HomeMy WebLinkAbout14-200Authorization Number Ji 4 —
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'Office Use Only)
VIII ...
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
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Iowa City, Iowa 52240-1826 :"rgs_tfa _' .ro..i"rrYN tt,..�.. ems ,a�ndr,rf.....e @.. ...la......�l ur�aBPP"r�.ssrdt•1@.....@ ...............................
(319) 3S6-5040
(319) 356-5497 FAX
Middle ,� Last
1. 2. Mailing U
Address (("2IEQUIRED �
Ipp p
3. Contact Information (REQUIRED) Email: --LV.
Cell Phone:�'t
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 been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?.
Tag of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
B. Has y66rr driver's liceiise'or chauW bdrs license 6e -eh suipbndgd 6 revoked in the last five years?7,/f_'
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)
09/2014
P hereby cer#j(y t t I have i to me by the Iowa Department of Transportation a valid Chauffeur's license number
6A4 ;; (( ( . I understand that if I falsely answer any questions in this application, that this
applic ts� a onn 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 Nc6Vil l?u0c)
Signature ofApplica '� Date C716F�J I ji
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 cr t', )•P1— . On this 1�..__, day of
c .. �.�.,.. L-_ ._ J L L
I have reviewed this application, DCI raport, 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).
Signa re of Tr
e 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.
Sign ure of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/a" (width) and 5'/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
C,erkrrAXIDRIVBADDEAPPL92014amended.Doc 09/2014
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PO Box 9204 I Des IIRIRI¢R@ilwW, IIA 50NIG444
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Ceirtiif ed Abstract of IDrdAng IRecord
Inquiry Dater
8/23/2014
DN.p811In :
432YY6:1.21. (IA)
Nance:
Strickler, Karla Mary
ciass:
D
Address:
3701 2ND ST LOT 3
Audit=
7350063
Restriction
None
Issue Dates
09/17/2013
Ciity/Staten
CORALVILLE, IA 52241.3203
Expiration Datoa
12/25/2015
rrid® vnents:
3
Mailling Addreww:
119 BOK 57.13
IRestrictionor
NONE '
IDate of lilirtte:
:0.2/25/7.960
Medics City/Stater TIFFIN, IA 523400518
Sea:
F
History Information
CianviCtWns
i,mtAuuu Oate
canvica.w n De a
AGO
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03/2.6/2014
x08,1 IL4120i4
M114
hail to Obey Trai'i7ic
Custanner :
-
692807
ID Status:
None
Di. Statue;
VAL
CII. Statue:
None
DIOL Certstatus::
None
ODII. Med Statue:
None
Restriction
None
Supplement
wddentw ... Accident "unveiv alment li n3diwalte d does NOT ulnaaan the inrrdIvirdu W was at faauait OF given aw citation.
i,ccidu..nn i Date�iL!;�w roe a disevtti�weair.
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Name: Strickler, Karla Mary DL/I®: 432YY0121
w„ .� l r ♦ .r
the custodian of by
Or ver ervIces, t
at Lots
.. , r r'. t.: . w
said office, andt
. b.n authorize, by the Director of Mep..rtment of Transportationto
r7useV, mv signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
15
office of Driver Services
Im Iowa Department
oerAug.29. 20141, 4;27PMCab Div of Crim nal Investigat on
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Dor NOWr & Iowa $0319
(516)•725.6090 Fax
(FAX)31933aTdNo. 8376 P. 1/11002
DOIAccount NumberW• 9967•-F
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PA Box 428
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(319) 339,9777
Phone]
.VAX, (319) 33.9-7302
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Al
a search of the provided narno and elate of bhIh revaaledW
No Iowa CTIMinal History R000rd found WI& DCI i.
Town crwna matory Raeord eftolsed, Der : a
rI6rRlfsela
Received Time Aug.25, 2014 9:17AM No, 8313