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Home My WebLink About15-128��oo., yryhM®CIL CITY OF IOWA CITY IDENTIFICATION NO 15 12-3 (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (3 19) 356-5497 FAX First Last 1. Name (REQUIRED) G��: syn��r� /1/1j�cLR� II ✓ �uv 2. Address (REQUIRED) d 3. Contact Information (REQUIRED) Email'raon.�Cell Phone: (All w tteen�o�®n%ntvia email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) rte//,w �� 4e 5. Prior experience in transportation of passengers: 6� t x7 r /vt� r�� `S T -Q Y 1, S & Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? e --r Type of offense Where When o What happened to the charge? (Circle one) :74c- <r- Convicted 74 c^ ^� < r�- Convicted Dismissed Deferred Suspended lead /Gu _-q r Have you been arrested / charged with any traffic offenses in the last five years? s � Type of offense WhereWhen y r S p u„/ i -Z.a -, e --My . / - y - ; l / r/cC1n What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPI/ e d G 1 Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /tit p 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) 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have iss e to me by the Iowa Department of Transportati a valid Chauffeur's license number issued on 5 3, ^ter �✓ expiring on I 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 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant c /� �ry ^¢ Date 6-1 'j - I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C r =; r nU e it� �' on this /9 41., day of 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 Cade). Expiration date of Chauffeur's license 2a/15/2 -Z Signature of Po' ief or designee ��zzl�S 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. Signa are of City Clerk or designee ac�_145 D to Office Use Only _a PP application Approved a ' cn DCI report c a -C ro ro State certified driving record Website update Cry v w Y N W Cler AXJDRWBADGEAPPL92014amended DOC 0312015 IU'WA DOT SMAR tcn I SR€APL4 i I CUSTOVIEF RMN Office of Driver Services PO Sax 9204 r Des Mcxnez, IA .5031)6-9204 Phone F16-244-8224 ( SH -51-2-11211 i Fax: 515-239-1837 wvnv.IawP,d6t.gflY Inquiry Date: 6/17/2015 Name: Pogue, Christopher Michael Address: 424 S LUCAS ST APT 6 City/State: IOWA CIN, IA 522405157 Mailing Address: 424 S LUCAS ST APT 6 Mailing City/State: IOWA CITY, IA 522405157 Convictions Certified Abstract of Driving Record DL/ID 7f: 803ZZ6639 (IA) Class: D Audit #: 8028929 Issue Date: 04/30/2014 Expiration 02/15/2022 Date: Endorsements: 3 Restrictions: NONE Date of Birth: 2/15/1983 Sex: M History Information Customer V: 5051546 ID Status: VAL DL Status: VAL CDL Status: None CDL Cert None Status: 01/04/2011 CDL Med Status: None Restriction None Supplement: X04/26/2011 Citation Date...... Conviction Date..... ACD Explanation County 308, 12/06/2010 01/04/2011 S92 _... Speed Johnson _SIA 04/13/2011 X04/26/2011 iS92 _... ;Speed .Johnson IA 07/11/2012 108/13/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Pogue, Christopher Michael Dill 803ZZ6639 Pursuant to Iowa Code §321.10, 1, 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: 3'pFNltlf "a,, M1'�� ,�'rwDdddd�WE.. f Name: Pogue, Christopher Michael DL/ID: 803ZZ6639 6/17/2015^, Office of Driver Services Iowa Department of Transportation iun,IT 2015 3�22PM Div of Criminal Investigation ND 9200 P. 3 Pr�n,...,.y .,, ,,.. w.. 4..r Cl erre �+n 1oe ero unn>uyi VE/1G 120'15 15:063 41RB P.002/002 STATE OF IOWA„ Criminal Hisfary Record Check1 fo: lovwa 1)ivlslcn of Criutinal loveaigatiou Support Operations Bureau, 1" Floor 215 E. 7" Sireci Des Moines, Iowa 50319 (515) 725-6066 (515)725.6080 liar; 1 aol requestin an lova Last Name (n,enaawp') Date of Birth (r„a„delm Record Check ons First Name m,a C� r, ) -/., f Gen 1 t'ripJ,w� 17CI Account Nltmbei: _o{ (if bpplicablC) Frons: Ciof In,va Citk'___� --_._-- City Clcrlds Office 410 )✓. Washingtoh Slrcet ON, TA 51240 Rhone: 319.356.5041 Fax: 319-356-5497 ----- (' �fViale ❑female 7 C r— -/> `--)11 ct W11iVerlrlforrnaH0Jl- Without a signed tvaiver from the subject of the request, a complete criminal History record ma), not be releasable, per Code of Iowa, Chapter 692.2, For complete. criminal history record information, as allowed by law, always obtain a waiver signature from the subiecl of the reaussei II'ltiver Release; I hercb)' give s,,,issian far the above «quelling olficial to eondut( Ja 101Ya tfimio0l Li51ory record check ,l'ilh 111c UiviSiee of Criminal Investigation (f)C 1) k, criminal history dale coneeauius mt Ilial is m8iw:sined by the DCI meyhcieleated as a%wcd by lase. Waiver Siglratlire: --- -�-----.... __..,.,.,. u.w (Del use mly) As of � (� �r a search of the provided name aid date of birth revealed No Iowa Criminal I lislur}r Record found with DCI cl i e l if. Iowa Crimiwal History Record attached, DCI # DCT initials___ t na DCl-77 (08/25/10) — --- --- -._ _-..-- Received Time Jun 16, 2015 3:03PM 11o.0823