HomeMy WebLinkAbout14-114410 East Washington Street
Iowa City, Iowa 52240-1 82 6
(3 19) 356-5040
(319) 356-5497 FAX
First
1. (Name C_ Arr'.57
2. MailingAddress...................... C
Authorization Number
(Office Use Oniy—)
(Police Department review must be made
between 8 a.m. to • ...d
3. "1eiephone: IOome............................................... ��._............. .` .....
...................................................
4. Prior experience In transportaflon of passengers „_
Ii C 16
Other:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VC%
mit' t�
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? nio
7. Have you been convicted of any traffic offenses in the last five years?
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the Cast five years? ,_____ Al
When
9. Have you ever applied to bb�//
e an Iowa City taxi driver using a different name? If yes, please provide the name(s)
/Vo
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
d6MIWO&W9 03/2014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
(�I t'. e'r" 2 W..316 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 wiu
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)
.'. r
Signature of Applicant , . . �„-� � �°°•°°°��"' Date_Z
.. -2 vl
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 lcgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed
and sworn to before me by
C.— 4k-FT%a,iA
. On this J �i�'t".�(. day of
$.^. ......................erg...:`>..
"r
ir ^
�y
in and for the State of
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Y .
Signature 'lice Chief or designee
C7ate
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signature of City Clerk or designee
4 to
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/:" (width) and 5'/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derWWidq=adaeapp2014.dcc 03/2014
r
Div of Criminal [nvestigat on
„
M
dci 10A0. 99.93 P. 1/1
,
0
STATE OF IOWA
\v
Criminal R ttr er Check
Requept Form
+`B
'j'a. Iowa DwhIm of Cllwwma 1hun8dsmHod
ftppm opors6*00 puma, rw Nov
2'd3 At
q8� �Sw$m6Paa fl��9b �%�
Cies} Ua
(Sd.5)" o
IN
I
DC1AdcoQntNVW= 1313'"
FC -
Cue �' k
A res'Fam
116 j�cvo*s
/�� age .�nY$�nm �$ fir'( r
aiver14/or iva'. w66homrta 01ped waiver bmw ame Nobjed OT Me requIN4 a CoNvIde cdmwml Watery u red May aoa
The woempmumal coh,arlewYo,chmplor 69= per.amftedvalhmihist"Iry HuRwMadDs.stIle¢ AWAY$
mrikWm mmauamammwml .wMVtrz$Dlv$a$mumG'z:uWNd
airo44 ft DO wybaw u dk=A kr 4w.
Pb—
DO 6aaYieW%.
Received Time May, 10. 2014 12:29AM No. 8145
are nnbpp
:r
F
�.i
nmm~.
»..n
!tea
m
e,
u
I
OOT
p g y!N fg �w e
doLgOV
SMAR 1, 1N P, U'Al p k. 'P' 1 C Qj� f d l /. � , R' 'U uW `� K. � P u`4;V000W�m rvilN�'IN'�OMOitlMIMoiNil9�WI M1IgFMuulpinlTiN1 ✓Pad l oiillalLRi!!(/NnnOIHNrtMMmiggro,
!