HomeMy WebLinkAbout15-15374r"1111�lp���
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319)356-5040
(319) 3S6-5497 FAX
1. Name (REQUIRED) -
IDENTIFICATION NO. _/,j - /,53
(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
rst
Middle
2. Address (REQUIRED) aa5cA t-,pNj-G ST, T v.3SR rr-I
3. Contact Information (REQUIRED) Email: CellPhone:(31-q� 45-1-1/7't
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) (2_ S' 87
b. Taxicab Business Name (REQUIRED) _ y(U i_D w /A,03
5. Prior experience in transportation of passengers: -oftT , Te)�
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A J(O
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
r\1D
Where
-AA
When
What happened to the charge? (Circle one) 3,A os .?(toz p4nA"9
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?� j
Type of offense Where When
SJ�('r�ti nim P
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 QtaTIFI&
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Cl-ilrl E%EW - rl.
You must apply for an individual Department of Criminal InvestigationReport (form availa ppoajequTY
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY
02/2015
Crs
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
:Y –4-q V `/ ltLB -f issued on 2 l expiring on o ,)g' ` a . 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 provisio s of��Title
�//5,/�, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant_S2��� `UG/� Date 6o1GLS
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by fsn_— `J�i l,y� on this 13 day of
A%,,, , 43 1N
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 031LA (2pl G)
_LI LA _ bsbas—
Signature of Police Chief 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.
Signature of City Clerk or designee
Date
♦*******xh*kh********xkhh;h*tk*****************hkk*************;;hkk*h******k**k**;x*k**kh*k**********x*xxh**********k**k*hh**#***********xhh*#*
Office Use Only
,
Approved application
DCI report
c,ly_<
State certified driving record
c,a
w
Website update
�
cn
Clelk,TAXIDRI 6 DGEAPPL92014amended.DOC
03/2015
(101UWADOT
SMARTER 6 51MPL£R ICU' T�}MEF pRJVid }JUW4V:tC11NaCit7t g4V
Office of Driver Services
PC BoN 9204 ; Des Pdoknes, IA 5930E-9204
Pho€3e: 515-244-61241 ff00-532-1121 ( Far.: 515-239-1837
www.iowadotgov
Certified Abstract of Driving Record
Inquiry Date:
7/23/2015
DL/ID 7e:
779YY1257 (IA)
Customer U;
5054097
Name:
Suhr, Scott Michael
Class:
C
ID Status:
VAL
Address:
2259 DAVIS ST
Audit A:
7186993
OL Status:
VAL
02/17/2013103/21/2013
Issue Date:
07/30/2013
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
03/04/2016
CDL Cert
None
522405858
Date:
Status:
Endorsements:
NONE
CDL Med
None
Status:
Mailing Address:
2259 DAVIS ST
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth;
3/4/1988
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522405858
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
]UR
02/28/2010
105/06/2010
':820
-i Driving While Suspended, Denied, Cancelled, Revoked
Johnson
IA
07/27/2012
'.09/10/2012
':851
No Driver's License
Johnson
IA
02/17/2013103/21/2013
B20
Driving While Suspended, Denied, Cancelled, Revoked
:Johnson
IA
Sanctions
Type Effective End ACD Explanation Occurrence JUR ]UR
Suspended 12/19/2012 07/29/2013 D53 Non -Payment of Iowa Fine IA IA
Name: Suhr, Scott Michael DL/ID: 779YY1257
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:
��o0pER16Lf.d��ipto
7/23/2015
�' IOWA
ri���f
091VER $�J
Office of Driver oi cs
Iowa Departmentof Transportation
u'r.30. 2015 10:29AM Div of Criminal I n v e a f i g a t i o n No, 2013 P, 1/4
Fr.., u.....,. — .1— —, Ole" vi,...n — --4 07/29/2016 11.- 417b --2/002
sTAI E OF �WYA
CC>rilrlillai History Record Check
Rey r> at Forlrl
To: Iov:a ➢ivieiim of Criminal investigation
4uppart Operations f3urtau, la` ploor
215 t, 71" 4treet
Ars h1e6,es, iawa 50319
(515)%25-6066
725.6080 )'ax
lam requestin + an lot�'a Critninal_1-1
Last Nalele (maneatoq)
Aatc Df l3irf[t (ntanda,ory)
P2
))CI Acooilw Number:
(rapplir8blc)
Fr(m: Gam' of lowt3 (iC� -- -- _ -
Cite Clerh's Olrjuc -
4)0 E. Waghipytou °street
r r„a Cit
XL M s�zao .-......._.._..._.-_...-._.
Pbone: 319-356.9041
Fax: 319-356-5497— -----"--
yhlt lle El Female
e
lypiver Iltformation., w"0011141 signed waiver limn Lhe subJecl of the reyucsl, a complete criminal history record may nal
be releasable, per Code of Iowa, Chapter 692.2. For complete criminal histury record blforma(ion, as allowed by law, ahrays
obtain a waiver slpnature from the suWeef of the re4uesl.
W'lti"J'ReWSe; l hereby give permission fonhcy.' ave ra
mvcstigalinn PCI). Any criminal hisloq dale canceniI nit 0,41
hVaiver5'i;trdfurel
is "ollool all lona erimiuel histop' record cite): wish the Division or Criminal
r rhe DO may be released as allowed by law.
Iowa Criminal History ReC01i'd Check Results
As of_ 45 a search of [lie proAded name and date of birth levea
1yo Iowa G-intill al History Record found ,with D(7
11 ILMIa C:firoinal Hislor)' Record attached, DCl #
DU iniiials_L�W_
DC1-77 (06;/251110)
Received Time Jul, 29. 2015 11:03AM Na 4 15 3
c ,, CL
(UC�I 9su a,;ly)