SECTION 1 APPLICANT INFORMATION
Company Name/DBA:
Address:
City:
State:
Zip:
Phone:
Authorized Representative’s Name (First, Last, MI):
Address:
City:
State:
Zip:
Phone:
SECTION 2 CORPORATION INFORMATION
*If a corporation, a certified copy of the Articles of Incorporation with the name, age, residence, and mailing address of the primary
officers are needed)
Name (First, Last, MI):
Address:
Name (First, Last, MI):
Address:
Name (First, Last, MI):
Address:
Name (First, Last, MI):
Address:
SECTION 3 VEHICLE INFORMATION
Vehicle #1
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #2
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #3
Lic. #:
VIN#:
Year/Make/Model:
Capacity
*For Additional Vehicles, please attach a sheet.
SECTION 3 ADDITIONAL INFORMATION
Location of Depots or Terminals:
Number of Vehicles Operated
Experience in the Transportation of passengers:
Color scheme or insignia to be used to designate the vehicle or vehicles:
*Certificate of Insurance is required to be from an Insured Company authorized to do business in Wisconsin and shall
contain the vehicle identification number, and the number of the state license plate for each vehicle covered by the policy,
and such policies shall indemnify the applicant in the amount of $500,000 single liability coverage for the injury or death of
one or more persons and damage to the property of others for any one accident due to the negligent operation of any vehicle
covered by such policy. (A copy of the Certificate of Insurance must accompany this application)
SECTION 4 OATH
St. Croix County, State of Wisconsin
, being first duly sworn on oath, says that he/she is the
person who made and signed the foregoing application for an Operator’s License; that all the statements made by applicant are true.
Applicant Signature: Date:
Subscribed and sworn to before me on this of , 20
Notary Signature: Date Expires:
FOR OFFICE USE ONLY
Taxi Fee Collected: $100.00/yr (First Vehicle) Yes No
$25.00/yr (Additional Vehicles
License No:
Council Approved: Yes No
Date Issued:
_____/_____/_____
Approved by Clerk: Yes No
Fees Paid: AR Court Parking Utility Taxes
Date of Background Check:
______/______/______
City of Hudson
Application for Taxi Cab License
SECTION 3 VEHICLE INFORMATION (CONTINUED)
Vehicle #4
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #5
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #6
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #7
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #8
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #9
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #10
Lic. #:
VIN#:
Year/Make/Model:
Capacity
Vehicle #11
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #12
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #13
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #14
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
Vehicle #15
Lic. #:
VIN#:
Year/Make/Model:
Capacity:
City of Hudson
Application for Taxi Cab License
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