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Home My WebLink About15-134r t CITY OF IOWA CITY 410 East Washington Street �ua Cit Iowa 52240-1826 (319)356-5040 (319) -5497 FAX 1, Name (REQUIRED) _ 2 Address (REQUIRED) IDENTIFICATION NO. 15_ 1 3 q (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 Firsttll. / _ / Middle ,,q i / Last 3. Contact Information (REQUIRED) Email: (All email) I Phone' ci7��-aCJo2-c7 4a. Chauffeur's License expiration date (REQUIRED)� zOCr/yk b, Taxicab Business Name (REQUIRED) _ye-11^x,U eC,6 5. Prior experience in transportation of passengers: &Us r; ve 4- far 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? AJ 0 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense WhereC- n c= What happened to the charge? (Circle one) t 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? n f1i d 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) ti 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 he ce tify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number /`�Q jJC �(l� issued on %6z3//z expiring on /d/z3�� 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 cr 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 ! — Date_7 STATE OF IOWA ) COUNTY OF JOHNSON ) ubscribed and sworn to before me by �\t t+ • A,'n on this b day of Public in and fo the State of Iowa 71 � I I� 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). Expiration date of Chauffeur's license !cam 12J L2ar7 `f tD7Q 22 S Signature of Polide Cifief or designee 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. 14,1�F, Signa re of City Clerk or designee -7/< // Dpfe N _ Office Use Only O C= Approved application --fC c^ DCI report —<r— —p pr� i � i State certified driving record % " a Website update cn cierar IDRWBADcenPPLszmaamended.Doc 03/2015 Jul. 1. M; 4:14N Div of Criminal lnvesfi atlon Fr_..,._ _� _. •.- _ Gle,.. ._..�.. .. ..... ......r_..• Oi/OL 2D'I6 12:.No. 030 P. 1/12/D02 STATE OF 10�7j/A Criftlitlat History Record Check Request Form 'ro; town Divisiva of Criminal Invesfiga(iou .`;uppUri 01)era tions Hureau, I"FInor 215 P. Ta street Des Moines, IOWA 50319 (515) 725-6066 (515)7254080 Pax I am re uestirt r all IrAva Cript(q; Feast Name UnandalorY) Date of Birth (mandamy) ._d3._iT On: y iirrs1t iNarne (n,andalo)r %I 11 C- C l el, DC:1 Aceonul Number: U2—� _---- 61'ap�licable) _--- t`Ynm' City of !Gu'a Clfv City Clcrlt's Gf(;cc-------_--"--"- _4101=, Washin�lon fitrecf IInra CIl , IA 52240 Phone: 319-356-5041 fr®x: 319-356-5497 A, �4 v/'j �/ Mlale OPentale I tl — a — 6 6 S"—` Vi'dlver jnforinolitllR Without s signed waiver from the $ubJeci of the req uestues , a� crisnin81 Idstory record ntay not be releasable, per Code ofiatra, Chapter 692.2, hot cow criminal history record iufa•ma(ion, as allotted by Ieh•, always obtain a waiver si nature from the sub'ed of fhe request. Waiver Release; I hcreb iv x lnvestiea ( 1. An cr' rg �nennissiun for 1),e abo,•e req,Icssing afliciar to cooduel an lora crinsinul hisroy record cl,ttk rvish she Division ofennmiaal ° tion DC) y ,urinal hi -lop• data cm,ccnmsg me 1)131 is maintahtcd by die DCI may be released as allotted by 131t. Waive)'Signarure OVVa CHtll%nai FIistor r Record Cheek Resultjealld v - \ (DC) „se o»irl As of—� � � A search Df the provided name and date Of bi u� —I A" No lows Criminal History Record found Willi DC']waCrimnal Ilistmy Record attached, DCIDO initialsDCI-77 (OS/2/10) —. Received Time Jul. 1. 2015 12:32PM No. 1990 Y 111111 ►DDT 'mWi0wadottlov SMARTER I SiMPLLR I CUSTOMER DRIVE14. Office of Driver Services PO Be,,( 92041 Des MOEot , LA 50306-9204 Phone: 595-244-91241800-532-1121 [Fax:515,239-1837 vCJow1adot gov Certified Abstract of Driving Record Inquiry Date: 7/1/2015 Name: Hunt, Mlchael Anthony Address: 2437 PETSEL PL APT 4 City/State: IOWA CITY, IA 522463613 DL/ID #; 124AC2612 (IA) Class: e Audit #: 6409870 Issue Date: 10/23/2012 Expiration 10/23/2017 Date: Endorsements: PS Mailing Address: 2437 PETSEL PL APT 4 Restrictions: NONE Date of Birth: 10/23/1978 Mailing City/State: IOWA CITY, IA Sex: M 522463613 History Information CLEAR DRIVING RECORD Name: Hunt, Michael Anthony DL/ID: 124AC2612 Customer #; ID Status: DL Status: CDL Status: CDL Cert Status: CDL Med Status; Restriction Supplement; 5223692 None VAL VAL Excepted Interstate None None 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, apd 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: v/0 to 7/1/2015 10WA : ¢f%y r 9/ Sol VEA Office of Driver Services Iowa Department of Transportation Name: Hunt, Michael Anthony DL/ID: 124AC2612