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HomeMy WebLinkAbout15-108CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319)3S6-5497 FAX 1. Name (REQUIRED) . 2 Address (REQUIRED) IDENTIFICATION NO. /5—/0( (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 application Last 'a6 v 3, Contact Information (REQUIRED) Email: �.DQiSUd-.T2©`T��I�, , �� Celli QD--V7!3 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) qi,e a / 2%) I I /,V- b. yb. Taxicab Business Name (REQUIRED) _ V61—Lo" 0i 5. Prior experience in transportation of passengers: S I i i C h 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When / llv� What happened to the charge? (Circle one) c Convicted Dismissed Deferred Suspended Plead Guilty Epther 7. Have you been arrested / charged with any traffic offenses in the last five years? ZES2 i i t _Type of offense Where _ f" <r`"' a ��. o0 Q What happened to the charge? (Circle one) (.n ua 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? '),7"1 Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the names) 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h % certify that I have issued to me by the Iowa Department of Transportation p v lid Chauffeur's license number C2 Z,2. I -A issued on xpiring onli I understand that if I falsely answer any ques ions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provi ' ns o Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant .+ Date 'Va9y'r STATE OF IOWA ) COUNTY OF JOHNSON ) n Sub ed and sworn to before me by A ron this ��y�� day of " s, E K. TUrn F Notary Public in and for the State of Iowa 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 City (Title 5, Chapter 2, City Code). J, � Expiration date of Chauffeur's license / J / — /— / i Date 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. Signature of City Clerk or designee -.2g-/5 Date C=rWrA IDRwEADGEAPPi92014amendad.Doc 03/2015 : C1 :,Ir. In Office Use Only i� =t -FC7 r Approved application _ DCI report c co !� State certified driving record Website update m C=rWrA IDRwEADGEAPPi92014amendad.Doc 03/2015 r Iowa Department of Transportation 01i of Dayff services (loll F Ice) AM 532 1121 f'at PO O'9204, DBs M1aom, 44 5039159244 515.244.4124 SAX, 515 239183/ CLEAR DRIVING RECORD Name: Dresden, Arthur Anthony Jr OL/ID: 960ZZ6211 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: 5/27/2015 ' 10WA M1 f d.0.T � ll�h,i's Office of Driver Services Iowa Department of Transporation Name: Dresden, Arthur Anthony Jr DL/ID: 960ZZ6211 Certified Abstract of Driving Record Inquiry Date: 5/27/2015 DL/ID #: 960ZZ6211(IA) Customer #: 1024572 Name: Dresden, Arthur Class: D ID Status: None Anthony Jr Address: 4219 Lloyd Avenue Audit 7t: 7593269 DL Status: VAL Se Issue Date: 12/08/2013 CDL Status: None City/State: Iowa City, IA 52240 Expiration Date: 12/11/2018 CDL Cert Status: None Endorsements: 21- CDL Med Status: None Mailing Address: 4219 Lloyd Avenue Restrictions: Corrective Lenses Restriction None Se Supplement: Date of Birth: 12/11/1954 Mailing Iowa City, IA 52240 Sex: M City/State: History Information CLEAR DRIVING RECORD Name: Dresden, Arthur Anthony Jr OL/ID: 960ZZ6211 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: 5/27/2015 ' 10WA M1 f d.0.T � ll�h,i's Office of Driver Services Iowa Department of Transporation Name: Dresden, Arthur Anthony Jr DL/ID: 960ZZ6211 OS/MdY' {5, 20.153 � 41 FM Ceb DIV 0{V CVYlml hdI ihY2S{IgdtlOfl (FAX)310330211�� r�86 P. 20.153 STATE OF IOWA s • • • -Request Form ck To: Iowa Division orCrlminal Invactlgatlon Support Operations Bureau, I" Floor 215 E. 71e Street Des Mo)nos, Iowa 50219 (515) 7256066 (515)725.6080 Fax DCI Account Number; -9967-F (if Applicable) From: 'Yellow Cab of Io1va City P.O. Box 426 Iowa City, LA. 52244 (319) 338.9777 Phonoi Fax: (319)339-9302 Last Name wkndaa First Name (mandpioryy i dd77dle Name (recommended) 'WiSI3$ M .r r N�fioN Date of.Lirth-lanondua) .-- — -- • •C3onderihuiloia" ' "` Sc"cial 5eaurl NLLIt7ber recommended j z, j 6'� Mule ❑Fotnaie6��.S+��t:Sc�y Waiver Informaflon, Without a signed waiver from the subjoet of the ret(past, et complgte crlminnl history record may not be releasable, per Cade of Iowa, Chapter 692,2. For complete criminal hlstoryreoord Informatlon, as allowed bylaw, always obinln a watvarsl nature Cr9m the sub eat oftho request, DC1 initials_ hLt—_ Wal ver Release: I hereby givo perinlulun roe iho Above rsquvtlog at0alel to gonduo(sn Iowa odmlnal hinory teoord ehsok wirh the Dlvinon oCCrlminel Incelogsticn(DQ. Any atimloolhltieryduAeonm (ns molhtlltmeimAlnedbyoto DCrmeybeteleuoduAllowed byItw, Waiver signature; (DCI we only) As of _ 5��� a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI j ❑ Iowa Criminal History Record attached, DCI # DC1 initials_ hLt—_ Al