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Home My WebLink About14-159I b i �Awkumffi 4. �® °5 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX First 1. Name „• rr% 2. Melling Address 3. Telephone: Home 4. Prior experience in Authorization Number f� (Office Use OraPy) Department review must be , ,d. between a . to 3 p.m., Mondayrich ---0 Other: W4 ILast --- 6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 1 6. Have yob convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years 7. Have you been convicted of any traffic offenses in the last rhee years? 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ulm 1fim 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) YOU Must apply for an Individual D Ina TAT (OVER FOR REQUIRED SIGNATURE AND NOTARY) �t1°' 03/2014 I In re;by q i at I ave issued to me by the Iowa Department of Transportation a valid Chaufteurs license number "y I understand that if I falsely answer any questions in this application, that this app ication 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) �Ap Signature of Applicant, k , N2 µ� m. Z....._..._. .. Date •• M 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 x _ ______. On thisr_ k w.. day of a.— , . � * 1 a 4 1 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). ^P k' Sign re of M 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. gna urfe�of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update deik4adddvbadgeapp2014.d= 03/2014 ' Aug. 7. 2014 12:57PM VIII IIID nog. J. 4v1Y IIiUlnm IIIIVIII ?ilia IIIIIII Div of Criminal Investigation VIlf b1Clh b.lV U� IVIIo blt� STATE F IOWA O i arta fZ,Criminal - coYd Check, Request , 1, IoWablVlfiloll rii RIS r„r. D" , I,; 0 Fay hNo.Y6 578 U. 1 City Clerlei Office 41,0L N�aaPnVaa�„foa at"xe, •...ob�,q?CV ,Q';4ffz.... r�/». :"(ICV.. ........ Phone, 319-356-1041 ..................................................................... 3664407 X8 of w ::" �w 0, sea fi ofs Tranarided narne, and date ab�"VMb No Iowa Criminal ffistory Riecord found with i; �. Iaswo. CriMbyfl Hscrokcarg^' Reaoa"«f aaaobealp Df*1 f#..... DCI Initials...........: � �% .... r�r'r mors n . � O7AM 11,111BM N� faQG ��ii I e r e int O ��ll n ra � a ries il Oil �1dlcxm 1A l0avetl sel°'scii.S (Tall tl Irl m h BOO 632. x,12% A01 BOX c21104, Din! Moms, Uk'a� �tl��"�f�':�U1�3IC �s"I'I5 244 9111"/4 0113 FPVL1uG61G v):) I183F fault or given a citation. Pursuant to Iowa Code §321A0, 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: t"III'tlllfied Abstract of DriMing 111tecoilrd Inquiry Dalan 8/5/2014 LPL/ID #= 769YY6103(IA) Customer #: 915880 Name: Heath, Thomas Class: D ID Status: None Edward Address: 2801 HIGHWAY 6 E Audit #: 6044993 DL Status: VAL LOT 394 Issue hate. 06/13/2012 COL Status: None City/State: IOWA CITY, IW IExpllratlon Darbe: 05/19/2017 CDL Cert Status. None 522402658 IEndorsemenlis: 3 CDL Med Status. None Mailing Address. 2801 HIGHWAY 6 E Restrictions. NONE Restriction None LOT 394 Supplement Date of Birth: 5/19/1959 Mailing IOWA CITY, IA Sex. M City/State® 522402658 History InFortnnatiorl fault or given a citation. Pursuant to Iowa Code §321A0, 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: Wim, IOWA !� D,.,O T Bell.« «»\ \\ Office of Driver services Iowa Department «___r Maium Heath, Thornas E.dward DLIIID:: 769YY61.03