HomeMy WebLinkAbout15-038QTY oi:- lom Crry
410 East Washington Stireet
rawa City, Iowa 52240-1826
(3I9) 356-SO40
(319) 356-S497 FAX
1. Name 1)
2 Address -);
IDENTIFTINTIOIN NO, "Z)
(Office Use Only(
APPUCKFION FOR TAXICAB I MOTORIZED In'EMCAS VII DRIVER
(Police Department review must be made between 8 a.m. to 3 p..m.., Monday ..- Friday)
3. Contact Informahon 11-�E6A.M:MD/ EirnaK:
Celle
sent via ernail)
I ast
(yge.2f.offense
Where
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jw8th—en
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7, Have you been arrested /charged virith any traffic offenses in the last five years? _rz1_V_WQ1 R9LW-&a
]' 'ofo((ense
INFUT17=1
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When
I& Has your driver's license or chauffeur's license been suspended or revoked in the Ilasi: five ye ars? -1- -- -A-9e)-
ense
Where
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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 MCSTiGA-710N (M) REPORT' AND STATE CER'nFIED
DRIIVING RECORD II ACCOMPANY "I'MAPPUCATION FOR PM ICE CHIEF REVIEW
Ym4 must apply for an individuaJI Department of Criminid In iiesflgaticn Repoft (form avaliable upon request).
(SECOND IPAGIE FOR REQUIRED SlG11qA'ru1Rl:., AND NOTARY)
PP11II.I3CAI"hl loN FOR .U.. AMCAB VEHiCl IE D111�WEIR
Page .
nse
concent s allow a fors fp lli ati n, that thus @pp ecation may be denied. .agree that in making thisapplication, I
areby certify that I have issued to me b the Iowa Department of Transportation a valid Chauffeur
�aU ®U 7 issued on —0 expiring on - d �I undersand that if I
faYsel answer an 9 B
gemployeesty f Iowa City, Iowa, In their discretion: to examine any and all records and
documents relating to this application, and Y further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to he signed in front of a Notary Public)
Signature of Applicant fp
;...... Gate - 2
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STATE OF lOVVA )
COUNTY UST JOHNSON )
Y A spit, c:.Y- on this �p W� , day of
and sworn - to before me b a
In aim#'four fibe
I have reviewed this application, DM report, and the Mate certified driving record of this applicant and have deter-
mined that there Is no iratorvruatlon which would iradicale that the Issuance would be detrlmental to the safety, heaalth
or urdf'rare of residents of the City of Iowa city crwe fi, chapter 2, City code).
.. _____... _...._.....
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AFTE-IR AUIMTuliSOVArL BY Tltllt UNITY CLEERK 'tP`OU•N P' IRIR "-' U V"li'i IIGr'.)I RtUZE° ID "I'o DRIVE A4 "I"�d' MC..'Anliii IIN 10WA CITY FOR NO
iVUt"yRIE THAN i" NEE YlliAft 1`I10 THE IDATE, LISTER) II:'y!I::IlrrrO@tUf°
II"f•4IB Ih"I'U«'f•:i4:"q"IVE EX11"Tr WILL IMAU"TCI. "TI itis 6; HAnUri6"U::OriilUR'S II...ICIEIIVNSE IIi:IS&PIIU A"II'M IIT U...ESS THAN A•U YEA IR.
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Office Use Ttnwly
Approved application
DCI report
State certified driving record
Website update
W ansrcao7 arroaw> rc�xu �ora�lx ou 02/2016
02tF e6 ®20._ 20158 3:21 PM
Div of Criminal Invest,gation DrE ioKNo.0793 P. 1/1
YrATE OF IOWA
Criminal Mstory Record Check T
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Received Time Feb. 19, 2015 12:02PM No. 1310
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i&IIlrec of Pylver services
FO,Box 9',W4, D kisAmia, M8 ziX36a r^ 0:?..06.
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ertffled Abstract of DrMng Record
Inquiry Date:
2/25/2015
DL/ID :
013BB2642 (IA)
Customer #:
3959505
Name:
Casella, Michael Peter Jr Class:
D
ID Status:
None
Address:
2110 N DUBUQUE ST
Audit #:
6831235
DL Status:
VAL
Issue Date:
04/03/2013
CDL Statum
None
City/state;;
IOWA CITY, IA
Expiration
12/27/2015
CDL Cert
None
522451624
Dated
statuses
Endorsementsi 3
CDL Meas
None
Statues:
Mailing Address:
2110 N DUBUQUE ST
Restrictlemc
NONE
Restriction
None
Date of Birth:
12/27/1956
Supplement:
Mailing City/State:
IOWA CITY, IA
sex:
M
522451624
Cltat'an Dry conviction Date d:co M-Planutioa Caunm'j 3UF1
11/_01/2_009 111/30/2009 X592 Speed Johnson IA
12/09/2010 �._.,.'O1B021201,1..�592 ;Speed (10 mph &.under in 35 55 mph zone) �.��� :Cedar�.� ,IA
Name: Casella, Michael Peter Jr DL/ID: 013BB2642
Pursuant to Iowa Code §321.10,.1, Kim Snook, Director of Omce 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 caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
°`..... 'N
2/25/2015
lowA `te
4
c`°••••°°° E
Office of Driver Services
Iowa Department
of Transportation
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