HomeMy WebLinkAbout14-267Authorization Number
1 1 1 (Office Use Only)
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
Iowa City, Iowa S2240-1826&99X":..o$&"ww9d'wdN&"F"�6'd:_re'`r°,wappaa9f�&'4'"a'd�`R&waID'9',R¢°"aaP9M*A�d CPR��,8"'¢Pfl�ffJ�O�q&?_¢N"S,X.7R"ACPd"W
319}356 504g.,,...?
(319) 356-5497 FAX
1. Name (REQUIRED) First �p�� � �� Middle� Last
2. Mailing Address (Hr Q 914 0 N: b) °"l rmre S " r " 1 "a a
ell
4. Prior experience in tral nspp)rtation)of passengers:�� i Phone:C� y co"v4y
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6. Have you ever been convicted of any misdemeanors and/or felonies in this State or el an „ r '" 9
Type of offense Where apry �r `ter as
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense Where When
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7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type ofoffense
'g ae
Where
When
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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 INVESTIGATION (DCI) REPORT AND STATE CERTIFIFJ1 a
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF"REVIEWf
You must apply for an Individual Department of Criminal Investigation Report (form available' pion request)
r ti„
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
./-!;t 2EAil ri- 7o '7 - . I understand that if I falsely answer 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)
Signature of Applicant t .:�1A," a M w w42--,1)P/-
YOU
- y-
f_.... Date �°��-_ B.`, �)P/-
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 swom to before me by 3,- nitr e I- On thisr;Z i'O,V e 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, heath
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
--l I Ul `-,
Signature P is hief or designee I 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.
Sig—mats reof City Clerk or designee
Taxi cab businesses are required to tsovtds Driver Identification cards. Carus must be 81/2" (width) and 51/211
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerkrrAXIDRIVEADGEAPPL92014 mend DOC 09/2014
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be . 8. 2014412:1�OPN� Div �of Crim nal Investigation
10
No. 5825 P. 1/1
IVU. JTJ I I r U L
To; IOWA S1011 Of CrIMM21111vestillfitIOR
Support OperationsBureau, FI O
219 1% le Street ,
Des o 50319
(515)126-6066
6I:u Fox
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Phone, 3.d9-356.5041
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1.owA "Record Check Regults
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Received ..TiM..tpl)ec. 15,v2,014 2a00PM No. 51.5