HomeMy WebLinkAbout14-152f � t
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CITY OF IOWA CITY
4.10 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
Authorization Number _ f
(Office Use Only)+
`l arc
-0' .:. y. r �- : Y . � . 0 ,•.
(Police Departmentamade
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2. Mailing Address 3 �Z. .... %.��• �:N.. � gym ZS.- a,..
........-............. _..........
-
3. Telephone: Horna'....., j� .. _..______.............. Other':
.._ ... .................................
__--_......_....__..______...............___.. .............___.
4. Prior experience in transporfation of parsci2gcts:.. " un ,C^ -°.L
w.............. ___
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? T} o
r
mm
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ho
am
7. Have you been convicted of any traffic offenses in the last five years?
M&M
When
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? +1
I
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
n a
You must apply for an Individual Cri„ ..
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
u'WMMdrsvM1g 03/2014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
�'
� „ t".0 i -els"" . 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 to be signed in front
of a Notary Public)
Ll -
YOU
Signature of Applicant � ��. �f. ,,J. r ^- ... ���'�"'4'.r..�„- Date �el .- _ f __
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 byp.2 -. Ph this day of
:;.�.__...... .
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).
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.
w
/
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/x” (width) and 51/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
d9-k:1wddr m.ozoi4.doc 03/2014
o/(Jul. 9. 2014' 3:34PM
Div of Criminal Investigation:-.. , DCI. iowNo.3960 P. 0,o64
STATE OF 4,
Check �+
Request Form
(if agpaicabkj
r os ooh t t iaaDa otN rD�Ilunet6rpx Rt al¢6oau Fro um',x'1{"Imat �....
Support o@eroe8onue Bureau, taa Floor 116 Steven Dr.
516 &7"Street
50.�1.�G................ _............................ _.............,......_..:..__""____.�egMwlcnyya. N iiN�u
(515) ni 66 _
(.5a5) 72MO80 AexC5t9) 337-1294
Phow
Fuaxa (319) 551-5244
y,�ao�llw• p a��e �"e�ate � �•••� �. R
Waiver fi;firmatbw Wtthoau0 o m1ped waken bom theoollajece oX the rejwxL a complete ertaotsaaal1h Anry record may not
he rateerxlMte, Per Code of toaro, Ch aFRer 6g= For Spjvjft, 9ar8uurelleaad hiftr p r8ftrd 9otoruoMION, oe afl6oaa Od bF llW, MWAY:a
angnrwn ua wetvor et FFraaa a mr¢aon tae eon a of ¢tlae r aaeaeJ „............................................. _................
.'itrlvor. arfraw i two6yrivrmo iaawn Durum �.�.,... ilagw el uwwQd on Iowa Mw" huram Nwra eAmkwn....�.,..w»,,..,�-............,,,.�,.�.....„�--,
amm�Gah raEV9Y"�d aY{��'i�l%BOd%�
H�iarlaG�aiiuseu :'D. �vup a',a'NaaeDaawak DuR�n ier�i�uueae9ua aria G�la%{a swam I GOda Hb�eUear lar, arodamm,�G mu e49wwrauG Uap l'urw.
walversignaaeff- -R-04—
As of —1 �.
„ a sench of the provided norne end date ®f birth revealed:
u
No lo%0aa Crh=al History Record bund Yvith DCI
® Iowa Caarninaf History'Rcooxd alta rhed, DC1 d _...
Da -7 7 Cows/1033
Received Time JA 0, 2.014 12:34PM No. 3772
Iowa Department Transportation
fOWN d DOW ftraw 6104 role) MAM-1 112t
CartMed Absbvct of Driving Record
Inquilly Date, E/4/2014 DL/10 a 12 ISS (IW) Customer0 2108144
Uittach
b ]a gas CWe C ID None
Address., 3255 HASTINGS Jeoffit a 61 08316 Dre" States, VAL
AVE
CRY/iiftbe'. ILA
MIM
Melling m .3255 re NGS
AVE
reOWreire I A CrM IA.
/ a 522454022
67/10/2®12
MWIFOOM fi 0710812017
P
Restrictions: Correefive Lenses,
out air
brakes
ffie of Ofi „ 7/6/1942.
M
i
Means- IJittschwage a Robert James DL/ID: 126AC61SS
CDL VAL
Cre„ Cast libibuic,
Non-lBiceptad
Intrastate
CDL Had Stabon
None
Restriction
None
Sap rnt:
Pursuant to Iowa Code §321,86, Ia Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do
thereby cartily that I am the Custodian of the records held by the Oilice of Dilver m „ that this is a true and accurate copy of
an officlM recoryl currendy in the custody of said 011ice, and that I have n authorized I* the Diremor of the Iowa Doinrtment
of II-ansportadon to so cart ,
4/4/2614
N.. anger, Robert James DLIID: 126ACOISS