Gender
Last Name
SS #
Applicant Information
State
Business/Cell #
Email
City
{[PNAME]}
Application
Date of Birth
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[PPHONE]}
Township of Verona Official Website
Application Type
Residence Address
ZIP
First Name
Residence Phone #
  • Applicant Information - Cont.
  • Employment Information
  • Certification
Have you ever been denied a limo/taxi license?
List all Motor Vehicle violations and charges in the past 5 years:
Driver's License #
Height (Ft. & In.)
Please list any Scars/Amputations/Tattoos: (If none, Type "NA")
Has your driver's license ever been suspended or revoked?
If "Yes", please specify when, where, and why?
If "Yes", please specify when, and why:
Company Intended to Drive For
Weight (lbs)
If "Yes", which?
Are you or have you ever been addicted to intoxicating liquor or drugs?
State Issued
Marital Status
Have you ever had a limo/taxi license revoked or suspended?
If "Yes", please explain when, where, and the charge: (List all previous crimes/offenses)
If "Yes", please specify when, and where:
Applicant Information - Cont.
Have you ever been arrested of a crime or charged with an offense?
Have you ever been denied a NJ Firearms Identification Card, pistol purchase permit, or gun carrying permit?
Previous Motor Vehicle Violations/Charges
If "Yes", please specify when, and where:
Address (No PO Boxes)
Phone #
ZIP
City
Previous Employer Information
List the names, addresses, and dates of your employers over the last ten (10) years:
Employer Information
State
Email
Employer/Company Name
Type Full Name :
Sign With Hand
or
Date photographs were taken:
Applicant Signature
Pay Later
Certification
Application Fee
By signing below I do hereby swear that all of the foregoing statements are true and correct to the best of my knowledge and belief.
If you need to make your payment by mail or in person, our office is located at:

Township of Verona
Bloomfield Ave
Verona, NJ 07044

Attachments
Please attach the following:
  • 2 sided photo copy of current Driver’s License.
  • Two 2x2” recent (within the last 60 days) personal photographs.
In order to receive your license, you must first pay the Application Fee.

If you'd like to pay now by Credit Card, click the Submit & Pay Now button below.

Fees
Pay By Credit Card