HomeMy WebLinkAbout15-027� � 1
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
i. Name (REQUIRED)
Authorization Number,,,,,,__„
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
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2. Mailing Address (REQUIRED)
Contact3. w s i Fteff-rP MI . f*ell Phone:
R �y
4. Prior experience in transportation of passengers: tau 0 0XI tep- F0 P- T,*x4?-h'AAA
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NONE'
T e of offense Where
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 16
When
7, Have you been convicted of any traffic offenses in the last five years? NONE ®®
Type of offense
Where
When
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? NOME
Type of offense
Where
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
i
DEPARTMENT OF CRIMINAL INVESTIGATION (DCQ'REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPIylC(Q$IOy,I.
,F p}E CHIEF REVIEW
SII
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE MID NOTARY)
09/2014
I hereby certify that I hays issued to me by the !owa Department of Transportation a valid Chauffeur's license number
Di S Po & LI i DL I understand that if I falselv answer anv questions in this application. that this
application may be denied. I understand that if i falsely answer any of the questions in this application, that this application v✓ill
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 a license
is granted, to comply at all times with all of the provisi ns of Title 5, Chapter 2, of the City Code. (Needs to be signed In front
of a Notary Public) -7
Signature of Applicant Date ? Dr
YOU ARE NOT VALID TO DRIVE_ A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by �° r
t� cev
�. On
this Vi t -A
day of
w
1 iokRx a
� g
T Pi�O f �aAr�_
g Notary Public in an or the State of I a
o
MY Explue
3*****
47T
1 have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Signatu of Poli ief or designee
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signature of City Clerk or design
'Y--45
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81%11(width) and 5 %11
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerkrrAXIOPoVBADGEAPPL92014amentled.DOC 09f2014
Jan.23. 2015.10:51AI Div of Criminal Investigation No.8699 P. 1/3
II Oda. Ll. ZVI) Y:I)r10 bILY u I e r K - k,NLY of Iowa city No. 99/9 r, L/L
iii om
STATE OF IOWA
r@naalrmal Mstory 9ecoxd Check
Request Form #
I)GI Account -Number, Qt®ppflaabt®}
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21.5 da. 71h street
Diem mkhaaN,r drumwan 50319
(915)72,5-6966
(5,15) 725-6909 rom
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-----------------------
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Walver'Warmadon., Without a mfghe6 waiver freym Theaubjee'dadthe requa rt, as eommp kto e#dndnal hhtea7 record may not
be reloasabloy per Code of Iowa, Chapter 6911 par.aaxa&.taa ardmmOuhaW hdatory.rocuM WrarPmnsatlon, as allowed by Raw; alWAYA
eulln6aakgn*x wwsaivrersfunnature.brastm the tvuhdudaet of the rennuest ___ -- -___ _---n__---
Waiver oleff-.T&1110phkmNaaper orlon Who 060V
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Iowa CriminaLlbtorj Reg
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0 No Iowa rly Rccox d found with ►'
pbvra Crimirial History c®a d attarhed9 DGA
1leteived Time-Jan_21.,-2015— 4:11PM—K 9219'— --
(ACham enly)
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1/15/2015
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Class:
Address:
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Audit #:
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City/State:
TIFFIN, IA 523404719
Expiration Date:
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CDL Med Status:
Endarsomentm
Maiilliing Address:
l"tt IIAp1I tfY#p 1,') IDtl IIirk9r9m, A FAYM 4d'2i
Restrictioran
3/11/1987
V rIcm, r,: dria4 X41" 0,241 8&P[i-,'13 f'11 1` I ar,. 51,p1ia 7'3.1.1w7- Mf 3�1
Date of Birth:
Mailing City/State:
'TIFF.IN, IA 523404719
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Certified Abstract of Driving IRecord
Inquiry IDatm:
1/15/2015
DL/ID #a
INairne'a
Wolcott, Stacy Fredrick
Class:
Address:
277 HICKORY CT
Audit #:
01/15/2015
CDL Status:
Issue Date:
City/State:
TIFFIN, IA 523404719
Expiration Date:
PS
CDL Med Status:
Endarsomentm
Maiilliing Address:
277 HICKORY CT
Restrictioran
3/11/1987
Suppla nerib
Date of Birth:
Mailing City/State:
'TIFF.IN, IA 523404719
Sex:
CDL Downgrades
1D;De, BDii"IectV'o:m End
II"P:aPa inglarlua _..... .. 051X%l;2W4 rpyA/Ip
,
075864102 (IA)
Customer a
4010271
B
ID statue.
None
8769316
OL Status:
VAL -
01/15/2015
CDL Status:
VAL
03/11/2023
CDL Cart Macaw
Excepted Intrastate
PS
CDL Med Status:
None
CDL Intrastate Only
Restriction
None
3/11/1987
Suppla nerib
M
History Information
C';s44.4- fIUX'*OtI
ALGID IXasufln t 'JWFIIB
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 tl
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 se
office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify.
p °°'.a® N1/15/2015
k°^••°•'
Office of Driver Services
Iowa Department of Transportation
INarnea Wolcott, Stacy Fredrick DL/ID: 075664102