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CITY OF DOUGLAS TAXI APPLICATION FEE: $15.00 per year/per vehicle Business Name: Tax Business Address: Sales Tax # Owner/Applicant: SS DOB: Address: Drivers License No. State Certificate of Insurance Attached: Y Other Names Used (Alias): Have you ever been convicted of any crime (misdemeanor or felony)? Yes No If yes, specify date and nature of conviction. Number of Vehicles to be used in taxi service: Description of each vehicle/license plate number in use: (list information on additional vehicles on separate paper) Make: Model: Year: License: Make: Model: Year: License: Employee(s): (list information on additional employees on separate paper) Name: SS# DOB: Address: Phone: Drivers License No. State Other Names Used (Alias): Have you ever been convicted of any crime (misdemeanor or felony)? Yes No If yes, specify date and nature of conviction. Date: Applicant Signature: Result of background investigation – Applicant: Result of background investigation – Employee(s): City Council: Approved: Disapproved: Date: License Term: Amt. paid: Receipt City License ---PAGE BREAK--- ****STAFF COMMENTS*** CITY ADMINISTRATOR ADMINISTRATIVE SERVICES DIRECTOR CITY CLERK CHIEF OF POLICE PUBLIC WORKS DIRECTOR COMMUNITY DEVELOPMENT DIRECTOR