DCA license renewal form is a document that should be filed on time by all professionals who hold a license from the Department of Consumer Affairs. The form is used to renew licenses and update contact information. It is important to file the renewal form on time in order to avoid any penalties or late fees. There are several ways to submit the renewal form, including online and by mail. Make sure you know which method is best for you and get started on your renewal today!
| Question | Answer |
|---|---|
| Form Name | Dca License Renewal Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | taxi permit renewal, shall broome renewal, drivers license template editable word, dca renewal application |
APPLICATION FOR RENEWAL OF TAXICAB DRIVER’S LICENSE
Pursuant to Section
“Application for License Renewal shall be made at least thirty (30) days prior to its expiration on this form. Applications submitted less than 30 days prior to the expiration date of same shall be treated as a new application and shall be subject to the requirements and fees applicable to same. (Sections
Attach additional documentation as necessary.
I the undersigned do hereby make application for renewal of my license to drive a taxicab within the County of Broome, pursuant to the relevant provisions of the Local Law of the County of Broome and any amendments thereto:
Last Name:__________________________ First Name: _________________ M.I.: ___
Date of Birth (mm/dd/yy):______________ NYS Chauffer’s License # ______________
Home Address: _________________________________________________________
Name & Address of Current Employer : ______________________________________
______________________________________________________________________
Date Original Taxi Driver License Granted (mm/dd/yy): __________________
License Number: __________________________ Expires(mm/dd/yy):
Since date of original taxi application, have you been arrested or convicted of a felony, misdemeanor, DWI or illegal drug charge?
Yes |
No If yes, explain: |
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APPLICANT MUST REPORT FOR A DRUG SCREENING TEST ON
THE DATE OF THIS SUBMISSION.
APPLICANT SHALL ALSO BE SUBJECT TO REVIEW OF HIS NEW YORK STATE
DEPARTMENT OF MOTOR VEHICLES DRIVER’S LICENSE ABSTRACT
AND ANY CRIMINAL HISTORY
ATTACH COPY OF CURRENT TAXI DRIVER’S LICENSE
APPLICATIONS FOR RENEWAL SUBMITTED LESS THAN 30 DAYS PRIOR TO THE
EXPIRATION DATE SHALL BE TREATED AS A NEW APPLICATION
“PURSUANT TO THE NEW YOUR STATE PENAL LAW SEC. 210.45, IT IS A CRIME PUNISHABLE AS A CLASS A MISDEMEANOR TO KNOWINGLY MAKE A FALSE STATEMENT HEREIN”
Applicant Signature:
Date: (mm/dd/yy)
,being duly sworn, deposes and says that he/she is the
individual making the foregoing application for a taxicab driver’s license; and that the answers to the foregoing questions and other statements contained therein are true of his/her own knowledge and belief.
Subscribed to and sworn to before me |
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__________________________________ |
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Notary public or Clerk of Broome County |
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FOR OFFICE USE ONLY |
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Taxi Driver License #: |
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Expires(mm/dd/yy): |
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Copy of current Broome County Taxi Driver’s License attached |
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Copy of NY State Chauffer’s License |
Expires(mm/dd/yy): |
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DMV Driver’s License Abstract Attached |
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Criminal Records Check completed & attached |
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Drug Screening |
Positive |
Negative |
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Fee collected ($ 60.00) Cash |
Check |
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Check # |
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Processed by |
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Date (mm/dd/yy): |
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Approved
ATTACH ALL SUPPORTING DOCUMENTATION
Denied Reason:
__________________________________________ Date (mm/dd/yy):
Director of Security