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CITY OF IOWA CITY
Authorization Number_
(Office Use Only)
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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 52240-1826 FBAAtT tC cR1 A(ete will result iedenial of'thg EP larat`/arra
(319) 356-5040
(319) 3S6-5497 FAX
in QMl�ddle r Last
1. Name (REQUIRED)
Y t
2. Mailing Address (REQUf&�ED)
3. Contact Information (REQUIRED) Email:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or
Cell Phone: 3 k4 41Z 2s°2.Afi
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?&
fiT-TRN=
7. Have you been convicted of any traffic offenses in the last five years? l ff �4
e
Type of offense
rr�V"
a6ml
When
B. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? NO
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 theme(s)
Snvi
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CRTIFIlib
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF?REVIEW %,', r'
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY) k
09/2014
I hereby cercify at I have issued to me by the Iowa Department of "i ransporiation a valid Chauffeur's license number
u�4Zu� . 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 tomes with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to La signed in from
of a Notary Public)
Signature of Applicant 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 fcgov.o:g.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by f.c>�. d t On this /ry� day of
ilic �. }sem' >`+70N. c n. 1 e
for the State
1 have reviewed this application, DCi report, and the State ccrtifled 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).
Signatylibfpoei
�hief 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.
Signatur of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/s" (width) and 5'/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIeAc?A%IDRVaADGEAPPL92014am ded.DOC 09/2014
121 91 38A
Div of Criminal InvestigationDCI 10&. 5967 P.
$TATE OF IOWA
CAMinal ffistury Record Check
Request Forte
To.- Iowa DW em of CrImInal 1"MA940100
Sap vs orndoos Suremu, 10 yk*r
215 L 100
Des M01Mo1 m MI 9
(411) 72"M
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DC1 AMOUnt NUMbW
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Mims-IMOOKMAK
Am of . . ........... . I a wmh of *@ providcd ame aAd date of b1fib MV6910d'
No Iowa crw%fill Hl." ReCOW found with DC,
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Received Time Dec. 9, 2014 111: 34AM No, 5911
Inquiry Date: 12/9/2014
Name, North, Cody James
Addresso 138 PARSONS AVE
City/ffitatar IOWA CrrY, IA 522453332
Mailing Address 138 PARSONS AVE
Mailing City/Stater IOWA CITY, IA 522453332
Name, Ruth, Cody James DL/1Dr 846AA4243
CertMed Abstract of Driving liter ord
DL/1D Aa
846AA4243 (IA)
Customer is
5108020
class:
D
ED States,
Num
Audit Ot
0265722
OL Stainer
VAL
Issue Dater
07/18/2014
CDL Statuse
None
Expiration Davin
10/08/2018
CDL Cart Statuan
None
Endoroamandais
3
CDL Ned Watusi
None
Restrictions:
NONE
Rastriction
Nom
Date of Birth,
10/5/1989
Supplement:
Sara
M
"iffitoll yr Anio -matuout
CLEAR D NS RECORD
Pursuant to Iowa Code 9821.10, I, Nim Snook, Director of Office of Driver Serolces, Iowa Department of Transportation, do hereby certify that I am the custodian
of the records held by the Office of Driver Servlces; that this is a true and accurate copy of an official retard currently In the custady of sold afltco, and that I haus
been authorized by the Director of the Iowa Department of Transportation to on certify.
In oiliness whereof, I have caused my signature and the seal of the Depertnrent to be set upon this document, at Ankeny, Iowa this date:
Ramer Ruth, Cody James DL/IDn 846AA4243
em nPm"3920 [4
®e ° ®y0®� n
Office of Driver Services
Iowa Department of Tmr6porli tion