HomeMy WebLinkAbout14-254410 East Washington Street
lova L
lova 52240-1826
(3196-So40
(3I9 - 497 FAX
1. Name (REQUIRED)
w k1
Authorization Number /ii.m..
(Office Use Only)
Ila r"'51'4 X1
Ea-1krre to corrt0ete tho "rea4md ' enforunation WL11 reguit in efertfal of foe. q lfcatlart
Middle
M
3. Contact Information (REGi(1112ED) Email: , jvmu'l, c e, -m Cell Phone: '.3 325'- ;31-�00
4. Prior experience in transportation of passengers: — %, a-Al2° Fw d1 `l
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? �y 42
r
7. Have you been convicted of any traffic offenses in the last five years?
Tvpe of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? h d
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,pame(s)
f� (�
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CEiRrlktb
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C14WFREVIEW
You must apply for an individual Department of Criminal Investigation Report (form avallal"le upon,requ4
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
.'o
k'„
0912014
I hereby certi that V have issued to me by the lovra Department of Transportation a valid Chauffeur's license number
dli. �j 91,67:51'r . I understand that if I falsely ansover 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. (iveas to le sig -,;tad In a g
of a Notary Public)
Signature of Applicant Date d " —
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 sworn to before me by �3gvfL,a On this day of
it t_. , n., . t., n e—
have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that then; 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).
Signature oli6 � lief or designee
8
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.
Signature of City Clerk or de igne
i
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5 %"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIe*ffAXIDRKnMGEAPPL92014amended.DCC 09/2014
N Criminal Investigation
VIII Nov, 19. 2014, 11:06A Div of C V
VIII VIII.
VIII
uu
STATE f O.1O.F IOWA
Al
Criminal History Record Check
I;
6E lRequest
Form ,i
To; Division of al'I • ,tl6h
Support Operation Bureau, Floor
219 B. Io' Streat
lies Maines, Iowa 60319
7X5-6096
(5f 5) 729-6080 Fax
aaa..]a Waa.
u 27 d' I .....-.CO
®&t:
iNo: 4510V. lP. �1/1
Fr:assao Id:'qy' o.y.YCowwaa duty
City Oerfes O.fflee
T-6 M Wmisprpm91ee1 91rd st
IlmOiyM.244240 ......
Phone: 3b9-366-MO.W..
hx:rn ....:�9-3q'd-.9499
Allah
5' 70 6 If 71
ave"Per l'oforknufleft, without qa signed waiver groat the ,stah,➢eet of flus requatm a complete erlamInal history Irooeavl :nay hot
he relonon age„ Baer Code aflowve,, Chapter 6 ;T, 17orggM&1McrPmfWal history record pmfmrraatpon, as a llawftd hyr law, ftsys
Wffiper Aele(fse. l hewhy give permission fbr:ao above rcqumilag ofllola( to conduct an Iowa orhnioal idsloy rewrd cbcck avi:h ale Division off .hail al
ldveasigalloo(DC4. Any cftioslbistarydataooaccmingmed:ariamalnlahledby die Mmaybarelewedasailowedbylaw.
MM
.Iowa Cr' c i
,,,. w :m '.. (uclusa°ally
As o g. a a searrch of ie.poarrvrn�eaf novae., arag date of bfitIra rove ale �
II"
No 1[aartraa Orasrltaaml.Historyy R.e ccird found W..hI
Iowa. Q:a°srcandt al Ifistoz y Record a¢ 61,L4 DCl ��.........
Received lime. -Nov, 11,0014 8:40AM No, 4192
tIowa Departnient of "Transportatioll
Ck a, IDIi "I FA"tVKa% 1,11NIll lig a u d 1r32 11121"t
PO AhX I Mel, tRMS !ilg,'I s, A WIN 9A4 b9',z ?4W 97,24
1 8 a 51 23.f '4 A1'
City/Stage:
elydfied AImbract ofDilrMing Reowird
11/13/2014 DL/ID #: 43OWW8558 (IA) Customer #: 1306832
Rasmussen, Perry Class: D ID Status: None
Allan
414 Pleasant St Audit : 8571396
Issue Date: 10/29/2014
Iowa Clty, IA 52245 Expiration Dates 12/9.8/2022
IE:ndorsernal :3
Date of Birth: 12/18/1960
Mailing Iowa City, IA 52245 Seas M
City/State:
1History lint'orm ation
Name: Rasmussen, Perry Allan DL/ID: 430WW8558
DL Status: VAL
CDL Status: None
CDI.. Cert Statumr. None
CDN.. Mad Stal None
Restriction None
Supplement:
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:
it "
rt
11/13/2014
�'
0W
8
Q ..
Ire"
ON 0 ^
ri r ,fw IWS^ ,4 ori ^�w
re
Office of Driver Services
Iowa Department of Transporation
Names Rasmussen, Perry Allan DL/ID; 430WW8550