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Rev 9/14/2020
VEHICLE INFORMATION
Year: Make: Model:
VIN: License Plate: (If applicable)
Taxicab/Pedicab #: (If applicable)
Design and Color Scheme of the Vehicle:
Color of Lettering:
Dispatch Phone: Mileage:
Per regulations set in Columbus City Code 501.05(E), the License Section has the power to make rules
regarding the “qualifications of the applicants and the conditions precedent the applicants must meet
prior to the acquisition of licenses.” Following this direction, all applicants must be able to read, speak,
and comprehend the English language in order to obtain a valid license. By initialing on the line below,
you agree that you are able to fulfill this requirement.
_______ Initials
All information contained in this application is subject to disclosure as a matter of public record. Any false
statement made or given in this application shall result in denial, revocation, or future revocation of the
license under Columbus City Code Chapters 501 and 540, and may be referred for criminal prosecution
under Ohio Revised Code Chapter 2921.13 (A-3).
State of Ohio, County of Franklin
I, _____________________________________, being duly sworn, a
ffirm and swear that I am the
(Print Applicant’s Name)
individual making the foregoing application; that he or she is knowledgeable with respect to that which is
to be licensed and to the information contained in the application; that the answers, statements, and
allegations made in this application are true and accurate to the best of my knowledge and belief; and
that I am an owner of that which is to be licensed by this application.
____________________________________
(Applicant’s Signature)
Sworn to before me and subscribed in my presence this ______ day of ___________________, 20_____.
________________________________
Notary or Agent of Director of Public Safety
