DC Department of Motor Vehicles



DISTRICT OF COLUMBIA TAXICAB COMMISSIONPUBLIC VEHICLE FOR HIRE VEHICLE REGISTRATION ONE STOP FORMType of Application:____ Color Change___ Replacement Tag ____ Vehicle Change____ New Registration Renewal Registration ____ Duplicate Registration DCTC No._Type of Vehicle_____ Taxicab_____ LimousineVehicle ID (VIN)Year: _Make: ---- ModelTag#_ Owners/Co. Full Legal Names_ I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best or my knowledge, information and belier.Last four of SSN#________ DOB ____________ Vehicle Millage __________ Owner's SignatureDate Signed_ Address_ CityStateZip Code.Email address_Primary phone numberAlternative phone number_SECTION1Type of Application:____ Color Change___ Replacement Tag ____ Vehicle Change____ New Registration Renewal Registration ____ Duplicate Registration DCTC No._Type of Vehicle_____ Taxicab_____ LimousineVehicle ID (VIN)Year: _Make: ---- ModelTag#_ Owners/Co. Full Legal Names_ I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best or my knowledge, information and belier.Last four of SSN#________ DOB ____________ Vehicle Millage __________ Owner's SignatureDate Signed_ Address_ CityStateZip Code.Email address_Primary phone numberAlternative phone number_SECTION1SECTION 2Association or Company Name Cab Number _Association or Company Official's Printed Name_I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best of my knowledge, information and belier.Association or Company Official's Signature Date. _________________Signed_ Insurance Company Name- Policy NumberPolicy Effective DatePolicy Expiration DateInsurance Company Official's Printed Name_I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best of my knowledge, information and belief.Insurance Company Official's SignatureDate Signed_Association or Company Name Cab Number _Association or Company Official's Printed Name_I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best of my knowledge, information and belier.Association or Company Official's Signature Date. _________________Signed_ Insurance Company Name- Policy NumberPolicy Effective DatePolicy Expiration DateInsurance Company Official's Printed Name_I declare and affirm under penalty or perjury that the statements made herein are true and correct to the best of my knowledge, information and belief.Insurance Company Official's SignatureDate Signed_SECTION 3 DMV INSPECTION STATION STAMP AND DATESECTION 4 DCTC Approval:Date:Seal To report waste, fraud or abuse by any DC Government office or official, call the DC Inspector General at 1800-521-1639.Rev 10/30/15 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download