The URL can be used to link to this page

Home My WebLink About14-247t :Lill p" CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Authorization Number I q -_a"1 (Office UseOnly) 91F-1"QWC® APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) sella ��n_fgaarraz/x//qp "`taafa_ra�¢uul_ aa�ret mr�o r7d� �TEa f 1a nc_c f �¢ PLxdEEtmprt 1. Name (REQUIRED) 2. Mailing Address (REQUIRED)e-j i Prior experience in transportation of passengers: 5 -Z'7 -5'g- 3. Contact Information (REQUIRED) Ema -5'g— 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? •,J t) Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1,1D Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? 'E 4 When Type of offense Where When 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? N D Type of offense Where When gam' 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide th"ame(s) f1% t! 1 - DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEIEfTIRED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CtHEF RREW ^' You must apply for an individual Department of Criminal Investigation Report (form availaMe:upo§i request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) C3 09/2014 I hereby certify that I have issued to me by the Iowa iaepaltment of Transportation a valid Chauffeurs license dumber D a-"-1LaS I understand that if I falseiv answer anv 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. (mvsat'is to it;a sigrad in fmt of a Notary Public) Signature of Applicant - a _ 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 vvebsite at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) Of 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). kiv Signature ief 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 lcgov.org. 414U/ U .e" SionbttX6 of City Clerk or designee Da e Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/211(width) and 5'/:" (height) and prominently displayed to all passengers. *#Roti**ttttt*}ttttxRttttit#tt#tit*xtttt*ttttttttt##t*:FR}Rti#ttttti**kttt*ttttt:Fktttt}tiff*,F.ltt:H:ttx#kttttttttt:Fk#tt*t*ttti#t*tttttk#t#Yr#ttttttt Office Use Only Approved application DCI report State certified driving record Website update CImWrAXIDRNB GEAPPL92014amazWed.DOC 09/2014 IQ/ Uct,®[r. [MB!t,44t'ivf—abc®iv or t,rlmina: invest lgat ,on (FAx)310330200•413I Y. 1/1002 0Gf i�6'�k kSTATE OF IOWACriminal History Record Check ,n Request Porm Ter Iowa Division , SuPPDrt Opbr9flovis Bureau. ]"Floor 216 X. I" Street boo Molnes, low$ 80319 (310) 726-0066 0 Fax r DCYAouoomrge'Nurrebsr8,,,, 9967, — (lltapppYcabNs) peo me `&"oogrrw Cab aer.1towm Cly �.0,13ox 4288 ®..... �.._ .' 7epvv,,,,,... jo Cjty '� u 4 . ............................... (319)333 7 Phommg ...... alae ramage N WMEr-las,®rrmation, Witgonoat a Mdpwd vre[mer ironm gCreosmllpoos og P,gge reapv�eekl ooampgaro grinagelzl hiltory r000gd mmmynot be metoasmg go, tact dodo saRAarve, ChqpJar 6P2,2, mr 0,osapu�te orhOnml agsaaary record Nrnforumaeg®n1 as allowed by Ow, always elvarAs/oaysm: I h aeby Deva yaelmMon ebs Oka move raadaaU ft oNNNetw ae Nmvaeo@IMURMCD. Any odmlWtlNsaorydcaaeaam nmaaaathatBsM*r0BPpedeye "`19l1psr signaturea sap Pavan adm Irma higmy record oh"k VAH196 8YMdon offOrBr od nay he ftasad ea MHOWadS by raw, @CN am& only) Am of ��_� �` � a e h of the provided twine and dau of , [ No Iowa Crlraalaasal History Record .fcsaaand with DC1 r a1 lava'a Crlrrvslanm& History Record m96mas&aasdl Dc1 k .. DO inidale r> DC1.77 (06/25/10) Received Time Oct. 27, 2014 9;11AM No, 3873 m Iowa e pa Trans u n lit i lion Pio :P dui e lrrt �� u 0 ii�¢i0) 81,1 N32 1121 N.e Bux TIN, EN,,3 fitiflE1fIJ; tk 5C,(3&;*'!)M14 S1 6, 244 191124 I - li-a"wh:51R4fim )Yv"@'iM City/State: LONE TREE, IA Expiration Datm 12/22/2014 52755 Mailing City/State: Date of Birth: LONE TREE, IA Sex: 527550183 T Corrective Lenses 12/22/1967 M History Information CDL Mod Status: None Restriction None Supplement: Name: Lathrop, Kenneth Dean DL/ID: 082CC2468 " Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department.of TriWsportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a iriie andraccurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director of the Io4Ya 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: u '. 14„ r %tli 11/1/2014 1� 0. 0. T. 94 r4 r a"^4 nl4.tpuu u,��k�( �,�� Gnf4Tios^ of V)� Yver SRewuce� Iowa Department of Transporation Certified Abstract of Driving Record Inquiry Date: 11/1/2014 DL/ID #: 082CC2468 (IA) Customer #: 2931188 Name: Lathrop, Kenneth Class: A ID Status: None Dean Address: 4763 HWY 22 NE Audit : 4033375 DL Status: VAL Issue Date: 01/21/2010 CDL Status: VAL City/State: LONE TREE, IA Expiration Datm 12/22/2014 52755 Mailing City/State: Date of Birth: LONE TREE, IA Sex: 527550183 T Corrective Lenses 12/22/1967 M History Information CDL Mod Status: None Restriction None Supplement: Name: Lathrop, Kenneth Dean DL/ID: 082CC2468 " Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department.of TriWsportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a iriie andraccurate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director of the Io4Ya 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: u '. 14„ r %tli 11/1/2014 1� 0. 0. T. 94 r4 r a"^4 nl4.tpuu u,��k�( �,�� Gnf4Tios^ of V)� Yver SRewuce� Iowa Department of Transporation