Doug Belden, Tax Collector Application for a Public Vehicle Driver's License (PVDL) 1. (Last Name) (First name) (Middle initial) 2. Social Security # 3. Current Address (number, street, city, state, zip code) 4. Birth Date 5.Place of Birth / City & State 6. Race 7. Height 8. Weight 9.Color Hair 10. Color Eyes 13. Phone Number: 14. Email Address: 15. Ever been issued a PVDL 16. If yes, when? 17. Are you on probation or parole? yes no 18. Florida Driver's License # 19. Issuance Date: 19. Expiration Date: 21. List all criminal offenses which you were found guilty or been convicted of or pled guilty or nolo contendere to (your entire lifetime). a. Offense b. Location of Offense c. Date(s) 22. List all traffic offenses for which you were found guilty (excluding parking tickets). a. Offense b. Location of Offense c. Date(s) 2814 E. Hillsborough Ave., Tampa, Florida 33610 813-635-5200 www.hillstax.org
This section MUST be signed by the applicant and filled out by a Notary Public. Under penalties of perjury, I declare that I have read the foregoing [document] and that the facts stated in it are true. {Violation - F.S. 92.525 a felony of the third degree}. Further, I understand that this application is subject to public record request(s). X Oath of Affirmation Signature of Applicant date State of Florida, County of Sworn to (or affirmed) and subscribed before me this day of, 20, by. Personally known Produced Identification X type of identification: Signature of Notary Public - State of Florida Date of Expiration of Notary
Doug Belden, Tax Collector PVDL APPLICATION Exhibit A Acknowledgement of Ordinance 17-22 For the Regulation of Vehicles for Hire Ordinance 17-22 details important information about the rules and regulations of Vehicles for Hire including Taxicabs, Limousines, Handicabs and Vans and its Driver Requirements. I understand that it is my responsibility to read, understand and comply with the Ordinance and any revisions made. I have read and understand the Ordinance, its requirements and the penalties imposed as defined. Signature: Date:
PVDL APPLICATION Exhibit B Compliance Affidavit I, (PVDL Applicant) do hereby swear and affirm that I am in compliance with all applicable county and municipal ordinances and codes; state laws, regulations and codes; and federal laws and codes. Applicant s signature: Must be signed in presence of notary public. State of Florida County of On this day of, 20, personally appeared before me the above named person, who is personally known to me or who has produced as identification and who did take an oath. Notary Public My commission expires:
PVDL Checklist Step 1: Fill out the ENTIRE application and have it notarized. Do not leave any questions unanswered. If it does not apply, indicate not applicable or "n/a". Photocopies of applications will not be accepted. Step 2: Present application in person to the Hillsborough County Tax Collectors Office located at 2814 E. Hillsborough Ave., Tampa, FL 33610. Our office will take your photo as part of the application process. Step 3: Present your Social Security Card and Florida Driver's License. Handicab Operators please note: Within thirty (30) days of obtaining a PVDL, all drivers who operate a handicab must have completed a certified standard first aid course; state certificated standard CPR training course; and a defensive driving course. All drivers issued PVDL's to operate a handicab must maintain these required certifications and must provide evidence of such at the time of renewal and upon the request of the Agency and/or Department. Step 4: Sign Acknowledgement of Ordinance 17-22; Exhibit A. Step 5: Sign Compliance Affidavit; Exhibit B. After Application Has Been Submitted: Step 1: Take transmittal form (given by the HCTC representative) to the Hillsborough County Sheriff's office I.D. Section (2306 N. Falkenburg Road, Brandon, FL). The Sheriff's office will take your photo and fingerprints at no additional fee. Step 2: Call our office at (813)635-5253 within four to five business days from the day your finger prints are taken. Once approved, you will be directed to pick up your PVDL badge at the Hillsborough County Tax Collectors Office located at 2814 E. Hillsborough Ave., Tampa, FL 33610. A $65.00 applications fee must be submitted at time of application. The application fee is non-refundable.