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Home My WebLink About14-153Authorization Number_ 1-� 1 1 a (Office Use Only) To Te(" I CITY OF IOWA CITY APPLICATION FOR TAXIIMOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made 410 East Washington Street between 8a.m. to p.m., Monday—Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX D I . I id Ie ast 1. Narn4? ... ..... + 0 0 � .... kµ� `............................_..._............................ ........�...::::.......:...._ ............ 2. FlailingAddrpsss a 3. Telephone: Home—.2.......................................... _................................... Otlhelr:............. & ....................................... 4. Prior experience in ransporiahon of passengers: A ....... .... .. �... 5. Have you ever been convicted of any misdemeanors and/or felonies in this ,~erste or O ewhere". _ Tvpe of offense Where When 6. Have you bepeg convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Al 0 Tvoe of Offense Where When _.... 7. Have you been convicted of any traffic offenses in the last We years? ............. .._ ,,,_s"- .......................... of olfQ erise Where Wbytnen. fl' i"A Rrp fiN A fi u � -;Z 0 X,p .M 'h+" + ¢� ........ ... '4 �® u ,,,,,,, 8. Has your driver's license or chauffeur's license been suspended or revoked in the (last five years? .......... W� _ Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) Q) 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) derklmddd bada 03/2014 bymfy th tI gave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number .3 . , ! 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, complyy t�t times with the provisions sions oit e Chapter ethe City Code. (Needs to be signed in front of a Notary Signature Applicant ll1 Date AV � 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 ) 1 ��Mm.. ��n _�� t ., of Q.u.. Y r .r. i �E?�. � �� ao..�°' ti On this day of b cubed and orn to befo a me b **k#*k#######***********kR**k#**#####!******RRR**RRR***R**R**k*****k#**kk###!#*!##*k*********MM*RR#***k**kk####!###*!*#****R****#***kk###k!##k# 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 # re'of Pc hief 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. ) i - ul :91I inn' ��,_ A jig Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 1/21, (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derkFb=dnvbadgeapp2014.Abc 03/2014 Jul. 31. 2014 4:21 PM /Div of Crim nal Investigation VVI,JV, LVIY J•L/IITI IIIb 'wit, v. ivnu �I •/ u j Il� � PiUil � Criminal r ;rr. Fr1fRequest Forin F To; Torva Division of Criminal YDwAgation Support Operation$ Bureau, l" Floor 215 D.7" Street DesMo1nos,ToWp 50319 (515) 725-6666 (515) 725-6080 Fax NNP. 6 1 P P.P. vl/1 1 From: Cl(y of 1Co�a C► ...................:.......................... (:::lty cwenB z Ottteo �11,01t. OWaeiclu I toWa_... 17�1}f; �PWISPT1 Iowa Criminal t E RetMtDr Check .. "n �I., ��e (Del oso only) As of 3� :°;'.J ...!I ............... a search of the provided name and date of birth revealed: I No Iowa Criminal,fHisto'1ry Record found with DC1 r� Iowa Criminal Mstory cord attaehc4 I)(:l" .............. ........................................... ..... ...... DCl .initials.......: ........... nnT 177'A9h n0N Received Time Jul.30. •2014 3:23PM No -5970 y P I q�gpryµgp ry ypk RIFLER @m p p i U DOT J �� go' ^""'°BARTER 6 n✓Il p6��Y LER q (U Su{.k V'bR Ml.P DYR]V �YT+.u'Wnyi(^�X'g"A�"+� t..x}Il. o.�'.iVIUIVVV Nrn&ntl4dllW ld'R(IOON V"4„pyXW Pltiloa at ldrltar S'@?Vk..:eaf 1170 IF..OK 92.04 u EMs Ma0I to 1 '%9#klI Phtonw 515 24.4,912.4 9 W. 3 x3? -'1 121 t I• = fs'15-2. 9-4'937 w'onw.Navra+*A.gaV DennisInquiry oaten: 6/19/2014 Name: Declarer, Address: 3212 IVE City/state: IOWA CITY, IA 522454021 Mailing Address: 3212 HASTINGS AVE Col victpons Cltatlon Date _ Convle.UOUT, Date 011/051201.1.. -:li0/.18/2011 __.. .._. 0111'7/20:1.2 .. ,02/02/2012..... .... 05/2312.012. ......... -09/66/2012 7.1/22/2013 12/11/201.3 DL/ID #; 153BB2737 (IA) Class: D Audit ; 7636196 Issue Date: 12/24/2013 Expiration Date: 12/01/2015 Endorsements; 3 Restrictions; NONE Date of Birth: 12/1/1948 Sex: M History Information Customer #s 4101693 ID Statum None DL Status; VAL CDL Status; None CDL Cort Statum None CDL Mad Stators: None Restriction None Supplement: _.... IA ACID Explanation County 3U R II Fall to Obey Traffic Sign/signal... _.._ _.. Johnson ........ IA. . 1:134 Defective Lights ..... _.:aohnsorr ._.... IA .. S92 __.. Speed .. ._M ._. ._...W .....__.� 0hrrsoin _.... IA E54 Fail to Urn Headlights ,..,. Johnson IA 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 caysed my signdture and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: '° �®,'°®` ®®o 6/19120:14 I0 )° e e• -' uv . ® e'••••°' _ Office of Driver Services Iowa Department of Transportation 40 t- ,, r.