HomeMy WebLinkAbout14-241I
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CITY OF IOWA CITY
410 East Washington Street
101va City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
( rCo
Authorization Number- % Y—a V I
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
IrSt
1. Name REQUIRED "rcr 1� a pmt
2. Mailing Add (Izrc�tri�ai
3. Contact Information (C21 C21J61'I=LY} Email A"' r i C "ya m Cell Phone:Gp7 d Sol -
4. Prior experience ce in transpppo.5rtation of passengers. f fl pA , n
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? UD
Pipe of offense Where When
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
7. Have you been convicted of any traffic offenses in the last five years? rd.:
Type of offense Where
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` ur(d ver's license n �
8.
Hasfi se or Chau ur's I rise ee suspehded or"re'IW
I
When
' -�_X2r__
c,('- �...i
five years'
When
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 (DCQ REPORT AND STATE 4),Ft11Fl
F
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CF�((�FIREVw
You must apply for an individual Department of Criminal Investigation Report (fort
1 11 s ti
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2014
I he cerci that 1 have issued to me by the Iowa Department of "transportation a valid Ghautfieurs license number
3 1 X x 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— DateO, D,7' Y
YOU ARE NOT VALID TO DRIVE A TAXI IN IOVVA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERICS 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 vo A,-_ __- 1s o a _ _ On this g2 `1 day of
M, 0-. On � r .IM Q -- -
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 _o the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
SignatN a of P 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.
Signatur f City Clerk or designee
lo, /a- l
ff Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerkrrAXIDRIVBADGEAPPL92014emendedDCC 09/2014
1®nbct. 15. 20.14, 10_30AM
Vv of Criminal Investigaf on , nC1 IowNo.2024 P.—.1/11
69TATE OF IOWA
Tog Iowa iWlf 110an OrCrialliaoll 1n cadge tlon
214 & I,, SftVd
DOE M .n, Rave 30.319
(595) 7 3
(51.3) 9 Pax
Demong KarcoPou TW
1®tee dIn 52240
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Phones ,315 337-004
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P ...10101301 4
a search of the provided narric and datc of birth revealed:
PNo Iowa Dimind History Record foind with DC1
ID Iowa Criminsi History Record atimh ud, III✓I
DCC iagitiale /
DCI -77 (005/10)
Received Time Oct. B. 2014 11:52AM No.2321
rd�x IIIIIIIIIVf
vi10 T
V�
wa_I Box MZ4 G D6% rui v; ' IA SnIbi
Phome'. x.515-,:44-°11241 CVOdlr-r024129 VeW 5115-2.194 Mr
reaasV .fit
Certified Abstract D/IDrler'ln,g, Record
Inquiry Date:
10/7/2014
DL/ID BE
Name:
Kober, Tara Ashlee
Class:
Address:
4906 UTAH AVE SE
Audit or
08/29/2013
CDL Statian
Issue Date:
City/Sutes
IOWA CITY, IA 522408322.
Expiration
3
CDIL lead Stataa:
Data:
NONE
Restriction
Endoroementa:
Mailing Ackhresin
4906 UTAH AVE SE
Restrictioren
F
Date of sirtm
Mailing City/State: IOWA CITY, IA 522408322
Sex:
431XX7973. CIA)
Customer BE
4283012
D
ID Statuan
None
7292821
DL Status:
VAL
08/29/2013
CDL Statian
None
10/12/2018
CDL Curt Statuan
None
3
CDIL lead Stataa:
Norte
NONE
Restriction
None
10/12/1985
Supplement:
F
History Information
Accidents ... Accident Illnvaaaly ennent Indicated does INOT Inmean the Iindividual was a't'fauu6t air given a citation.
Case "ummlasr
;Idlti
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:
Office of Driver Services
Iowa Department of Transportation
NaiKober, Tara Ashlee DL./IOi1431XX7973