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APPLICATION FOR TAXICAB LICENSE FOR CITY OF JEROME Notice to Applicant: Providing false or incomplete information may lead to the denial of this application. Final approval of the application is in the power of the Jerome City Council. 1. Name of Applicant: (If a corporation, attach a copy of articles of incorporation and certificate of corporation. Also attach list of officers). 2. Address of Applicant: (business) 3. Address of Applicant (residential) 4. Address of Applicant (mailing) 5. Date of establishment of residency in Idaho: 6. List vehicles to be operated as taxicabs: Vehicle Year, make, and model: Vehicle Identification number: Office Use: Fee of $25 unless issued after July 1 □ $25 Fee Paid □ $12.50 Fee Paid □ Copy of Regulations and Unlawful Acts provided to Applicant ---PAGE BREAK--- Certified copy of insurance policy as required by Jerome Municipal Code 5.28.070; please attach. Vehicle Year, make, and model: Vehicle Identification number: Certified copy of insurance policy as required by Jerome Municipal Code 5.28.070; please attach. Vehicle Year, make, and model: Vehicle Identification number: Certified copy of insurance policy as required by Jerome Municipal Code 5.28.070; please attach. Vehicle Year, make, and model: Vehicle Identification number: Certified copy of insurance policy as required by Jerome Municipal Code 5.28.070; please attach. Vehicle Year, make, and model: Vehicle Identification number: Certified copy of insurance policy as required by Jerome Municipal Code 5.28.070; please attach. 7. List all persons who will be employed as operators of taxicabs. Attach copy of valid (chauffer) driver license for each. ---PAGE BREAK--- Driver Name: Residential Address: Driver Name : Residential Address: Driver Name : Residential Address: 8. Copy of the rate schedule to be used by the applicant during the ensuing year; please attach. 9. License fee of $25.00 for the current year ending December 31, 2008, made payable to City of Jerome attached. ---PAGE BREAK--- THIS APPLICATION IS MADE BY THE UNDERSIGNED, who hereby affirms the truth and veracity of every statement of fact stated herein. Dated this day of , 2 . (Signature) PRINTED NAME OF APPLICANT: Office Use: □ Certified Copy of Policy of Insurance Attached – (Property damage not less than $20,000 per occurrence, public liability not less than $100,000 for one person, not less than $300,000 per occurrence). □ Rate Schedule Attached □ Valid Chauffer Driver License Attached for Each Driver. □ Approved by City Council on