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Home My WebLink About14-230Authorization Number 2 (Office Use Only) r p- arlll APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER CIN OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 410 East Washington Street lona Cit . lows 52240-1826 all' re fo cons leEe ff/p� "`r a of°' dnf¢rrmatlon will result in denla6 of the ap�aldcafaorr (319) 356-504 (3I9) -5497 FAX first Mi le Last 1. Name (REQUIRED) 2. Mailing Address (REQUIRED) L na/zq _ Y" - 3. Contact Information (REQUIRED) Email Cell Phone: 4. Prior experience in transportation of passengers: VC 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offense Where 6. Have you Peen convicted of operating a motor vehicle while under the influence of alcohol years? Type of Offense "- 7, Have you been convicted of any traffic offenses in the last five years? M Type of offense Where When rt)ru>�s ----------- -*a lari,Re %Ilti"fin .,7, "" rs, '1pill When 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 names) NO DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 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 Date 1.0 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 ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by Kr,mt*,j � r) tu4.t m.. On this � day of 49vo -NIDY Y M1,WPt`'.R Notary Publicgh and for the State X C:cadwinni,�ua.im C.r�gvvvmc 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). Signature ofP,efce"Chief or;desigp e 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. 21IZ94ref;,#ems„) . � Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/�' (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Ci4d✓raxiDRM3wceAPPL92014.n ded.00c 0912014 4464.j- wi400T SMARTER I SIMPLIER I 01STOWER IlYMYIT. V%/W%vJuAiadot gov PO Box 9204', Des Wines, IA 503064204 Phone. 515-2449124 1800-532-1121 1 Fax: 515-239-4837 WVcW.fowadoL9av Enquiry D 1019/2014 Name: Same, Kernel Gassmelseed Aomori 1454 ABER AVE Citylstatez —1011A (Zrk, IA S224647TP, Mailing Address: 1454 AVE Mailing City/State: IOWA CITY, IA 522464700 2MMM33M3MZM3MJ3HMM7X= DL/ID is 131AC5076i Cu mer it 5239074 Class: D ED Status: EXP Audit is 6916748 DL Status: VAL Issue Date: 05/0312013 COL Status: None Expiration Data. 08/02/2017 COL Cart Staii None Endorsements: 3 CDIL Med Staturra None Has-trictionsi NONE Restriction None Date of Hirth: 8/2/1966 Supplemeni Basic F1 Clitatilan Date, Con vIlctlain i ACD I-Expianatilan County 31.IR 0790°wn1 08/2.2120:111 S92 Slipm-d Johnson IA oq/:11:11/20 12 1012.1/2012 S92 slipeedi Keokuk IA wV06/2013 08/Z!V2013 S92 Speed (;110 iln1ph & under 11 in '15 .55 rnph zwi m) Keokuk IA 04/25/2014 ............................................................... 4kW271MM4 . .......................................................................................................................................................................................................................................................................................................................................................................... 592 Slipped (10 inph & under lin :35 0 mph zone) Wasillinntain ............................................................................................ TMA Accident U dta Cam 1114unillber JUR U!,UW2013 713612 M Names: Slams, Kernel Gassmelseed DIL/IlMi 1.31AC5876 Pursuant to Iowa Code §321.10, 1, 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 cfan 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 at the Department to be set upon this document, at Ankeny, Iowa this date: 10/g/2014 ur D 0. Office of Driver Services DAN Iowa Department of Transportation Name: Slams, Kernel Gassmelseed Dli 131ACS876 Oc t. 15. 2014 10:25A ty� va•r� o, Lu14 L:Llrly Div of Criminal Investigation arty LI"rK - Viiy or rows tiny T07 Iowa DIVIA1011 of ae, ; e U ! � ; 4NIOO. 215X 7'� Street DesMaines,lawy, 90.319 (MS)M-6080 Fax r No. 2028 ko, 7L71 P. 2/3 F. L/L H:?OIAmowitNumbct: �� "r �... (if®ppr W— From _0.Q;�✓a��.�P�'WN'8�_�_'IIP�.__.._. ___.•________.._ City iCy AC'm Office 410 Eo a$' ington street Y@W,s ON (s! 52240 phohe; nxt��93y'..a�a9'y Ilesvama�� eco:ird Resnug mcrrl:ay�,ry) As of.--- ��°��Vt, __________ _�„�, a search of the provided name and date of birth revealed: No Iowa Crimiriel history Record footed with DCIn. " a Iowa. C¢irminal ma., gnord woobed, DCI WIhalt4als _ Ar-- �.______ (deceived Tim