Phone: 6032051788

TAXI INFO, BobKat Transportation LLC Brother/Sister Company Of Market Square Taxi Portsmouth, NH

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METERED RATE

$3.50  FIRST 1/8 MILE

 
        .45  EA. ADDIONTIONAL 1/8 MILE


.45  PER MINUTE WAITING TIMe

$1.00  EA. ADDIONIONAL PASSENGER

 

Taxi Portsmouth NH BobKat Transportation LLC

CITY OF PORTSMOUTH, NEW HAMPSHIRE
OFFICE OF THE CITY CLERK
TAXI OPERATOR LICENSE APPLICATION
INSTRUCTIONS: Please print or type all required information clearly. Along with your
application, you must submit the fee, required photographs, employer statement, and
driver/criminal records must be attached or this application will not be accepted.
APPLICANT INFORMATION
Name of Taxi Company Employer:_______________________ Status (circle one): RENEWAL / INITIAL
Name:________________________________ Social Security Number:________-________-________
Address_:_____________________________ City/State/Zip:__________________________________
Daytime Telephone:_____________________ Evening Telephone:_____________________________
Date of Birth:____________ Driver License Number:________________________ State:________
Height:_________________ Weight:____________ Hair Color/Eye:____________________
REFERENCE INFORMATION (List three references not related to you)
1. __________________________________________________________________________________
 Name of Reference Telephone Number Relationship to Reference
2. __________________________________________________________________________________
 Name of Reference Telephone Number Relationship to Reference
3. __________________________________________________________________________________
 Name of Reference Telephone Number Relationship to Reference
EMPLOYMENT INFORMATION (List the last three employers)
1. ____________________________________Start (month/year)__________End (month/year)___________
 Employer Name Length of Employment
 __________________________________________________________________________________
 Employer Address Employer Telephone Number
2. ____________________________________Start (month/year)__________End (month/year)___________
 Employer Name Length of Employment
 __________________________________________________________________________________
 Employer Address Employer Telephone Number
3. ____________________________________Start (month/year)__________End (month/year)___________
 Employer Name Length of Employment
 __________________________________________________________________________________
 Employer Address Employer Telephone Number
CERTIFICATION
Have you ever been convicted of a felony? YES / NO If yes, please attach a separate sheet and explain.
I do hereby certify under penalties of perjury that to the best of my knowledge, the above statements are
true and I have submitted the following required information with this application:
! $50.00 Application Fee (non-refundable)
! 2 Photographs
! Statement from Employer (or intent to employ)
! Criminal Record (Processed from the New Hampshire Department of Safety/State Police Division)
! Motor Vehicle Driver Record (Processed from the New Hampshire Department of Safety)
Applicant Signature:_________________________________________ Date:____________________
PLEASE DO NOT WRITE BELOW THIS LINE – POLICE DEPARTMENT USE ONLY
POLICE DEPARTMENT REVIEW
Triple I – (date):______________________________ (attached)
Global – (date):______________________________
State AP – (date):____________________________
Motor Vehicle check – (date):___________________
Recommendation Information:____________________________________________________________
THIS APPLICATION IS (circle one): APPROVED / DENIED
APPROVAL STIPULATIONS:____________________________________________________________
Police Department Signature:_____________________________________ Date:________________
RELEASE OF 
MOTOR VEHICLE 
RECORDS
(Pursuant to RSA 260:14)
NH DEPARTMENT OF SAFETY 
Division of Motor Vehicles
23 Hazen Drive, Concord, NH 03305
Tele: Driver Records (603) 271-2322 
 Registration (603) 271-2251 
Repro (603) 271-2128 

 Title (603) 271-3111 
Fax (603) 271-1061 (all areas)
Form DSMV 505 (Rev. 07/09) 
I. Requested Information: Are you requesting:
A.  Your Motor Vehicle Record?
B.  Another person’s Motor Vehicle 
Record?
The back of this form must be completed and notarized.
C.  Another person’s Motor Vehicle 
Record as an authorized agent of 
your employer or a company?

