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LADOT For-Hire Policy and Regulation Division Response Form
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Name (First, M, Last)
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Contact Number
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Contact Email
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Address (Street, City, State, Zip)
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What type of service is this about.
Name of Company (Taxi/Ambulance/Other)
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Vehicle Number / Licence Plate
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Driver Permit
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Driver Description
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Date of Incident
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Time of Incident
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Location of Incident
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