Application for a Transfer and/or Affiliation - New York City
OLD VEHICLE INFORMATION
(Fill out if requesting a Vehicle Transfer only)
VEHICLE ID #
PLATE #
YEAR
MAKE
Name
StateCity
Mailing Address
D/B/A
Cell phone # Other Telephone #
Zip
EIN or SS#
Licensing and Standards Division
32-02 Queens Boulevard
Long Island City, NY 11101-2324
Please visit our website for Staten
Island office information
Corporation
Sole Proprietorship
Partnership
Business Type
(please check one)
Email Address
(Required)
APPLICANT INFORMATION
NEW VEHICLE INFORMATION
Note: If vehicle has a NYS DOT operating authority (MC 300), a Visual Inspection is required, no fee needed.
YES NO
YEAR
Page 1 of 4
VEHICLE ID #
PLATE #
SEATING CAPACITY
MAKE
HAS THIS VEHICLE BEEN STRETCHED?
IF YES, GIVE THE NAME OF THE COACH BUILDER:
TLC License number:
TLC H Record number:
YES NOIS THIS VEHICLE WHEELCHAIR ACCESSIBLE?
FOR-HIRE VEHICLE
PARATRANSIT COMMUTER VAN
Wheelchair Accessible Vehicle Non Wheelchair Accessible Vehicle
Street Hail Livery Vehicle ONLY
Vehicle Classification:
Please Note: A Wheelchair Accessible SHL Permit MUST affiliate a Wheelchair Accessible Vehicle.
TYPE OF VEHICLE:
Transfer Plates
Affiliate vehicle to SHL PermitTransfer Vehicle
Transfer vehicle to another base
TRANSACTION TYPE:
BASE, PLATE AND VEHICLE TRANSFER AND AFFILIATION APPLICATION
FHV, PARATRANSIT & COMMUTER VAN
Residence Address (No P.O. Boxes)
City State Zip
Page 5/8
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