HomeMy WebLinkAbout15-023Authorization Number.
t (Office Use Only)
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CITY OF IOWR CITY APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.)
410 East Washington Street
Iowa City, Iowa S2240-1826 6Pas ,�r�w a:a cme,F� � _ �re _•x( a . J ¢ a w°wi t'arew nalk a �B_will resultn_denia9 f the
(319) 356-5040
(319) 356-5497 FAX
dle
1. Name REQUIRED R t w � � � I� (4 � Lash
(
2. MailingAddress (REQUIRED) 2A01
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or
'P .,.
,V�,. ;
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_
Where
7, Have you been convicted of any traffic offenses in the last five years?
Tvpe of offense
y
Where
Where
a
When
When
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 INVESTIGATION (DCI) REPORT ANl).STATfE yC�ERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC � t, ° EW
You must apply for an individual Department of Criminal Investigation Rep6A (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)w
09/2014
i hereby carti5r that I issued to me by the Iowa Department of Transportation a valid Chauffeur's Icanse number
understand that if i falsely ansv✓er any 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 will
be denied. I agree that in mailing this application, I consent to allow agents or employees of the City of iov✓a City. Iowa. in
iheir 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to ih, a 31gnad 'erg fr nt
of a Notary Public) I X
Signature of Applicant °' t dV� Date rq
YOU ARE NOT VALID TO DRIVE A TAXI lid IOWA CITY UNTIL AUTHOR17ATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
STATE OF IOWA )
COUNTYOFJOHNSON )
and sworn to before me byiib 6'.A.cx P. On this ,-A, day of
CA.A ��C ;� ., v A
Iowa
I have reviewed this application, DCl 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 resr nts of the City of Iowa City (Title 5, Chapter 2, City Code).
or designee
T1f/3v// i"
f°" Date
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.
gn ure of City Clerk or designee
xz'
ate
Taxi cab businesses are required to piovlde Driver Identification cards. Cards must be 8%" (width) and 5'/]"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Cle,kfrAXIDRNBADGEAPPL92014 mwded.DOC 09/2014
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Inquiry Italian 1/28/2015
Namm Hope, Michael Glenn
Adel 2401 HIGHWAY 6 E APT 1003
City/state: Iowa Cm, IA 522406706
Mailing Address: 2401 HIGHWAY 6 E APT 1003
Mailing Dllty/Stwu n IOWA CITY, IA 522406706
Ceirti ffiad Abstract of (Driving Record
DL/ID D.
Class:
Audit #:
Issue Date.
Expiration Data:
Endersementw
Restrictions:
Date of girth:
Sena
ISSAC4503 (IA)
D
0437720
09/11/2014
03/06/2019
3
Corrective Lenses
3/6/1960
M
History Information
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Customer Ali.
IID Status.
DL Status.
CDL Statum
CDL Derr Statum
CDL toad Ssatum
Restriction
"3upplemant.
Accidents Accident IInvol vainem: indicated does 1140T nnean r he ind9naid0all was at 1Foullit or (given a Citation,
Casa i'murnlli,er
Sanctions
Name: Hope, Michael Glenn DL/ID. ISSAC4503
3239199
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that a been authorized by the Directorpa of R
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:
IWUams Hope, Michael Glenn DL®IID; ISSAC4503
Vie' I�Bd@% eonip"
D"O,OffIcT °
"'
aT
of Driver Services
AU
Iowa Department of Transportation '
Iowa
Iowa
IWUams Hope, Michael Glenn DL®IID; ISSAC4503
Jw� '13. 2015.10:57A Div of Criminal Investi;ation No. 8699 P, 2/3
dans Lb LV I) IV; 99RIY kIly blerK " bIly 01 Iowa 6ity ho.99C1 P. L
STATE OF IOWA
rnmifi ll History ry aa® eck
Request
DC1 Acoou nt ffumbtr;
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rw Iowa Division of Criminal Investigation From cl of town Cp&�
SupporL operations Duroau, r Floor City Ckdes ofBdto
215 E, 7n' flet b10:g4 wastoBegtaonRr�et
Des Moinnos, %wa 80319
(515) -1 6066 Iovra CV x� 522b®
(515) 725.6080 Fax
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a :ce¢Ynuesrtung nn'.Yowa hoinall,Hist'oryOrd Check op,
Lost Name (ftlan6var ps"1,9 aDume 1e00eae Middle ROM
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Wadverruformation.WithoutasIzA waiver Fromm the Subject ofthe reaposst,acompVotecriminsghisteryrecord may auot
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per code -of Tow% CkaapbrOZA par OMP-90-10 orlwaVnsl lndttory rseord nmafornnatVon, as alpowvod by laevo Alwape
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To Iowa. Criminal history Record found with DCT
Iowa criminal:l:Iistory Record AttadLed, .DC]C �...........
PDCliloitials __.......
Rerp.;ved Time -Jan -99, IAIIi 10:,69bll-Ma. R"A
cl,&n.23. 2015 10:57AM D,v of Criminal Invest;;aton No.8699 P. 3/3
IOW4 CRIMINAL HISTORY DCI 00494587
COURT DISPOSITION PENDING
PAGE I. OF :t
STATUS UN. OTO DATE PRINTED-
DC.r.:004945e7
NAME: HOMMICHAEL GLENN
DOB SEX RAC HOT WGT EYE RkXR SKN POB
19680306 M W 602 320 BLU BRO FAR IA
ADDITIONAL. IDRNT'.II:FIII. RS
CCU RECORD ***
O1 ARRESTED 19950207
AGENCY: ZA0520100 CORALVILLE PD
CHARGE NO- 01 IA STATUTE IA124-401-3
POSSESHION SCHEDULE I-MARIJURNA
TREK#: 014615801
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA123-401-3
POSSESS CONTROLLMD SUBST CE/OCH ULM I/EARIJUANA
TR4K#e 014615801
,SENTENCE DIED EFYc DAT
DEFERRED JUDGEMENT 19950707
PROBATION 1.Y 19950707
COMMUNITY SERVICE 10®H 19950707
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD DUT CAN ONLY BE RELEASED TO uOk—LAW
ENFORCEMENTD,
DIVISIONIN THE ABSENCE OF FINGERPRINT$ FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR 08NY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
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