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CITY OF DOUGLAS, WYOMING Taxi Permit Supplement Form PERMITTED COMPANY: TAXI LICENSE NUMBER: SUPPLEMENT TYPE: DATE OF REQUEST: Driver Addition Request Driver Removal Request Vehicle Addition Request Vehicle Removal Request DRIVER ADDITION/REMOVAL: Full Name: All Former Names and/or Aliases: Birth Date: Phone (Home) Cell: Email Address: Home Address: Since: Driver License #/State: Exp. Date: PHYSICAL DESCRIPTION: (Not necessary for Driver Removal Requests) Gender: Height: Weight: Hair Color: Eye Color: Driver Signature (Driver Additions Only): Full Name: All Former Names and/or Aliases: Birth Date: Phone (Home) Cell: Email Address: Home Address: Since: Driver License #/State: Exp. Date: PHYSICAL DESCRIPTION: (Not necessary for Driver Removal Requests) Gender: Height: Weight: Hair Color: Eye Color: Driver Signature (Driver Additions Only): VEHICLE ADDITIONS/REMOVALS: Year/Make/Model: Color: VIN: License Plate State: Year/Make/Model: Color: VIN: License Plate State: Authorizing Signature: Printed Name: