HomeMy WebLinkAbout14-115Authorization Number _ 1 — 1 /
I 9 ? (Office Use Only)
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I F IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDiCA VEHICLE DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.)
Iowa City, Iowa 52240-182
.1 5
913.56-5640:)% 5(0
(319) 356-5497 FAX
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1. Name ___---..____ __
2. MailingAddress %" �� ` _ " _fau" ` '- p
3. "telephone: Horttre _
4. Prior experience in transportation of passengers:
6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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6. Have yoy,been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N10
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7. Have you been convicted of any traffic offenses in the last five years? V'& 9
1C.Yt^..I:,..p'a..mt(trif. Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the 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)
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
denbadadvbadg 03/2014
i hereby ce ' hat Ihare issued to me by the Iowa Department of Transportation a valid Chautteurs license number
1 r . �c " r 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
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.
STATE OF IOWA
COUNTY OF JOHNSON
.., u�,Vaivu. r as y u r „
Subscribed
and sworn to before me by Nota f�ublic in and of r 4he On this day of
a�
e ,
,„„ ry `State of Iowa Y
1 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).
Signae o oWOhief 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.
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Sign” !„..
atap�.lof Ci �
Clerk o
r es�Tgnee ..)ate
Taxi cab businesses are re 1” ulned to provide Driver Identification cards. Cards must be 8'/2" (width) and 5'/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derN MdiivbadgewP2014.d= 03/2014
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Certified Abstract of Driving Record
Inquiry Datep
4/30/2014
DL/ID :
082BB0656 (IA)
Customer :
1563118
Name:
Lenlhan, James Edward
Class:
D
ID Status:
None
Address:
2976 BLACK DIAMOND
Audit #:
4630118
DL Status:
VAL
RD SW
Issue Datea
08/27/2010
CDL Status:
None
city/State:
IOWA CrN, IIA
IExplratlon
03/03/2015
CDL Cert
None
522408454
IDatn:
Status:
IEndorsementm
3
CDL Med
None
Statusa
Mailing AddirewN
2976 BLACK DIAMOND
Restrictions:
NONE
Restriction
None
RD SW
Date of Birth:
3/3/1960
Supplement:
Mailing City/Statm IOWA CITY, IA
Sax;
M
522408454
Citation Deba Data ASM 7 p ianatloira .......,.,County 3gAtu
."zp7eed 'inewa~^slfuua^Ya .........IA
10/29/201.3
Name: Lenlhan, James Edward DL/ID. 082BB0656
Pursuant to Iowa Code §321.10, 1, 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 retard 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:
4/30/2014%yyFj
Office of Driver
Iowa Departmentlil
f Transportation
0°11111°°I May. 6. 2014 10:43At� Div of C(iminal Inu ',I afloi)
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