HomeMy WebLinkAbout14-272'ill p p� 1
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa S2240-1826
(13,19) 33.,SLe.SJ1.4A."
(319) 3S6-5497 FAX
1. Name (REQUIRED)
Authorization Number®�
(Office Use Only) M
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.)
Eailuree to carsa9lalete lire "caetre'rerJ" ae�icr�ecea4ioru_uw6dV re smolt frr clan®a9 of telae alZElacaBr�ra
First
2. Mailing Address (REQUIRED)
3. Contact Information (REQUIRED) Email:
4. Prior experience in transportation of passengers:
yt"116
4
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or
Where
),Cell Phone:
d'aI
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Have you been convicted of any traffic offenses in the last five years?
When
8. Has your drivers license or chauffeurs license been
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 6iia (s)
e
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERT-IFIE
ve
D
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
I hereb certify hat .Mhave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�� X 0 , i . I understand that if I falsely ansvuer 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 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
of a Notary Public) , ) I
Signature of Applicant ,f&4&1Date 2)— /
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 )
�jUgscribed arld sworn to before me by M & y1 On this day of
I 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).
ph
Signatu717
1 61" Chief or designee 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.
SighatuYe of City Cler'x or designee
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81%" (width) and 51/:"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CleddrAx;DRNBADGEAPPL92019emended.Doc 09/2014
PADOT
SISAR "A I LIN TLU", 8(ASTOY"""ER liRIV-! �d,rv��.� . . . . e ............ ..
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Certified Alhotirttrt of IDIrl Ming IS'. dtr)lu'd
Inquiry Dater
12/30/2014
DL/ID #:
428XX5051(IA)
Customer #:
4718071
Name:
Hulme, Mary Annis
Class:
D
ID Status:
None
Address:
3013 STANFORD AVE
Audit #:
5719978
DL Status:
VAL
Issue Dates
01/03/2012
CDL Status:
None
CRY/Stater
IOWA CITY, IA
IExplrathm
10/07/2015
CDG Cent
None
522454929
Datm
stator,
Endorsements. 3
CDL Med
None
stature
IMadliing Addrwm:s
3013 STANFORD AVE
Restrictions:
NONE
Restriction
None
Date of Birth:
10/7/1960
Supplements
Mailing CRVISiartm
IOWA CITY, IA
sax:
F
522454929
c0imt@' on IDE?lka
02IC 7/2013
Name; Hulme, Mary Annis DL/ID: 42MSDSI
4C CW 'iIr,"iR{A,iant&jtfen
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 caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this
date:
g_ y Ca
Name: Hulme, Mary Annis DL/ID: 428)(X5051
12/30/2014
Office of Driver Services
•s
Iowa Department of Transportation
Name: Hulme, Mary Annis DL/ID: 428)(X5051
Dec. 18. 20141 2:34PDiv of Crim,naI Investigations No, 6608 P. 5/5
STATE OF IOWA
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Criminal Hiatalrykecqd Cheek
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(515) 7254080 Fax
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As awd`........� „ a search of the provided name and date of birth revealed:
No ]Cohn Qiinlnal. History Record foetid `alai% D(111 i
Iarad;''a.Ofrxtllrai.Ilbstol'Y. rcur°d attached,'.11) ~"I9 ..... ..
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Received TimeTDec, 17.1(2014 2:23PM No. 6487