A Certificate of Authority must accompany this request, or one 
 must be on file with the Division of Motor Vehicles.
II. Requestor Information: 
Name of Requestor: ____________________________________________________ 
Employer/Company (If applicable): _______________________________________________ 
Address: ________________________________________Tele.#: ___________________ 
City: ___________________________________ State: __________ Zip: ______________ 
III. Requested Records:
 Driver Record (Certified copy): $15.00
 Driver Record (Non-Certified copy): $15.00

 Driver Record (Insurance copy): $15.00
 Registration Listing (Current Information Only): $5.00
 Registration (Certified copy): $15.00
 Title Search: $20.00
 License Applications and Letters of Verification: $15.00 
 Insurance Card (Accident use only): $1.00
 Accident Report (Requestor will be notified of cost):
 $1.00 per page ($5.00 minimum) 
 Other: _______________________________: $______
Make checks payable to “State of NH – DMV”
IV. Intended Use of Information:

IMPORTANT: To be completed only if you checked Box C above
 For use in connection with any civil, criminal, administrative or arbitral proceeding. 
 Docket # _____________________ Court: ____________________[RSA 260:14 V (a)(2)]. 
 By a bank or similar institution to verify the accuracy of personal information submitted by 
the individual to the bank [RSA 260:14 V (a)(3)].
 For providing notice to the owner(s) of a towed or impounded vehicle [RSA 260:14 V (a)(5)].
 For use by any private investigative agency or security service licensed by this state for any 
purpose permitted pursuant to RSA 260:14, V (a ), other than for bulk distribution for 
surveys, marketing or solicitati ons pursuant to RSA 260:14, V (a)(8) 
__________________________ [RSA 260:14 V (a)(6)]. 

Indicate specific reason here
 By an employer or its agent or insurer to obtain or verify information relating to a holder of a 
commercial driver’s license [RSA 260:14 V (a)(7)].
 By a public utility to perform its public service obligation provided the individual has given 
their express consent [RSA 260:14, V (a)(9)].
 For an insurance company or by its authorized agent [RSA 260:14 IV (a)(2)].
 Vehicle or boat information only. 
 For use by a life insurance company authorized to write life insurance policies in New 
Hampshire, or its authorized agent. In checking off this box, I represent that the 
named person’s written consent to the release of the record has been obtained 

and that the record will be used solely in connection with claims investigation, 
rating, and underwriting. ________________ [(RSA 260:14, V(a)(10)]
(Initial here)
V. Search For (provide all applicable information):
Name: _____________________________________________ 
Date of Birth: _______________________________________ 
Registration/Plate #: __________________________________ 
Driver License/I.D. #: _________________________________ 
Vehicle Identification #: _________________________________ 
Last Known Address: ________________________________ 
__________________________________________________ 

Date of Accident: ____________________________________ 
Location of Accident: __
 Route/Street City/Town 
_______________________________ 
Other Identification Information: ________________________ 

 VI. Signed Authorization: 
If you are requesting your record be released to another person, the authorization of the person listed in 
Section V “Search For” must be acknowledged by a Notary Public or a Justice of the Peace on the back of 
this form. 
Notary Public / Justice of the Peace Acknowledgement: 
I authorize my record to be released to a third person: 

____________________________________________________ Date:_____________ 
(Signature)
State of _______________, County of: ___________________ss Date: _____________ 
The above named ______________________________ personally appeared and made oath 
that the above declaration by him is true. 
In witness whereof I hereunto set my hand and official seal: 
_____________________________________ _______________________ 
Notary Public/Justice of the Peace Commission Expiration 
Certification:
I have read RSA 260:14 and I understand the 
limitations placed on the use of information 
received by the Department of Safety. This form 
is signed under penalty of unsworn falsification 
pursuant to RSA 641:3 and subject to the 
penalties specified in RSA 260:14, IX. 
____________________________________ 
Signature of Requestor
Date: _____________ 
VIII. PENALTY CLAUSE:
RSA 260:14, IX states as follows: 
(a) A person is guilty of a class B misdemeanor if such person knowingly discloses information from a department record 

to a person known by such person to be an unauthorized person; knowingly makes a false representation to obtain 
information from a department record; or knowingly uses such information for any use other than the use authorized by the 
department. In addition, any professional or business license issued by this state and held by such person may, upon 
conviction and at the discretion of the court, be revoked permanently or suspended. Each such unauthorized disclosure, 
unauthorized use or false representation shall be considered a separate offense. 
(b) A person is guilty of a class B felony if, in the course of business, such person knowingly sells, rents, offers, or exposes 
for sale motor vehicle records to another person in violation of this section. 
OFFICIAL USE ONLY
Date Received:_______________________ Date Sent:___________________________ 
Type of Identification:  Valid Photo Driver License  State-issued Photo ID  Valid Military Identification 
 Valid Passport  Birth Certificate  Other (specify) __________ 
ID Number _____________________________________ 
_______________________________________________ ______________________________________ 
Employee Verifying Applicant Identification (Print Name) Signature

-----------------------------------------------DO NOT WRITE BELOW THIS LINE----------------------------------------------
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