HomeMy WebLinkAbout14-127410 East Washington Street
Iowa CitYv Iowa 52240-1826
4=(3 19) 356-504
(319) 356-5497 FAX
1. Name
gy II"'III"^tet j
2. Mailing Address
3. "II"elephone: 11 home,.1
Authorization Number � 4„_ Irl
(Office Use Only)
APPLICATION FOR TAXI/MOTORIZED PEDICAS VEHICLE DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.., Monday — Friday.)
Other:
4. IPnf.xr experience In transIDortatiori of laassengers;0,� ... Z
... gqq .:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? I/
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?�(1i�
;(:re oly s �.h...ei;e When
a�� .,.7`ma'wra,, 2°"�yp". '�.w"✓'"�cYA"�`s^"'. ���,
""..n..:.aP 'a pu, -.s°e*se".d' u.. .s �°.........._• .�.. .✓ "��S'M�^";�'G"a:.a:..
...........
C7 -Have you been convicted of any traffic offenses in the last We years"?,,, 4...6
Tvpe of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? d _
Type of offense
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
• • 0 0• , I r
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
a vbadp 03/2014
I hereby certify thpt I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
. i °"" 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 Fubi€c)
Signature of Applicant:::, , $ ,,, 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 citywebsite at icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
t r e i0 fore me bipp riru UTTLE�s41g"E, m'.@... a& t w, is ..., day of
Subscribed and sworn to be y J On this
ar
�OTP
d
7 d gCELLV� 4C M rTLE t. .�,
i�r qo °'�n p 7° No ry Public in and for the State of Iowa
have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
minPd 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 I° Chiefordesignee to
Signature
YOU AR OT 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.
Signature of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'12' (width) and 5 %11
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
daddta1dddwetl;eapp2014.doc 03/2014
Jun. 10. 2014 4:30Pv11 Div of Criminal Investigation No, 2130 P. 5/6
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City Clerk's Office
410 B, Wo4ingtou Street
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Phouc 319-366-5041.
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'No Iowa Criminal History Reooad found `th )DCI t
Iowa Criminal History Rocord attaohed& DCI #_ r r
I DCI
Rec ived Time—Jun. 6._2014-12;49
CIowa Depairtiment of "fir i ll ii
PC) i X OEM,Do Iftnew,1A 069AN 515,2441124
AW FAX it 101
Inquiry Date:
6/9/2014
DL/ID #:
803ZZ6639 (IA)
Name:
Pogue, Christopher
Class:
D
CDL Cart Status:
Michael
CDL Mad Status:
None
Address:
424 S LUCAS ST
Audit #:
8028929
APT 6
Issue Data:
04/30/2014
City/State:
IOWAYTY IA
Expiration Datw
02/15/2022
52240
Endorsements:
3
Mailing Address:
424 5 LUCAS ST
Restrictions:
NONE
APT 6
Date of Birth:
2/15/1983
Mailing
IOWA CITY, IA
sere
M
City/State:
522405157
History Information
Customer #:
5051546
ID Status:
VAL
DL Status:
VAL
CDL Status:
None
CDL Cart Status:
None
CDL Mad Status:
None
Restriction
None
Supplement:
Name: Pogue, Christopher Michael DL/ID: 803ZZ6639
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 caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
Name: Pogue, Christopher Michael DL/ID: 803ZZ6639