Applicant ____________________________________________________________________________________

Address of Business ___________________________________________________________________________

Tel. # _______________________________________________________________________________________

Description of premises for storage of towed vehicles: _________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

If you intend to apply to tow publicly on behalf of the City, submit evidence of liability insurance to cover stored vehicles. By filing of application, applicant consents to the License Commission forwarding necessary information to the Chief of Police and the Building Inspector.


_______________________________
Signature of Applicant


_______________________________
Date of Application

(Do not write below this space)
____________________________________________________________________________________________

Date application filed with evidence Evidence of liability insurance to cover of DPU certification_____________ stored vehicles (if applicable)__________