Page 2 of 2
Rev 02/22/2019
Will the vehicle to be licensed conform to the City Codes, including, but not limited to the State of Ohio and Federal laws that
applicable thereto?
Yes No
Do you understand that you must notify the License Section of any changes including, State of Ohio Vehicle Registration, address
and phone number of owner?
Yes No
Do you agree not to interfere with any numbers or plates affixed to your vehicle?
Yes No
Do you agree to conform to and abide by all City of Columbus City Codes, Rules and Regulations pertaining to vehicle for hire
including, but not limited to the State of Ohio and Federal laws applicable hereto?
Yes No
Has any license issued to you or your company by the City of Columbus ever been revoked, suspended or refused within the past
three (3) years?
Yes No
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.
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, affirm 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
