HomeMy WebLinkAbout15-050crry OF IOWA Crj-y
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
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ora (.dsa„ Grrdy�
APN•rLgC�,'A"gON FOR 'E'
(Police De ACAig / �dNO'E'ON 2ZLD PIEDNCAB V6MCL E DIRNv811�
partmeunt rerruew mustNue Made between 8a -M., to 3
� llluiH Iii r p„hlftl,n Monday —PIPAday)
Name dRW� �
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_ ___. __...._. _.a 2. Address (. A .^ __3• ContacInformation (R AA
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4a. Chauffeur's License expiration date � ) CeN�ARorNo
(tluNuNto6 oauu urruLrr)rsaNrrcarw sent vua ernanG�
b. Taxicab Business Name (REk Ipl l iA r
5. Prior experience in trans o ....__.._..____._.._ ....._.
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transportation of :as�;w���n.�� �. .� ..... �..
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_.__.. ._........__..... ��._._._...___..._._........_......_........._........_............._....._._._....._._........._.._.__._._........_................__..........._._.....__._
• Have You ever been arra:.>ted /charged �^titNr an
fferase w and/or te:Nc�epuesAn tNNrcs S�rte rUr eGselnrN�era:°�
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What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended
7Have you been arrested / charged with an
° t cfta ns a Y traffic cfterpsePlead Guilty s Nru lhc” Na„;t five a
e•us'a y Other.....__.
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N.�uuVNpP�eS�CiR't
$ Has your driver's Suspended
Plead Guilty Other
license or Chauffeur's license been suspended or revoked in the Bast rAva e<. , „
��YP� raf_affenst:
Where y jrsd 9
_...______ ___......... _... _ When.,
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. ABarre ourovora � ___ _ .____ __
ppBG�.d to be _ ___ _ ___ -
&I NCvVja CftY t9x4 drover usrng a ditte?rent earn.... Nt e"w"Y_ _ __ _
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ADPP�N�kY"Nb4"N"OPCtttEmuunaaN
a' r0.nFprC„NE„ tNTnv= r8a
Ary
You unnius't a u .. 4 . ` m Report (to Cnt aroaaANa NeNiupon tvtty
HIS BtA PN..NCps A.N..t'ti 0Nz IIIA AA':"
Ns6uAY for• an NrudNvwd�gaA N::)n„ uartpnneunt o6 Cu°ArunNlaaN investigationW
(SECO�PIA PAGfEA-tbN�N�&t�OUAAS'E:DSIG"NdtN'NNA�EAM..:)N�'O-FARY) are¢y�est).
Aird°"t..mCA'I°It9N uI t R ..m.. II MAIM VB I1111ICLE DIIRW Iii
12age 2
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times with all of the provisions of Tifle 5, Chapterof the City Code. F be signed in front of a Notary Public)
Signature of Applicant ID a ke
STATE OF IOWA )
COUNTY OF JOHNSON )
Sgbscrlbed and swornr„ to before me by "`„t„ a. .. �,` ) n... a . r.... on this day of
I:"uEa1:: iIn aired”"furor tlhe State of
.&5C,„,,,11 , -
w;
y
signature of9 f or des„ignee
................m
R„ Pata
en"m ........... _
........_ - ----------------- ”
AI:: TEAR APPROVAL IBY "I ill: CI"I'Y CII..I ERR YOU ARE AUTHORIZED "II"O DRIVE A "U'A XICAB IIN IOWA. CITY FOR NO
IIWORI:..: "Irl IAN OIMPIII: Y11:..AR FROM ml:..: NAA"II"E II...IIS"i' ID B11:.LOW..
DIIIE EFIFII: arIVE II)A"r WIII...JI... IPWNA"Ir'CIFN 'irIHI!!: CIhIAUFIU::'11:..IJI:R''S I...ICENSE If:I IpIIRA'irUo9 9 IF II...IE'SS TI IAIIg A YII: AUk'.
Sign o of City Clerk or de sign erf
Approved application
DCI report
State certified driving record
Website update
CIeddTTAXIDRIVBADGEAPPL92614am ded.®OC 02/2015
DOT
a of Oliver services
Ph ..: 596-2 9tM i &M -632-l-.21 1 Fast: 535-;_3§-i&37
Wanw.mr.ung9M
Certified Abstract of Driving Record
Inquiry Date:
2/26/2015
DL/ID a:
769YY9401 (IP)
Customer a:
2348748
Name:
Tiet, David Cuong
Class:
D
ID Status:
None
Address:
1404 PRAIRIE DU CHIEN RD
Audit a:
7577206
DL Status:
VAL
IV28/2011
03/14/2012
Issue Date:
12/03/2013
CDL Status;
None
City/State:
IOWA CITY, IA 522455614
Expiration Date:
01/04/2019
CDL Cert Status:
None
(.72/12!2014
02/24/2014
Endorsements:
3L
CDL Ned Status:
None
Mailing Address:
1404 PRAIRIE DU CHIEN RD
Restrictions:
NONE
Restriction
None
03/06/2014
06/:1. W201.4.
Date of Birth:
1/4/1970
Supplement:
IN
Mailing City/State: IOWA CITY, IA 522455614
Ser
M
History Information
Convictions
OnaVan Date
conwbctlion Date
ACV
IExpl:auvavan
county
.."AUR
02124/201.1.
02/25/2011
S92
under In 35-55 mph zone)
Speed (10 mph aIN
Johnson
I1A07/3L/20111.
68/01/2011
M34
Fall to Obey Trsffic 519NSIgnal
7ohvvsne'i
IV28/2011
03/14/2012
M34
Fall t4 Obey Traffic Sip NSignal
W:nson
IA
06108/201306/13/2013
S92
Speed
Johnson
IA
(.72/12!2014
02/24/2014
M34
Fail to Obey IrRffir- SSUI':/5{grlal
Johnson
IA
02!14/20:1.4
02/24/2014
N82
Improper Backing
Johnson
IA
03/06/2014
06/:1. W201.4.
M14
Fad Ca ObLy Y'raffic S19Wsignal
:lal5rsson
IN
Accidents - Accident Involvement indicated does NOT mean the individual was at fault or given a citation.
Acodent Date
Case Nuuni ar
3UR
IJ6/06!20 k.0 ...
_ 57511,9
1A
02/03/201).
6:156911 .
N ...
1.2J14l2O:t3
'773213
,A
Name: Tet, David Cuong DL/ID: 769YY9401
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I 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 mused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
prFlIP4 �o
2/26/2015
Office of Driver Services
Iowa Department of Transportation
Feh.21. 2015. 9:21AM Div of Criminal Investigation
rk zo. iui) i:qurm Oily W erK - Li[y or Iowa Lily
STATE OF IOWA
isi� tr I
To: Iowa Dlvleloll of Crlminal Investlga[lon
Support Operations Bureau, V Floor
215 F, 7m Street
Dee MoInw, Iowa 50319
(515) 725-6066
(515) 795-6080 Fax
No. 1305 P. 1/9
No. 5013 r. 2
DC1 Account Number; t -f ptug °
toeersr,�ercb
From: Ctty of Iowa CIC✓
city Clorles ofnee
910 Fa ashhagtassa 5`Sreet �--
T.eww 4"I�, I� 5224Q
Phone: 319466-9041
FAY. 319356.5491
lowaCrimiul -ifni-v Record Check Results
As of -1-21 —101� a soarch of the provided name and date of birth revealed:
No Iowa Critainal Matory Record found vAth DCF
Iowa Criminal history Record af@achedm DCI #
DCI initials
R e t e i v e d ' me7Feb.`2��T1015 1:48PM No, 1243