HomeMy WebLinkAbout14-097410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
Authorization Number V —ql
-- . I (Office Use Only)
Department
between 8 a.m. to 3 p.m., Monday — Friday.)
First (Middle Last
1. Name_a___------_..____________rt�ver__�5___---_____._
2. Mailing Address, �f "S:_� _---— t>aa� cPIy�...tj __ ?2 r�ca__________.__---._________________
fi' o Other:
4. Priorexperience iuv transportation of passengers: _ _��+
5. Have you ever been convicted of any misdemeanors and/or felonies in fts SUte or elsewhere? A0
a
rf"
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? NO
7 Have you been convicted of any traffic offenses in the last five years?
KM
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Il Q3
MM
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
defW s dmbao 03/2014
1 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
Y3Y z z._o5 ';X S . 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, 1 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 )
S scribed and sworn to before me b _--------------------- On this ��14%-"" da of I� y " r.r�uP;eR � �y
A'. I ) „,w, , r __ _ ____
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that then: 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).
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 -6f City Clerk or designnee �h
rg._r/
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derk4m:ddvbe gmpp2014.doc 03/2014
o3/,Mar. 2B. 2014; 1 : 02PM Div of Criminal Investigat on 4 DCX jiowk 3402
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CHwAuRl Hbtory Record Check
Request Form
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Received fimie Mar. 26. 2014 12:13PM No,55999
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Inquiry Date:
4/18/2014 111 3:
434ZZ0578 (IA)
Name:
Parsons, James Samuel Class:
D
Address:
801 S 7TH AVE Audit 8:
6719710
Issue Date:
02/23/2013
City/State;
IOWA CITY, IA 522406205 Expiration
02/12/2018
Date:
Endomements;
3
Mailing Address;
801 S 7TH AVE Restrictionss
Corrective Lenses
Date of Births
2/12/1981
Mailing City/ IOWA CITY, IA 522406205 S :
M
Name: Parsons, James Samuel DL/ID: 434220578
Customer 8: 4732685
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cart 11'allassic None
,
si;. t - - er ,, I NN
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:
Named Parsons, James Samuel IOL/IDs 434ZZ0578
4/18/2014
Vessel
n
Office of Driver Services
Iowa Department of Transportation