HomeMy WebLinkAbout15-051IIDIE.':IPSTIFit:A'TIION N4.E.
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AIM-n,Im II&�R+➢ II::!0ll '11'I f MO"YORIZIED PEIDICAIS VEII EICLI::: DRIVER
CE OF IOWA E
(Prulloa: Department irtt:vIevor urcuuuu�t ftwe made Ituettmaeeuu 8 a.imn. to � Ip..mrp.y Iglauunday...... If°irlday)
410 East Washington Street
Iowa City, Iowa 52240-1826 1;al/f�lr l�ii �� irJ I� /r r�i�: !� �i�/I> >L //�/r�ll�� �'C��rl� ✓/1111; 1/I/ llr�l✓l'rl I rel !Ir »� `l� li!�r
,m e, e,n ,amore,,, ,,,,, more
(319) 356-5040
(319) 356-5497 FAX
First „ Middle Last
1. Name 2.
Address yLfUr.ilillI
R.
3. Contact Information UIIwLI'u Email:
(A!I W�rittencamelf
Phone
t ly.
municationenimaa
expiration (
i )(Mtkl 1))
b.
�. Business Name
)
5Pror experience transportation
m_
... _.... ._ .... ......
. a
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where
What happened to the charge? (Circle one)
Convicted Dismissed Deferred
Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the Oast: five years?,,,,,,- w; ?
vvhat happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years'? w y
E'ype at.affeinise Where mien
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) ,
DEPARTMENT OF CRIMINAL iNVESTlGAMON (II IRII POR'r AND STATE CERTIFIED
DRIVING I :.,:,CORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CI LIEF REVIEW
You muust, apply Vor art iindliviidaual Department of Criminal investlgallon Report, (Gerim available upon request).
(SIECOIN ID PAGE FOR IREEQUIRET) SIGMA -Ir -URE AND NOTARY)
02/2015
Mli:1I11..ilCA"M.MfMMf III1:01111 "'fA2MA'AB f«"E"iMlllCII!.IIIl� Il li'tNUIVMiiii!R
l3 ,rga 2
S -1-140
Y t of Transportation a valid Chauffeur's license number
falsely y answer y questions n this application, that this applicationeart expiring on ,r, , n-- r �r °g I understand that if I
w � � Y p
issued on Mr ,,� �., �
may be denied. I agree that in making this application, I
consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions of Title,„b, .C}fppipr 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of
STATE OF IOWA )
COUNTY OF JOHNSON )
scribed and sworn to before me bye r::u II' H + iM,u u r r m on this u dav of
_.� w_u LI "r�"V!➢ti�1fV g � �` fid"" rc � � J "� N� �¢
��1� �?aw i�hYg IhMnM r II'� N p� un uma:� V'oirMUuti SlIallRe cilf Iowa
4Signaref P Chief or designee
Dae
AFTER APPROVAL IBY `If N It::: CITY CII...I1:..1R C YOU ,AIME AU'll'IIIOI IZED TO IRIVE A "II"AAXICAB W IIOWA CITY FOR NO
11MORE"'II"I lAN ONII!!i YEAR FROM "II"I IIII!!: DA"II"E II..iSTED II31:::II."t'kF9if"
THE EFFECTIVE 113A'li"IE WII...IL. IMA,"II"CllllTHE CHAUFFEUR'S LICENSE IE'MNI IF (LESS "I"HAN A YEAR.
*��2' r� w ��
Signatu e of City Clerk or designee
EMMMM=A
Approved application
DCI report
State certified driving record
Website update
Date
Clerk(TAXIDRIVBADGEAPPL92014amend.d.60C 02/2015
Mar. 2. 2015 4:12P Div Div of Criminal Investigation
I cv. ca. Zvi) II,Jvnar pity Ul"K —blly u: IONd UILY
STATE OFIOWA
Oriminal History !',
t:�
Q urs ,1�
V',. est Filk. v,
Support Operatlousl)"nau, V Floor
215 X 7'h Street
Dog M011104 Iowa 50319
(615)725-6066
(515)725-6090 Vex
`LM
_, .
1�+
DCT Account Number
No. 1480 P. 3/6
No. 5054 P. L
(fiPsppQlcaD�j`;
Roma C44ivorrawa City
lily tiRorPcss (Bf1Rco
dI0 �, aahfea ton ufa`�ee „
Toava City, IA =40
Phone: 1X9-956-5041
Fax; 1X9-366-6491
ist®r ecl�� check 08 is �ncrt��o,tQyr
As of �` a search o£th® Ptovided Warne and date o£birth revealed: '
No Iowa Ctlminal Watoiy Record found with DCI
IOWt Cr' incl History Record attached, D CI
:v
DCI initials
Tf'i.77 /A9 1
Received Time Feb. 2 .0 22015 11:32AM No. 1853
i
A DOT
SMARTER SIMPLER I CU$TGMEP WWWaiwadotgov
Office of Drives Services
PO Box RM4 i Des Mah-os, IA 50306-3204
Phone: 515.244-9124 { 32-1121 (. 1'=5.15-23'9-1837
vrwwJowadut.gDY
Inquiry Date: 3/4/2015
Name: Nguyen, Son Minh
Address: 2557 INDIGO DR
City/State: IOWA CITY, IA 522406824
Mailing Address: 2557 INDIGO DR
Mailing City/State: IOWA CITY, IA 522406824
DL/ID #:
662YY1237(IA)
Class:
D
Audit #:
6884444
Issue Date:
04/23/2013
Expiration Date:
08/01/2016
Endorsements:
3
Restrictions:
NONE
Date of Birth:
8/1/1966
Sex:
M
09/25/2010
1-0/'2'5-/,,2, 0-1-0,
X593
ox/30/20x2
_
02012
/20/2
X592
31/26/2013
01/0_6/_2014
X592
04/05/2014592
CDL Ned Status:
None
Mr ,
Customer :
1895748
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Ned Status:
None
Restriction
None
Supplement:
.Speed (10 mph & under In 35-55 mph zone)
Accidents - Accident involvement indicated does NOT
Johnson
Jr^
IA
IA
coidant 53 to Case Number Weliuc _..
09/2�r/.Y010 .... .. .. .. 'a"Y786FE ..... ._.... ....... ..._.... ._..... _..._
.IAA
Name: Nguyen, Son Minh DL/ID: 662YY1237
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 am
the custodian of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently in the custody of
said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify.
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
Name: Nguyen, Son Minh DL/ID: 662YY1237
3/4/207.5
J1810
Office of Driver Services
Iowa Department of Transportation
Name: Nguyen, Son Minh DL/ID: 662YY1237