CITY OF MAYVILLE APPLICATION FOR PUBLIC VEHICLE FOR HIRE

							License Number ______________                                                                      License Fee $__________




         CITY OF MAYVILLE APPLICATION FOR PUBLIC VEHICLE FOR HIRE

To the Honorable Mayor, Common Council, City Clerk, and Chief of Police of the City of Mayville:
        The undersigned hereby makes application for a Public Vehicle for Hire License.

BUSINESS NAME
BUSINESS ADDRESS
BUSINESS TELEPHONE
OWNER(S) NAME
OWNER(S) DATE OF BIRTH
OWNER(S) ADDRESS
OWNER(S) HOME TELEPHONE
OWNER(S) DRIVERS LICENSE
NUMBER


INSURANCE CARRIER
POLICY NUMBER
POLICY LIMITS


ATTACH A CERTIFICATE OF INSURANCE INDICATING THE INSURANCE CARRIER, INSURED, POLICY NUMBER,
POLICY LIMITS, AND DURATION OF THE POLICY. ALL INSURED VEHICLES SHALL BE IDENTIFIED ON THE
CERTIFICATE OF INSURANCE.

METHOD OF CHARGING                              Metered Rates ___            Zone Rates ___        Vehicle Rental Rate ___
SCHEDULE OF RATES
NUMBER OF VEHICLES TO BE LICENSED


     VEHICLE ID NUMBER                 YEAR, MAKE & MODEL             CAPACITY        STATE AND LICENSE PLATE NUMBER




ATTACH A VEHICLE CONDITION CERTIFICATE FOR EACH VEHICLE CERTIFING THAT EACH VEHICLE TO BE
USED FOR HIRE IS IN GOOD MECHANICAL CONDITION. THE CERTIFICATE MUST BE COMPLETED BY A
REPUTABLE AUTOMOBILE MECHANIC OR GARAGE OWNER (and someone other than owner/owners employee).




Rev. 10/07
Please read the following definitions.

          A crime is any offense (felony or misdemeanor) for which the penalty could or could not include, but is not
          limited to: a fine, jail time, imprisonment, or probation.
          A civil forfeiture action is a violation for which the only penalty is monetary, such as a speeding ticket or
          municipal disorderly conduct, etc.

1. Have you ever been denied or had revoked, any Federal, State or Local permit or license?
     YES NO           If “yes” indicate CHARGE – LOCATION – DATE
   ____________________________________________________________________________________

2. Have you ever been convicted of driving under the influence of alcohol, drugs or reckless driving?
     YES NO           If “yes” indicate CHARGE – LOCATION – DATE
   ____________________________________________________________________________________

3. Have you ever been convicted of a crime, traffic violation or civil forfeiture violation?
     YES NO           If “yes” indicate CHARGE – LOCATION – DATE
   ____________________________________________________________________________________

4. Do you have pending against you, any crime, traffic violation or civil forfeiture violation?
     YES NO          If “yes” indicate CHARGE – LOCATION – DATE
   ____________________________________________________________________________________

5. Are you now or have you ever been on probation or parole?
     YES NO          If “yes” indicate CHARGE – LOCATION – DATE
   ____________________________________________________________________________________

I hereby certify that the information contained in this application is true and correct. I am aware that withholding information or making false statements on
this application will be basis for denial/revocation of license. I further certify that the above automobiles will be kept in good mechanical condition at all
times and will comply with the provisions of law pertaining to the mechanical condition of cars. I also authorize a review of and full disclosure of any and all
records, files and reports, which include any police contact as well as arrests.


SIGNATURE OF APPLICANT___________________________________________________DATE_________________________

DO NOT WRITE BELOW THIS LINE
---------------------------------------------------------------------------------------------------------------------------------------------------

CITY CLERK’S OFFICE:

Application received by: _________                           Amount of fees received: _______                           Date received: _______

Permit Number: _______                                       Permit Effective: _______                                  Permit Expires                __

Proof of insurance received: _______                         Vehicle Inspections received: _______

POLICE DEPARTMENT:

Application has had the required investigation.

LICENSE [         ] APPROVED [            ] DENIED

If denied, please state reason:
______________________________________________________________________________________
__________________________________________________________________________________________________
____________________________________________________________________________

SIGNATURE OF POLICE REPRESENTATIVE ____________________________________DATE__________________________

Rev. 10/07