HomeMy WebLinkAbout14-229i 3
CITY OF IOWA CITY
410 East Washington Street
Iowa Cit , Iowa 52240-1826
(319) 56-504
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Mailing Address (REG;
3. Contact Information (F
Authorization Number_ ) 4 -w") q
(Office Use Only)
APPLICATION FOR TAXI I MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday -- Friday.)
P giid(rg,(ea 2gMP.!91g.A4.q re cas_m;pc "„information will rssult.ln denjal orf thegp�ufa�Pu(®¢arl
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
6. Have you ben convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? hV
mm
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ hQ
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 name(s)
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)
092014
I he r& b(,�v certi�lL t I f re issued to me by the lova Department of Transportation a valid Chautteurs license number
9�t Z--
L� L`y 1 . 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 ro ba signed in froee'c
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 icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by r.nuP On this / day of
�e uqu:)� s MAY of
✓ Notary ublic in d for the State of a
� �'- Gnevuria;�issrcvuumrul�aBv 72'PBd.
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).
Sig naturePtf ce „ hief or designee Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION 1S RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Sin �
g atdre-of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81%" (width) and 5 1/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk/rAXIDRIVBADGEAPPL92015ameMed.DOC 09/2014
fou; COct.15. 2014 8:34AM CDiv of Criminal Investigation,
iliu�ll,miu
v " I I 111 I (Il °�
s .4f, l rr tai I llrlu I�r q, q Check
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,�„ �, Rc1 i -.f 1 rit
Support Operations Bureau, t
ms E. It, street
Des Moines. rowa 50319
(515) 72-4-6060 Paz
Mawr^s (Mm inaI
V�q J en � . .
q(5/
R.Emaid C:)hea;q,
Fast Name
Ni o.,2 8 8 6 pP. 1/1
DCI Ao®owit Nomber:
.. �wfiayrpYlcaLYc) ..."___
. �a�,q'"Q':".�o4'a"pY,'aa8 sllp'Gtee
. �t&V Ih; aspukru &mwh "s"u°uu t._ _.
TDwas Qw, Ada. 52240
Pam
...31..y-3s6Cu, 549
bale V:: male
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'1 �ec�ruty l�amurulaes� Cv�
N°1o�21a�� �rta�6arm��d��,^ ��'116anrruR an ,ai�;muu:d aara4ro"a�r � aaann �bnm areutnljsre�k e�lgxma 1°ea�aga»t� s eeuNV�QeRd au^tpmugmgat tolslem`�^ a°ea;ooq a@ paaa;;� ma.aa�
be veleasfibba per code of Iowa, Cinapaser l912.',Ip"erg2mm,PjAk erlmspaaal blmtaorry remdara lnfbR°mflomaa acaHrProw"ed by Rath, agmp"qs
WWW -R&061 Ihuebyghro permiarion 5or the above r quesling official to conduct an rosea crlmtnal bisloryrecord dmdhMlh the Dlvldon gXrlminal
InveatlgagontpCl). Mya(hlinalhlatoryduteconowingn,eWatismaPntainedbylheDCrmayberelesstaasallowcdbylasv,
(Dcntre only)
�" _ .�
As of ...:.......... �°.`..................................,y a search of the provided name and date of birth revealed:
No Iowa C.°a^p.minalHistoryRecord C'biandwithI)CC.I
t�
Iowa Criminal History Record attached, DO #
DCIM ivaa:taals -s,..P N
Received Timerjoct. 9.02014 3:19PM No,1628
101 a
fS "Fill
SMAM IW PLER I ('U57G1` r1,1' . ,
OffiieaOfUrtrumw Ndmilres
PO 1%ts't: TM04, I1ies I am1one k AH l'V!C r''V2,04
tnarlm e", e1 Er 2444"24 � MID '&"Il 1121" f w. ,*s'W?w.2T'I? 1837'
%uumv feraarWA glmr
Inquiry II:Mter 10/8/2018
INaumme'a Rodriguez, Oscar Antonio
Addres sa 2120 10TH STREET PL
CH;V/Staten CORALVILLE, IA 522411331
Nwu111ng Addlressan 2120 10TH STREET PL
IIMalttinS CL'tV/Sta'teu CORAlt.VILII..E„ IA 5224 11331
Ceiltli't1et1 Abstract. of Dirivirig lte ird
r€ ':r Mg 892ZZ9251 (IA)
Audit a; 6356605
Issue Date: 10/04/2012
Expiration Date: 09/30/2017
Endorsements:
Restrictions: Corrective Lenses
Date of Birthl 9/30/1989
Sam V
Hiiatalry linformatteln
�fl'®II�d�IlPall� c�lllftl�l��/tit�i�lli
Cumstoutner soil
5122888
'lift Status!
II::'2,IIr
tDII. Statuus.
VAL
CIDP. Status::
None
CIDL. Cart Status;
None
CDIL Pled ,amus
None
ttestrictllian
None
Suppiementr
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 daten
I ow
f M T 7,'
Office
Iowa Department ,
Name. Rodriquez„ Oscar Antonio IDL/1M 892ZZ9251