The URL can be used to link to this page

Home My WebLink About15-087� r , MMM®t�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1 2. 3. IDENTIFICATION NO. j !�-j, (-) f 9)-1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the ap0cation Name (REQUIRED)i Address (REQUIRED) XgN 3 Contact Information (REQUIRED) Email: 7}i (All 1idc/- 5 r �5 1) �. A C @ &-mt4 i L , C-oM en communication sent via e 4a. Chauffeur's License expiration date (REQUIRED) S — P I a wA c- 1 I , f A SQL 2't 1 _ Cell Phone: 3 % q 6 2-1- % % 0 S 0 b. Taxicab Business Name (REQUIRED) i L L CtV C I� ' 5. Prior experience in transportation of passengers: dclv [= 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?� Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? /,/o Tvpe of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /101 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provi nalaw(s)d DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHEVgL' 11 r * I You must apply for an individual Department of Criminal Investigation Report (form availatRzqiupon 4quesP +:A (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ca. 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereb certify that I have issued to me by the Iowa Deart[ ent of Transportation a valid haujigur's license number S6k�{ 1.1 6 issued on i'I `1'15 expiring on 5`"-i-r� [gftl understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in making this application, I consent to allow agents or empl oyees of the City, of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this appli ation, and I fu er agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provision f T 5, Cha er 2,.sf the City Cade. (Needs to be signed in front of a Notary Public) Signature of Applicant // /�_,I Date tt- f C I STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by Me_v�E%4 f n on this ) Lst , day of I in add for the State I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa C (Title 5, Chapter 2, City Code). Expira0ondaChauff ur's license 10 designee Dat AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. �i A Ld�� k . a��J Signature of City Clerk or designee �f �/ 7 Date' x•xx..aexxxxxsxvivxxx:v*xxx*****+************#i-*##******************####***#**********+******###*********+****F***# *******�k*****##**i � Office Use Only -~C "`�► Approved application C DCI report State certified driving record �•l Website update ca ClerkrrAXIDRIV9ADGEAPPL92014wwded.DOC 03/2015 Pagel of 2 C4iUVVALJOT WVAVJ0VV8d0t g0V Office of Drivef Services PO Box 9204 7 Des Moires, iA 50306-9204 Phone: to 15-244-g124 1 A013-532-11121 { Fax: 1115-239-i 837 Ww',YJ0W-1d0 g0V Certified Abstract of Driving Record Inquiry Date; 4/4/2015 DL/ID #: 556YY0216(IA) Customer #: 1937125 Name: Arp, Henry Nichols Class: D ID Status: None Anderson Address: 2843 BROOKSIDE DR Audit #: 8981549 DL Status: VAL Issue Date: 04/04/2015 CDL Status: None City/State: IOWA CITY, IA Expiration 05/01/2017 CDL Cert None 522455410 Date: Status: Endorsements; 3 CDL Med None Status: Mailing Address: 2843 BROOKSIDE DR Restrictions: NONE Restriction None Date of Birth: 5/1/1963 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522455410 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number TUR 05/11/2011 630262 IA Name: Arp, Henry Nichols Anderson DL/ID: 556YY0216 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 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: •."". :'y®..'i�r 4/4/2015 IOWA'S",, D. 0. T. ' + yf••""•• S` Office of Driver Services ORIYER,_ Iowa Department of Transportation Name: Arp, Henry Nichols Anderson DL/]D: 556YY0216 4/4/2015 hp I. I7, zuID II:2Vhivi ulv or briminal Investigation No, 4962 P. 1/3 From:Clly Of lown Clty Clerk C,ffloo 319 3566097 oa/13/2016 13:09 .+021 P.002/002 err„ STATEOF 10VIVA Criminal History R'il'!J; Check � �� ,• ReqaestForm To: Iowa Division of Criminal Investtgallon Support Operations Bureau, I" Floor 2359.7 Ik Street Des Nobles, Iowa 50319 (515)725.6066 (515)72S-6000 Fax Last Name (mandamry 'A P -P Date of Bilrth (mandal /1 /C 4fL-nl fZ Y DCIAccounrl\ranlber: 00 '�^ E= (if applicable) From: (IV of Iowa Cit City Clark's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319-3565041 Fax: 319-356.5497 Name Ni C-fi-a L � ®Female Waiver lr(formatilM Without a signed waiver from the subject of the request, a complete criminal history cord may ibe releasable, per Code of Iowa, Chapter 692.2. For complete criminalre history record Information, as allowed re law, always obtain a waiver slentnicer ere from the Ant ,f ehn .an..e�a Waiver Release: i ii give permission ter the above requeVIllit offlclal to conduct m lowac' liaall sorry record check wiallhepirlsion ofCrimioal fnvesligstinn (DCI). Any criminal hissary dale eollmnin. me Ihet i willeb� by the DCf may be eased as�tlmyed by law. Waiver Signature: Iowa Criminal Histor Record Check Re is IDCl use o)ilyr, `.�1`� As of a search of the provided name and date of birth revealed: No Iowa Criminal history Kecord found with DCT :91� -� ® Iowa Criminal History Record attached, DCI DCI initials DCI -77 (08/25/10) Received Time Aar. 14_ 9015 19:59PM Ain -5911