RENEWAL FEE: $10.00
• This application must be completed in full (no blank spaces) before it will be accepted by
the Taxicab Authority.
• Add NO, NONE, or N/A in the appropriate space if it does not
apply to you. No errors,
corrections, and No Blank Spaces.
TA Permit Number (if applicable): Social Security Number:
Company Working/Referral:
EMPLOYEE LEASE
First Name: Middle Initial:
State: Zip Code:
Email Address:
Place of Birth (State or Country):
Last Name:
Address:
Weight:
List any marks, scars, tattoos, and amputations:
Expiration Date:
YES NO
Driver’s License Number: State:
Have you ever had a driver’s license in another state?
If YES, which state(s):
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
http://taxi.nv.gov
APPLICATION FOR RENEWAL OF TAXICAB DRIVER’S PERMIT
1
City:
Phone Number:
Date of Birth:
Gende: r: Height:
-----------------( Match to Drivers License )-------------------
Hair Color: Eye Color:
(Write N/A if you do not have any)
(Write N/A if no other state)
List all other names and aliases that have been used:(Write N/A if there are none )
TA125 RenewDRivAp (8-24v5)
YES NO
Are you a resident of the state of Nevada or a state that borders Clark County?
(Arizona or California) (per NRS 706.8841)
YES NO
IN CASE OF EMERGENCY NOTIFY:
Name: Relationship: Phone Number:
Address:
City: State: Zip Code:
I hereby swear and affirm the the information contained herein is true.
Signature: Date:
2
Can you read and orally communicate in the English language? (per NRS 706.8841)
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
http://taxi.nv.gov
***TAXICAB AUTHORITY USE ONLY***
Application reviewed and accepted by Taxicab Authority Representative.
TA Representative Name:______________________
Date:_______________
APPLICATION FOR RENEWAL OF TAXICAB DRIVER’S PERMIT
TA125 RenewDRivAp (8-24v5)
ATTENTION APPLICANT:
Convictions may NOT necessarily lead to the denial of your application.
Applicant’s Signature: Date:
***TAXICAB AUTHORITY USE ONLY***
Application/Background reviewed by Taxicab Authority Investigator.
TA Investigator Name: P# Date:
Application/Background: Pass Fail
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
http://taxi.nv.gov
CRIMINAL HISTORY STATEMENT
TA320 CrimHstyStmt (7/23v2)
Application fees paid will not be refunded in the event you are denied a taxicab drivers
permit.
All convictions, arrests, and dispositions must be disclosed regardless of their date or
location.
By making this application, I hereby consent to an investigation of my character, reputation,
employment, and criminal records. I hereby waive any claim of privilege or privacy and agree
the Nevada Taxicab Authority may contact any individual, firm, or agency necessary to conduct
such Investigations. Any person, firm, or agency that furnishes information about me pursuant
to this consent and waiver shall not be liable for any loss or damage I may suffer by reason of
the release of said information.
I hereby swear and affirm that the information contained herein is true. I further acknowledge
that “ANY” false statement or omission on this application form may result in the denial of my
driver’s permit application (new or renewal) or revocation of my Taxicab Authority permit.
FAILURE TO DISCLOSE YOUR COMPLETE CRIMMIAL HISTORY CAN BE
GROUNDS FOR DENIAL!
Renewal Packet
You are required to complete this Child Support Statement and return it with your application.
Failure to submit a fully completed and signed current Child Support Statement will result in the
application for licensing being denied. (NRS 425.520)
I am not subject to a court order for the support of a child.
I am subject to a court order for the support of one or more children and am in compliance
with the order or am in compliance with a plan approved by the District Attorney or other
public agency enforcing the order for the repayment of the amount owed pursuant to the
order.
I am subject to a court order for the support of one or more children and am not in
compliance with the order of a plan approved by the District Attorney or other public
agency enforcing the order for the repayment of the amount owed pursuant to the order.
Applicant Name (Printed or Typed) SSN
Applicant Signature Date
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
https://taxi.nv.gov/
CHILD SUPPORT INFORMATION
TA018 ChildSupport (7/23v1)
Choose only one of the following
Renewal Packet
AUTHORIZATION FOR RELEASE OF INFORMATION
I, , hereby acknowledge that I am currently employed,
seeking employment, or an independent driver (lease) with
as a taxicab driver.
I further acknowledge that it is necessary for the Taxicab Authority to be aware of any fact
which relates to my suitability to meet the requirements as outlined in NRS 706.8841.
In order to facilitate this inquiry, I hereby authorize any law enforcement agency or any other
entity having knowledge of my personal, criminal, or employment history to release such
information.
A photostatic copy of the Authorization shall have the same force and effect as the original.
Signature:_______________________________ Date:_______________________
Nevada Taxicab Authority
State of Nevada - Business and Industry
2090 E. Flamingo Road Suite 200
Las Vegas Nevada 89119
Telephone (702) 668-4000 • Fax (702) 668-4001
http://taxi.nv.gov
TA038 AuthorizeRelInf (7/23v2)
Renewal Packet