Fillable Form 3: (409) 643-5705 1725-25 Street North Texas

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Form 3: (409) 643-5705 1725-25 Street North Texas

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In conformity with the City Ordinance concerning the Licensing of Ambulances Services, the EMS Provider listed below request
permission from the Texas City Fire Department to operate the following ambulance vehicles:
Type Year and Make Vehicle ID Number License Plate No TDSHS Veh Auth No
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EMS Provider Name Date
Texas City Fire Department
1725-25
th
Street North
Texas City, TX 77590
(409) 643-5705
FOR OFFICE USE ONLY
Received Date:
Am
ount Paid:
Issue Date:
Expired Date:
Permit No.
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Form 3: (409) 643-5705 1725-25 Street North Texas

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Completed 16 July 2020

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