAB

  1. CITY OF PLATTSBURGH, NEW YORK

  2. APPLICATION FOR PERMISSION TO OPERATE A TAXICAB

    APPLICATION is hereby made for PERMISSION TO OPERATE A TAXICAB, duly licensed by the City Clerk on the streets of the CITY OF PLATTSBURGH.

  3. First, MI, Last

  4. MM-DD-YYYY

  5. Street Number, Street Name, City

  6. GENDER:

  7. Number, State and Type

  8. If yes, please provide date, location, charge and court.

  9. If yes, give full details

  10. ARE YOU A MEMBER OF THE ARMED FORCES?

  11. ARE YOU A UNITED STATES CITIZEN?

  12. Please provide name and address

  13. HAVE YOU PREVIOUSLY BEEN LICENSED IN THE CITY OF PLATTSBURGH, NEW YORK TO OPERATE A TAXI?

  14. HAVE YOU EVER HAD AN APPLICATION TO OPERATE A TAXI DENIED?

  15. PLEASE LIST FOUR REFERENCES, INCLUDING ADDRESS, WHO WILL VOUCH FOR YOUR CHARACTER: (Mandatory)

    1.



    2.



    3.



    4.



  16. NOTICE: FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE PURSUANT TO SECTION 210.45 P.L., AS A CLASS "A" MISDEMEANOR. INCOMPLETE OR INACCURATE INFORMATION MAY BE CAUSE FOR DENIAL OF YOUR APPLICATION.

    ______________________________________________________________
    Applicant Signature


    ___________________________
    Date

  17. SUBMIT COMPLETE APPLICATION TO PLATTSBURGH POLICE DEPARTMENT, 45 PINE STREET, PLATTSBURGH, NY

    Please allow 5 to 7 business day for approval/disapproval process. At the end of that time you can contact the City Clerk's office 518-563-7702 to see if your application process has been completed.

  18. INTERNAL USE ONLY (POLICE DEPARTMENT)

  19. APPROVED/DISAPPROVED:

  20. MM-DD-YYYY

  21. Leave This Blank:

  22. This field is not part of the form submission.