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LADOT For-Hire Policy and Regulation Division Response Form
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What kind of response would you like to make? *
Name (First, M, Last)
Contact Number
Contact Email
Address (Street, City, State, Zip)
What type of service is this about.
Name of Company (Taxi/Ambulance/Other)
Vehicle Number / Licence Plate
Driver Permit
Driver Description
Date of Incident
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/
DD
/
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Time of Incident
Time
:
Location of Incident
Additional Information
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