HomeMy WebLinkAbout14-218Authorization Number_ _ \ ~- elb
(Office Use Only)o
_._
CITY OF IOWA CITY 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 ,19-rn . N,,&a�a�en�6;�9".1dcadarodad-on...will,Ralf,Pn„ . .. (.... me�zlc?ff...........
�pala(pm��aa;�ra
(319) 3S6-5040
(319) 356-5497 FAX
irst �Mlddle �-1 L st
1. Name (REQUIRED)
2. Mailing Address REQUIRED e F>
3. Contact Information (REQUIRED) Email: e/1 �&>r gy r- aV'1C'� .-��y� r1�.:.,-ca Cell Phone
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Where
IN
NL
6. Have you en nvicted 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? F-67 ob 1 5, t,?.f IT1,95-) /,,2..•
When
C.?Oi'r )'�ae- ("
IN
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years?
Where
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 Chauffeurs license number
63�-d D %: � N i(i . 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 or 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. (Meads lobe signed in front
of a Notary Public)� �:�., --_�_ .�...... - j
Signature of Applicant "�"q r �'L:° Date 0-,/- ,,, „1,,,
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 )
and sworn tojefore me by On this day of
?f ft�� .u*'a�V V% GC y�r��uur�x� a ur u�u,rm��.�r xt1 Notary Public in and for the State of Iowa
�. ��u°a FXMINIar
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).
Signatu licbrChief or designee
„f
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signature of City Clerk or designee
// �.
' Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2' (width) and 5 1/Y"
(height) and prominently displayed to all passengers.
'J4
Approved apoiiclatlor',i
DCI report
State certified driving "record i
Website u dam'
P n�
a0•..x
Office Use Only
ClerkrrAXIDRIVWGEAPPL9014zmended.DOC 09/2014
Z/'/i/ J G i,
43I,Ze #9 [Wil Scanv
Inquiry Date: 10/1/2014
Name: Story, Ernest Arthur
Add 203 SCOTT CT UNIT 5
01 CT , 52„539
Mailing Addrel tG SCOTT CT UNIT 5
Mailing City/State: IOWA CITY, IA 522453996
DL/ID Or
S8®XX9476 (IA)
Customer 8;
1135116
Class:
D
ID Status:
None
Audit 4:
6719158
DL Status:
VAL
Issue Date:
02/22/2013
CDL Status,
None
Expiration Date:
02/27/2018
CDL CertStatus:
None
Endorsements:
3
CDL Mod Status:
None
Restrictions:
Corra lve Lenses
Restriction
None
Date of girth:
2/27/1966
Supplement:
Sex:
M
History Information
11
Cltation Date.
Cooiva :tion (Date
ACID
Expinenarelao-n
Couwunty
JIUR
02/19/201112
04/17/2012
', M42
bripirollra::ir Laine (changing Ilalmes)
Johnson
IA
05/13/201..'!.
08/28/20712
'.111.4
Fall l to d'Slluey I'lla7l'Ific sIgim/":piIgin 111
JaAhin^soini
UA
402/22/2013
0sno/2013
1,4
IFaiill to O1Ytey Tuaafilfic Siign/SIgimlll
7ohimsoin
IIA
ilill I IF 11!
Accident Date Case INumber 1IUR
06125/2011.3 747232 IIA
I;1'TTSi:3T117'A;fEM-717TalTri �JFA4 Ai:IaX♦i4Ztf,":
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:
'••
10/1/2014
p
clee
er Servvicesr
Office of Driver
v
Iowa Department of Transportation
Name: Story, Ernest Arthur DL/ID: 580XX9476
09/Sea�29� 20p14511 16AM
O v of Criminal Inveshgal on��� q No. D772 P. 1/WVW3
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U347 (01 MM 0)
Received Time Sep. 24. 2014 11:18AM No. 1146
9ep,29. 2014 11:17AM Div of Criminal 1nvuski,gafion
1'OWA, O2,RIl4,I,T' hL R'•1 ATUR':W DClr 00600361
1S1508MRANOR (.'.0X'VICT;Id'9RR'S O RLL PA936 I OF I
DATE PRI'NTSID.,.
201,4/09/29
IfDC2i0060036'Sv
WAMEv RSTORT,833113IIP ARTHUR
DOE SEX RAC HOT CBOT EXE ,HAIR SKU PUB
19660227 M N 510 270 RRO &U:GC MEG
ADDIT"IONA.L '8RDENTTPIERS
Be ST EYE
TAT XF ARM
TAT R CALF
TAT R6 ARM
TAT U'S. ARM
TAT UR AM
CCRS RECORD mat
01 ARRENTID 19990626
At3ETOYz IA0576100 CRUAR RAPIDS PD
CHARGE IPO- 02 XA ;STATUTE 1A704 -2W
SIMPLE ASSAULT
°t YCR c 500369202.
rOURT P19POSIIT'IION
TaNC'T. 'TA05701SU LINN CO DIST COURT
COUNT No— 02 IA STATUTE IA708-2(4)
SIIMPLU ADSAULT°
CHARGE CT.ASSt MISDRMXhXOR CONVICTION
TRM $0030.9102
SEDTmRWCE p1mP RPP DAT
PLEAD SUIILTf 19990924
PJRS 4190 1999:0924
COURT COSTS 19990924
JAW ARR,"wFST TeR'H:'t"V,£OUT iD18P0'ro,IT20N IS NOT AN INDIC'A'TION O6 GUILT. THIS RECORD
MAvTDS'TAIrNED STP THE IONA, R.RIIDXSIYON OF CRINXEAL :11WESTIrA°m: ON, BUREAU Of
IDENTIFICATION IS A PUBLIC RECOR#ID BUT CAN °T BE :RYRLRdA ". TO XON—LAW
RRPORCEMRERT AG1WC=S BY THE W.X.
IN THE AbSENCE OF FINGERPRINT'S FOR POSITIVE IDENTIFICATION THIS RECORD :IS
BASED ON INFORMATION FUR.NY.ISHFD% WE CANNOT CONFIRM OR DENY THAT TRIS RECORD
COVERS THE SUBJECT Or YOUR INQU:rk''Y.
DIVISION OFCRININ" INVESTIGATION
lk 0772 P. 3/3