The URL can be used to link to this page

Home My WebLink About14-105t�rl�jl�®d1� ,, �� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First 1. Name 4 mat w 2. Mailing Address 3. Telephone: Home 4. Prior experience in Authorization Number. 144 — i oL (Office Use Only) Ra -f -c -,O APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 0 1 6 Himvm :�'T Vee T , Lov� ortation of passengers: ani ivL LO� cit Other: Cr Se�✓ei V -i DIS C qt'I N a.°„s 'I -a(,( U%/P—e,"ra In 3(q-cj3 S S co, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? () Type of offense Where When hY 1... 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? "0 Tvoe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? y T e f o en e. ` here When 8. FN yyO drr 5ie`ense or chauffeur's license bee sus`pehded�oY(re oked in the last five Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Vi U DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) cltMd idrivbadg 03/2014 hereby certify that I h ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number r"i(� � 3 4 � . 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 w 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. w.wwwww«x..w«axxw..+aw:ewwewwwxwwwwwwwwaxwwwwwwwwwwwkwwwwwxwwwwwwxwwwwwwwwwwwwm+wwwwwwwww«wsxwwewwww.x«xxwxxwwwwwrwwwwwawxnxwwwwwwwwwwxrwwwwwwwww.r STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by }�S �. Lt)P2t' RAZr v\ On this day 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). Signature of P i f 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. Signatu of City Clerk or designee 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. xxxwww.xwwwwwwxxxwwwwwxwxxwawwww>xxwwwwwww+axxwxwaww>wwwwww+«wwswwwwwwwswwxwwwwwwxwwwwxwxwwwwwwsxswxaxwwxwwwwwwxwwwwwssxxxwwwwswwwwwwxwwwwawwww+ Office Use Only Approved application DCI report State certified driving record Website update derMaxhfrlvI,adgeapp2014.doa 0312014 02,17eb.28. 2014912 04PM Div of Criminal Investigation DC1 100P,4094 P ,1/4 STATE OF IOWA Criminal history Record Cbeek Request Form) 'Y. TO: Iowa 11Wkloa OfCrlminal lovettlgattee Support oprranom 8ursou, l" Floor 215 L 7k Street on Melba, Iowa 50319 (515)725-6w (515) 7iU040 FBI DCIAwnuntNumbet; PA T (IPepelieable7 From; an,5 i 0.xl 6 5kevtw1 fir• 14000, A Phooe, ,{3lit 338- Fare, • Nq 351 - List Name - LastName mudeev First Name meaee I 11dlddleNome eeraa VV C2P�wvGbll �@ f CSL �1 Date of $irl I�7J Gender "w d.b Social Security Number Womn�eae2al fh(m�uq.e M. l �"f "J � OFemale �J l (j ale Waiver WormaUoN,' Without a lfgoed walvcr from the eobJect of the request, a complete criminal bUtoly rarord may got be rolmubte, per Code of Iowa, Chapter 6§12. Icor comblele ctlmlaal hhtory record tntermatyeu, a allowed by law, alWrYs oh Ib pw oral atureDom The subject arthe rMucat Wa)Ver Releaser I hembyalre p_idlee re, go ebdve eMquenln; agiwl a cVWW V toW c6mbal hlaaq mord cheek wtoL the Divhlon of CnAml rgvevaplfvn tUCl} A,wfriMWJhlelerydreae me h mehWlrodbythe nDCIMYIaF&�udlawdbylew. — - Waiver Sign Of laws Crimiual Mtory Record Cbleck Results loclveaanly) As of -a. (? - I a search of the provided name and date of birth revealed; , -} - 4- No Iowa Criminal History Record found with llCl s-1, 1 vl , ❑ Iowa Criminal History Record attached, DCI N x; 77 -10 _ r DCI initials 0A 2 N Received Time Feb. 25, 2014 11:56AM Ifo. 0340 `aiUVVA DOT SI APTEtt 15 1 b1A Iv,: , i CUST0;yt,;i D?, a''N,' Office of Driver Services PO Box 0204 I nes Moines fA 50306-9204 Phone: 515-244-9124 1 FOO -532-1121 � Fn+. 515-230-1837 rrvmvr.lowadot.govv Certified Abstract of Driving Record Inquiry Date: 3/7/2014 DL/ID S: Name: Wezeman, Peter Jenkins Class: Address: 1016 DIANA ST Audit #: 05/19/2009 CDL Status: Issue Date: City/State: IOWA CITY, IA 522404627 Expiration Date: 2L CDL Med Status: Endorsements: Mailing Address: 1016 DIANA ST Restrictions: 5/18/1951 Supplement: Date of Birth: Mailing City/State: IOWA CITY, IA 522404627 Sex: Convictions 012AA3346 (IA) Customer #: 3632089 D ID Status: None 3318758 DL Status: VAL 05/19/2009 CDL Status: None 05/18/2014 CDL Cert Status: None 2L CDL Med Status: None Corrective Lenses Restriction None 5/18/1951 Supplement: IA M 03/03/2010 �M 75 History Information a i'flora SY�ia ComriaYloax 3, E s.CD Pe .rlanation Cat: 3U2 04/08/2009 05/09/2009 M14 `Fail to Obey Traffic Sign/Signal -i.Johnson IA 05/04/2009 06/23/2009 592 Speed (10 mph & under in 35-55 mph zone) _ Johnson ]A 09/20/2009 . ... 11/02/2009 ,_..,. _.�92 Speed IA 12/16/2009 03/03/2010 �M 75 _..,., _ _____. . ..._ Passing School Bus ,IJohnson ... _ _._..,. ':Johnson .._. .. , .IA 02/04/2013 02/26/2013 864 No Insurance Card :Johnson IA 03/19/2013 04/19/2013 IN62 'Improper Backing Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Bate Case f7umber 3UF Name: Wezeman, Peter Jenkins DL/ID: 012AA3346 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: ......... ....... `S 3/7/2014 4%:'IOWA' 1",*f uglyEQ$ a IbwaeDepartment of Driver eof'Transportation Name: Wezeman, Peter Jenkins DL/ID: 012AA3346