AFFIRMATION TO REQUEST A REPLACEMENT CREDENTIAL
AFFIRMATION TO REQUEST A REPLACEMENT CREDENTIALI state, to the best of my knowledge, that no other person or business has any right to the lost or stolen Medallion/SHL permit and/or rate card reported here. Applicable to Medallion/SHL/RatecardApplicable to TLC Driver LicenseeI understand that by receiving a REPLACEMENT license that my original license will no longer be valid and if I am found operating with my original license, I will be subject to a fine, suspension, and/or , ___________________________________ , whose TLC license or CREDENTIAL number is: (Print Last Name, First Name)FHV DECAL ______________MEDALLION RATE CARD_____________TLC DRIVER LICENSE______________MEDALLION TIN _____________(Please check all that apply)LOSTSTOLENAffirmation- REQUEST for REPLACEMENT credentials to the best of my knowledge, was(Please check one)This statement is provided to the Taxi and Limousine Commission to REQUEST REPLACEMENT of IN MAIL (TLC Driver License Only) I hereby affirm, under penalty of law, that I have examined and reviewed the information in the submitted form(s) or application(s), including any supplemental form(s) and/ or docum
AFFIRMATION TO REQUEST A REPLACEMENT CREDENTIAL I state, to the best of my knowledge, that no other person or business has any right to the lost or stolen Medallion/SHL permit
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