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Home My WebLink About14-122I p I r .>.,llJnpi "� "ter m moot CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX / el Authorization Number (Office Use Only) lam - IV First ) 1. Name 2. wiling 3. Telephone: Home,._ w 4. Prior- experience in transportation of passengers (Police Department review must be made between 8 a.m. to 3 x Monday Middle 1� Z Other. �6 r e e - —j 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Tvlrua � offfense Where;ht 6. Have you beconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Cl Tvoe of Offense Where When 7, Have you been convicted of any traffic offenses in the last five years? Type of Where iqi Q 44 When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? __ 60____—___ Type of offense 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) (OVER FOR REQUIRED SIGNATURE AND NOTARY) dWMTd&1%'Wd9 03/2014 CIC I hereby ceitthat I p Issued t e by the Iowa Department of Transportation a valid Chauffeurs license number CEJ f 75 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 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 ?wort of a Notary Public) Signature of Applicant Date 7 ° 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 j COUNTYOFJCHNSON ) Subscribed and sworn to before me by ^b f ; µ �q : k7F1 W u •- w�,� On this �d )tI day of 1. 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). Signatu a ofP ' ie r designee Date 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. Signature of City Clerk or designee ate -- Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %'1(width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derMaAddvbateapp2014.d= 0$/2014 Ceirtilf red Abstract a f DrIlving Record Inquiry Date: 5/20/2014 DL/XD #: 701YY1753(IA) Customer *1 2857327 I j 11 I so-�� I A I 13V vvwwjJ, umi dot, g ov 10 Status: None Addrassa 011ibun till iX W4n 6590415 DL Statum VAL F1 aox 9AM 1Ms Wdnnll, A K2,Y' !VD4 102 Issue Dated 01/04/2013 k1h,ww b15-."44- 4124 f ,C-53�2:21 i Fax--a'Li 133 1537 City/Stats: CEDAR RAPIDS, IA Expiration 11/22/2017 IMAM MN" "O�t W Ceirtilf red Abstract a f DrIlving Record Inquiry Date: 5/20/2014 DL/XD #: 701YY1753(IA) Customer *1 2857327 Manneg Madden, Patrick George Class: D 10 Status: None Addrassa 3009 12TH AVE SW APT Audit #2 6590415 DL Statum VAL 102 Issue Dated 01/04/2013 COL Stators None City/Stats: CEDAR RAPIDS, IA Expiration 11/22/2017 CDL Cart None 524041460 Date: Statum Endorsements: 3 CDL Mad None Status: Mailing Addresm 3009 12TH AVE SW APT Restriction& Corrective Lenses Restriction None 113 Date of 111 11/22/1950 Supplarneft Mailing City/State: CEDAR RAPIDS, IA Sax: M 524041459 CC j ht 0'n103/21013 05/30/21)13 IM42 Illsviyrallamu Il ane �dhwngling anes) 30hin!!i0in I1A Name: Madden, Patrick George DL/3U 701YY1753 • .K J,, r re 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 authcxlzed by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my slgntIure ar,d the szall of the Department to be set upon this document, at Ankeny, Iowa this date: 5120/2014 X 40° T AND Office of Driver Services Iowa Department of Transportation a 01y,22: 2014 11:53AM (Div of Criminal Investigation 0 N o. 9467 P.P. 1/3 STATE OF IOWA A Crr Yt tn1 History Rs on Check Request Form DCf AwountNumberM I r To-, 1+�am, clNyYntlo�s�GS .... 5uD T a n firt Xwen n6.ftoww;s �nxh°� yah, t"C �90 • � IX� � Y �x a� a➢.�0 y_ vtwon __....." .......................................4]O g. ("ssBtffwucash6tart.ai......_.. Dej Molaes,YoWa 50319 (-Y6) 725.6066 :amble CAW;y, 11� 5224H .................� (516)725-6080 Vax YAW 319:396-54 97 t tweak oin .................:"............................... ............."..�� ..�....�rc( �"��TA.. Arrna¢YQaCoawV t�tahgalou° (nnrvadwtarg� ............ _.............:............................................................................. ...."....".. _..... roX�d"�°��r��i��: "6�XtixaYY.xP sa vNgmad �a&vemt°u•ama tltwasYntn,lew:t o$QPae h°e�na�ets � �oro�n�,gertr.Y 4°econ°d xrwuy not add&�'��"..�n��°e°RA�ya�.lkraA�a6y �jiVc grcr¢rnY.ssYan Saawl4o- aYunrre rngnsasauind a6k"aa6ak 4m auwadi¢ce om Xoeaa aainr�wwnll IMasYmrcy wcanrcd a9rotCt �uiVYu Nha%aPwPsYa¢w aro'wiwr¢InaP 't¢Yges¢R a2ienu YS:Ny. My giklnd hlslwy daflaeonamigg is that xreur¢a"rew{a"vasrrX Wg+wGoexSC`P, may be rcrrn.wrdmv0ava¢6dkv law. .. : .�. .............................................:'........_...._—.—.—.,........................................ "........._.."._................... .�............................n...... . ...'.....:.........:;.::.._ ..."."...._.¢_. .. .... 'he OP NJ Ao cro oxa eoaA of etre pro v & d name and data of1*1AseveW(;;d„ No Iowa Criminal History Record found wM DCI 6rv.w ,A N 0 To'wa0itananal.1 storyReoordattac ,IDCT #...........n €eived Time f�ad.2p. 2614 11..3IV�"�o.91/t: