HomeMy WebLinkAbout14-145410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3 9) 356-5497 FAX
® IFirst
1. Name W o�ai�l
2. Mailing Address
Authorization Number
(Office Use Only)
(Police Department review must be made
between 8 a.m. to Monday Friday.)
IMiddle
W, aed
3. "I-elephone: Home --3t 9 Other.
4. prior experience in transportation of
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Where
wj
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Where
7 Have you been convicted of any traffic offenses in the last five years?
When
Is"0101
When
8. Has your driver's license or chauffeur's license been suspended or revoked in Me last five years?
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
•;: �;. I
•-r • e +
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
"9'�'` 6Vbm% 032014
I hereby certify tha I have issu d to me by the Iowa Department of Transportation a valid Cnauffeurs license number
a C 1111 1 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 emp!oyees 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 r° ���-- �
9Applicant)
Si nature of ___ :�^ � 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.
•******************1**4R*4**4**44*********:Fk****************************************************************************4444*****4******h****:tk*
STATE OF IOWA )
COUNTY OF JOHNSON )
and swonj to before me by .. v _ 6 �Li,xr ., On this 1 day of
S.! ;qfk
'sivn Engri�e�rc
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).
Signature of Poli Chi, � g
or designee
,r
Dats°
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.
Sig naturg'
w
Sig f City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5'/:"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dadNsxidNbadgeapp2014.d. 03/2014
Jun. 4. 2014 2:10PM Div of Criminal Investigation
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No Iowa C.rikolnai MIstoasy'ILocoosd found with DCI
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Iowa Criminal Ljlgory Rgoordattaohsda DCI � 1
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Jun. 4. 2014 2:10PM Div of Criminal Investigation
IN THE ABSUNCE OF PXNGRRPRINTe, FOR. pO8I'PI'Wk3 IDZXTIFICR7I0N THIS RECORD I.9+
WED 09 INFORMATION FURNISRSO, WECWNOT CONFIRM OR DANY T'kMT THS RUCOAD
COVERS THE EiUBJ3CT OF S?CbUR TBOU'R°C.
DIVISION OF C'RI14IRhr' IXVERtlaaXOR
No. 01'f3t P. 10110
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YnQuiry Date•.
Name!
City/Stats:":
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5/29/2014
Schuetz, Kevin
Eugene
2904 HEINZ RD
1Y.7W F6 CM, 'EA
x72.408.6.22
s° 2904 HEINZ R6
Mailing Add,'
DL/YD Ota
Ciasse
Audit #:
Issue Data -
Date
gnalor.seT uewmtuxc
Restrictions:
Date of 9irtha
r.
"{!i°. mm0999 (Pi. :Nfl'1 0 sf'..
tafStataHq�
6134497
07/18/2012
06/11/2017
3
Corrective Lenses
6/11/1977
�, 1MTb 1'YC,' IdA14P..Ey4� 1N�'7'.
x03`:5602
Ncsnr.^,
VAL
DL Stotus•d None
CDL ;Status"•
CDL Cart Status: None
COY. Med Status" None
None
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Accidents �
fault
a�'a�fen a
Kevin Eugene DLAD: 753MM0999 artatton, do
Name;; Srhuetry and
of Td cr
I, Mro Snook, Director of Office of Driver r S rvlc s, to C9ep uronent
321.10, held by the Offtre of Driver Services, that the k)irfecto true
the Yowa fh`Paurate COPY of
PursrxanY. to Iowathat
as n the custodian of the records
certify of said Or""rice, and that S have Paean authorfzecl fay
harehy to the custody
on oyficiat record currently
y.
this document, at Ankeny, Iowa
of Transportation to so certif
In, vuBC.ne:`>=''rshereof, f Y^aiPe aau'ed toy Signature and the seat/ oP the DeparF.ment to be set upon
this dare: 5/2ep/2014
JOW
P ik
Office of Driver
r SeNkes
arty Iowa DePartment of Transporation