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Home My WebLink About15-113CITY OF IOWA CITY 410 East Washington Street to CIL , Iowa 5 22 40-1 82 6 19J 35S=5iii'4'0 t31 7 FAX /�4uft(Office n iVumber 15' 0 111 u vin F - ( Use only) c APPLICATION FOR TAXI / MOTORIZED PEDICA13 VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Failure fo complete the '4easired" informatlon will result in denial of the application I. Name (REQUIRED) I 1A 2. Mailing Address (REQUIRED) 3. Contact informaton (REQUIRED) Email: 4. Prior experience in transportation of passengers: 0 5 Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Who When 6. Have you n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last fore years? Type of_Offense 7. Have you been convicted of any trafRc offenses in the last five years? 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Igoe of offense When 9. Have you ever applied to be an Iowa City taxi driver using a different name? if yes, please provide the name(sr— DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE C7E7IIFI M DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE1ll You must apply for an individual Department of Criminal Investigation Report (form evallable upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 ti!! Z tJ fjBOwld to me by the Iowa '-)apartment of Transportation a valid Chautfeurs license number [„[ '?. I understand that 91 falsely answer any questions in this application, that this application maybd denied. I u Iderstand 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 Pubilc) Signature of Applicant �F I!C(1n Date i YOU ARE NOT VALID TO DRIVE ATAXI 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. M##iRRveRRfefMk444ffiYA*hIMRiM1RNMlfRRk4 V 4Mvk#kt4iMYMlnMFA4M4t4444'MRR,twH,Rfil441YRiM44i44aIiwRA4ittl44ifr/�fRHRR4Hr1,4M4i#R4I,4Mk�bMi4tMRi4AiY STATE OF IOWA ) COUNTYOFJOHNSON S bscribed and swom to before me by 1�2jo—+ � I f 1 On this 201't'k- 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). 112-b/r5 Signet of P ' e Chief or designee Date YOU A OT 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. WWI . Si latu f City Clerk or designee 1"4V//s f Date— Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'h" (width) and 5 (height) and prominently displayed to all passengers. Mawsr„nx4wR44wrrrrR4»eRRanaR4afRa4R4+4»+awr44a+aa44w4+wR44a4RR++RRx4R+.+4w4wf+RR•++++*Rwn�we+R4m4ae4sRaaa4.,e,Nw++R4e4RrR»4w4n,.4w44+x+e Office Use Only Approved application DCI report State certified driving record Website update CkmwrvmwIRADG errunmavm. .DM 0911014 lin. f,i p♦, 9, 2015 10:24AM Div of Criminal Investigation No•7666 P. 1/7 Jan, 8, 2015 11:51AM City Clerk - City of Iowa City No. 5524 N. 2 STATE 1,i i O, Y ,Ltd/1(•J Y r>,t��1 i 'I f Iall ..Ii i1 .bit IIVie,'•t!'d (Check kRequesi Form � Tor Iowa hfvldotl of Criminal Investigation 4upport Operations burcau, 01noor 219 $. 7'a Wool DsaMohlerjowa 50319 (515) 725.6066 (515) IM -6030 Fax I am reauestlac an Iow& alininal liistuivPAcord Check on: M Account Number: (ifappllca I¢ Fromr Cltyofiowacl Citycierlc¢a Ofllee 410 F.Washington 8trcet IowaCKY, lA 63240 - -- ca Phone: 319-596-5041 — Fax: 310496-9497 LikO 1l MO (nisndwo Mrst Name (mendalMY) Middle Name ttecemmuid A- W'sw k- U:X M c a� Date ofBirtd manes Cand.�errmandoo Social Security Numbcr ccconimordw 6d1Vialc OPetnale b d ! lj WdVL'F llijilO etaflour WIthoat a signed waiver from &c sub)ectaf the request, a complete criminal history record may aat berolcsssble,per CadeafXowa,Chapter 6912,For atecriminal historyrecord information, asalfowcllbylew,always ahtainawalverrf tureiFomthesnb eMofthaxe uosf, WaiVer B410(Ue: 1hemby give pumla lon bar the IbOveT<quetflniyerrlcioi to tanduct op Tow wieibW hhtory record check whh thobMilon ofCdralaal laveO tion(DO). Myalmt¢¢IhlctarydalecoactmlrFgmelbalhmlh7laDi¢dbyloo])Cla7eyhereleettduaaowrAbylorv. Waiver35'gnarfcYe;-QQ� ,S'( t/1 iA As of ( -1- Is , a seerch ofthoproWded name and dates of birth revealed: %- No Iowa Criminal Ostoay Rocovil found with )XI ® Iowa Wminal History Record attached, DCI # IDClinidab_LA Received Time -Jan. 8.:2015-11:550-6,7587--- }I f o O W1Av, 30YVc"1dCi gOV SMARTER ISIMPLER 1 CUSTOMER DMVEtd,.��.�� Office of Driver 5'arvices PO Box 91(41 Des hilkine5, 1A 50306 X9204 Phone: 515-24491241 BPU-532-1123 ( Fax 519-239-1837 - - www.kAvwdotyov Certified Abstract of Driving Record Inquiry Date: 1/8/2015 Name: Allison, Raven Michael Address: 621 1/2 BROWN City/State: IOWA CITY, CA 52245 Mailing Address: 621 1/2 BROWN Mailing City/State: IOWA CITY, 1A 52245 Convictions DL/ID #: 769YY0847 (IA) Class: D Audit #: 8730680 Issas Date: 12/31/2014 Expiration 11/29/2022 Date: Endorsements: 3 Restrictions: NONE Date of Birth: 11/29/1961 Sex: M History Information Customer #: 4292418 ID Status: None DL Status: VAL CDL Status: None CDL Cart None Status: CDL Mad None Status: Restriction None Supplement: Citation Date Conviction Date ACD Explanation County-) IUR 01/16/2012 02106/2012 ;Improper Registration ?Johnson 'dA Name: Allison, Kevan Michael DL/ID: 759YY0847 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Servloes, 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. I 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: D. 0. T Name: Allison, Kevan Michael OL/ID: 769YY0847 1/8/2015 Office of Driver Services Iowa Depe rtment of The nsportatlon C410WADOT MAORTER IStHt"LER I STt v' E>k,I°jfN vVtr.rc. LCt+tai, onv Inquiry Date: 6/3/2015 Name: Allison, Kevan Michael Address: 621 1/2 BROWN City/State: IOWA CITY, IA 52245 Mailing Address: 621 1/2 BROWN Mailing City/State: IOWA CITY, IA 52245 Name: Allison, Kevan Michael DL/ID: 769YY0847 Offir`e cif E?river sor+: c� q PC, Ro— 3"04 I � e'._ 'i1 f7En :-. I -t+ Sfh 244-111 2.1 www kw ivjoi,Gov Certified Abstract of Driving Record DL/ID #: 769YY0847 (IA) Class: D Audit #: 8730680 Issue Date: 12/31/2014 Expiration Date: 11/29/2022 Endorsements: 3 Restrictions: NONE Date of Birth: 11/29/1961 Sex: M History Information CLEAR DRIVING RECORD Customer #: 4292418 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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: >,......... ryN�Ei 6/3/2015 D,O.T� 9f gR®g Office of Driver Services Iowa Department of Transportation Name: Allison, Kevan Michael DL/ID: 769YY0847