HomeMy WebLinkAbout14-124410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
4
Authorization Number " 1
(Office Use Only)
t"') cql .
Department
between 8 a.m. to 3 p.m., Monday — Friday.)
IRmr Nd'dle Last
1. Name �._'.a ".:"�.... C iswo. C'S;0r%QA
2. Mail itrpddrass_....... .....I�.g. ..................:...u..... .... ... .............................. a'��n...a t
3. 'telephone: lHorne
4. Prior expedenrm In transportation of passengers:
Other
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Where
WIM
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? U 0
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
_,.. w, . ~t. ' B mb c ........t::.a7.................................................1.13.3..) ..Q._�'.u.,.....................................
uA a.0.;A�. y. .....y............(L.4.tJ............................................. a.......... I .... L .
B. Has your driver's Iilcense or chauffeur's license been suspended or revoked in the last five years? 0
Where
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
K. i 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)
d vbetla 0312014
I hereby certi� t3hat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
SSS y 6 t) 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)
Signature of Applicant DateC
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 )
and sworn to before me by I . J'J' o Es, c� L4.a f"w"' On this day of
Notary Public in and for the State of Iowa
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).
Sign roljce 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.
Signatur0, of City Clerk or designee
a-_._._._________.
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/211
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Inquiry Date: 5/29/2014
Name; Chay Escobar, Luis
Alfonso
Address: 1206 DIANA ST
City/State„ IOWA CITY, IA
522404629
Nailing Address: 1206 DIANA ST
I
Certified Allbotract of Diri1rliing Record
DL/ID #: 555XX6834(IA)
Class: A
Audit #:
7221147
Issue IDeta:
08/08/2013
(Expiration
12/24/2015
Date:
IEandorseinnentm f,
Restrictiamn Except Class A Bus
Date of Birtfig 12/24/1963
Som M
Name: Chay Escobar, Luis Alfonso DL/ID: 555XX6834
Transportation to so certify.
I;'miJalPlintlon
Customer #: 406903
ID Status: None
DL Status:
VAL
CDL Status:
VAL
CDL Cert
Non -Excepted Iuntrastete
Status:
CDL Had
None
Status:
Restriction
None
Supplement:
¢IFldfl to Obey ➢ aaffic P3I4yvll/Sglro&ell
5/29/2014
l � l
I fir`
Office
Iowa Department of Transportation
Namm Chay Escobar, Luis Alfonso DL/ID: 555XX6834