Taxi_Livery Drivers License Application

Borough of Madison Phone: (973) 593-3042
Hartley Dodge Memorial Fax: (973) 593-0125
50 Kings Road
Madison, NJ 07940

APPLICATION FOR TAXI / LIVERY DRIVER’S LICENSE - Fee: $25

Applications accepted by Borough Clerk on or after November 1, and expire December 31 in year of issue

Date:

TO THE MAYOR AND COUNCIL OF THE BOROUGH OF MADISON:

In compliance with the provisions of Chapter 173 of the Borough Code, application is respectfully made for a (Taxi Driver) (Livery Driver) license for:

Name: Age: Phone:

Residence:

NJ Drivers Lic.#

Social Security #__ __ __-__ __- __ __ __ __

Citizenship Date of Birth Place of Birth

Height Weight Hair Color Eye Color

Marital Status Driving Experience (Years)

Have you ever been convicted of a motor vehicle violation? (Yes)* (No)

*If "Yes", where and when

Has your driver’s license ever been revoked, refused or suspended? (Yes)* (No)

*If "Yes", when?

Have you ever been convicted of an indictable offense, driving under the influence of drugs or alcohol, or reckless driving? (Yes)* (No)

*If "Yes", when?

Please list two references:

(1) Name Address

(2) Name Address

Name of Employer:

Please attach the following to your application:

Physician’s Certification dated within 30 days of application, required every 3 years, (year due )
Three (3) 2"x 2" photographs taken within 6 months of date of application

Fee $25 - To "Borough of Madison" for Taxi / Livery Driver
FEE $25 - Certified check or money order to "NJ Division Of State Police" - Applicant, please take fingerprint card to Police desk for fingerprinting along with the $25.00 fee
(Rev. 6/04)