STATE OF OHIO DEPARTMENT OF PUBLIC SAFETY HP 32F HP …
|[pic] |OHIO DEPARTMENT OF PUBLIC SAFETY | |
| |OHIO STATE HIGHWAY PATROL | |
| | | |
| |APPLICATION FOR A PRIVATE PUPIL TRANSPORTATION | |
| |LICENSE FOR THE OPERATION OF A SCHOOL BUS | |
| |(Ohio Revised Code Section 4511.763 AND Ohio Administrative Code 4501-1) | |
|NAME OF SCHOOL / COMPANY (As it will appear on license) |
| |
|BUSINESS ADDRESS (Number and Street) |
| |
|CITY |STATE |ZIP CODE |COUNTY |
| | | | |
|PHONE # |FAX # |
| | |
|E-MAIL ADDRESS |
| |
TYPE OF BUSINESS ENTERPRISE – Check applicable block
| Private Contractor | Head Start Program | Parochial School |
| Day Care Center | Governmental | Community School |
| Private School | Other: |Describe | |
|NAME AND ADDRESS OF SCHOOL/COMPANY PRINCIPAL, PRESIDENT, ADMINISTRATOR, ETC. |
|NAME |COMPLETE ADDRESS |TITLE |
| | | |
| | | |
| | | |
|In accordance with the provisions of OAC 4501-1-1, a Bureau of Criminal Identification and Investigation report must be on file and a copy forwarded to this office|
|with the application for each person noted above. This report must be current within the last 90 days. |
| |
| |
|CERTIFICATION – The applicant certifies the information contained herein is true, and agrees that any untruthful representation shall be sufficient grounds for |
|refusal to issue a license or cancellation of the license. |
|PRINT NAME OF APPLICANT |
| |
|SIGNATURE |
|X |
|TITLE |DATE |
| | |
|NOTARY PUBLIC |EXPIRATION DATE |
| | |
(OSP-203.16-04)
|Mail completed application to: |
| |
|OHIO STATE HIGHWAY PATROL |
|OFFICE OF LICENSING AND COMMERCIAL STANDARDS |
|1970 W. Broad Street, 4th Floor |
|P.O. Box 182074 |
|Columbus, OH 43218-2074 |
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| |
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|APPLICANT DO NOT WRITE IN THE SPACE BELOW |
|DATE APPLICATION RECEIVED |
| |
|REVIEWED BY |
| |
|APPROVED: |DATE |
|YES NO | |
|DATE LICENSE ISSUED |
| |
|LICENSE # |
| |
|Once the license is issued, an audit of your company/school and an inspection of all school buses will be performed prior to the authorization/operation on any |
|school bus per Ohio Administrative Code 4501-1. |
| |
|For additional information on the laws and code regulating the operation of school buses: |
|codes. and ode.state.oh.us |
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