HomeMy WebLinkAbout15-018Authorization Number L,"k-
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CITY OF IOWA 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
Iona City, lona 52240-1826 w.k9FH�7�?S s�b_R:¢'C'k'9�'(!k' °w��A�m�&w: dR®9"awB, A°_�P'P �D �'d°mw.9�F¢rBwG_B�wd!C9� rrt��re&k' iri onHla,o�.�.'9.�Bgw a�.�q '9u�ai��ffi&JffR
(319) 3S6-5040
(319) 3S6-5497 FAX
It iddle
1. Name (REQUIRED) F Vt4 U, (-, e0Y....
2. Mailing Address (REQUIRED) ��� Gds t"01(l � ` ( �c� �r✓d/�� �' f y � �
3. Contact Information (REQUIRED) Email: yq hod � C /tom Cell Phone:
4. Prior experience in transportation ofpassengers: o c e r f- S;fj,64 --c_a s
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /W
Type of offense
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6. Have you convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_
Type of Offense
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A
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 rrarne(s) YV6
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
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You must apply for an individual Department of Criminal Investigation Report (form available u'por iequesO'
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
1 heyeb� ertifY that have issued to me by the Iowa Daparirnent of Transportation a valid Chauffeur's license number
S 3 `! 'i 5,1 3 . I understand that if I falsely answer any questions in this application, that this
application may be denied. I understand ihat if I falsely ansyrer any of the questions in this application, that this application will
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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
a a Nots:ry Public)
Signature of Applicant w..- .""._--------- .---- . Date I " L;'' ) 5`
YOU ARE NOT VALID TO DRIVE A'i AXI 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 )
COUNTYOFJOHNSON )
Subscribed and sworn to before me by`I oo.mic �.... �1$.,^r.) n.�. ` �_ On this � day of
1 have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that re is no information which would indicate that the issuance would be detrimental to the safety, health
or welfVf of re idSPt4Sf' ft City of Iowa City (Title 5, Chapter 2, City Code).
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.
Signati of City Clerk or designee
ate
Taxi cab businesses are requirsd to provide Driver Identlfication cards. Cads 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
ClerkrrAXIDRIVBADGEAPPL92014amended.DOC 0912014
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Jan. 20. 2015-
4,:.2 1 PMAA
Div of Criminal Investigation
No. 8381
P.
1/1
11
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Criminal II'p t t,u o
Check
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215 E. OStrest
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Certified Abstract of IDriving Record
Inquiry Date:
1/16/2015
DL/ID ffi:
555W7573 (IA)
Name:
Nunley, Donald Legene
Class:
D
Sr
Office of Driver Services
Address:
955 BOSTON WAY APT
Audit #:
8220748
4
Issue Date:
07/02/2014
City/State:
CORALVILLE, IA
Expiration
07/01/2019
522413180
Date:
Endorsements:
3L
Mailing Address:
955 BOSTON WAY APT
Restrictions:
Corrective Lenses
4
Date of Blrthe
7/1/1967
Mailing City/Statat
CORALVILLE, IA
Sax's
M
522413180
7'CCirf I'All114 I!.3aVa
06i,'";60 12 ....
Name: Nunley, Donald Legere Sr DL/ID: 555YY7573
Casa Numarrrv!ber
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Ned None
Status:
Restriction None
Supplements
3UR
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:
FIN
1/16/2015
IOWA o
P, , Tme
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selva
Office of Driver Services
Iowa Department of Transportatlon'
Name: Nunley, Donald Legere Sr DL/ID: 555YY7573
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