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Home My WebLink About15-152l IDENTIFICATION NO. (Office Use Only Air®� t sill �h * Amli 11 APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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 (319) 3S6-5497 FAX Fir$$t Middle Last . 1. Name (REQUIRED) !{X",f - ry 2. Address (REQUIRED) 3. l eir-st rt ri 3. Contact Information (REQUIRED) Email: r L i p ts Cell Phone: (All written comm nication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 13- 17 b. Taxicab Business Name (REQUIRED) M C i -C. ds 5. Prior experience in transportation of passengers: �FGk o.scr, Ce : �, t� 5 t A TS ds V eCtfS 'truck ! c , ' e - r- Ia -& �vr 'p- -f � ct -t 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 110 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? 110 Type of offense Where When What happened to the charge? (Circle one) 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? YI 6 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 names) na 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 hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ]ot �C cC I `S issued on 2—)6 - IZ expiring on Z- S- 17 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_ Date STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and sworn to before me by �� e f S. F t4„xs�4at"this- day of /-ivc�u c,$ J,�/-� 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 Signatur7 cd Chief or designee T�te 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. Ajgna nre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update S /s Date CierwrAXIDRNeaoceAPPr9214amended.Doc 03/2015 410WADOT 5MArCEQ I �tiiri"'LIR I ?I.S1UP,A�P MI'VtN' �l4iV 1C3t+fC QL.C�[?V Gffice of D€ive€ Services PO Bon 92041 Cres Moines. IA 503*13-9204 Phc:o: 515-244 X3124 P. 800-532-021 I Fax: 515-23y-1837 wive. r-auadotgox Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. �,.:4:::.. •0.-fe i •s R,l aon�3er assts 08/30/2014 ,814876....... :IA Name: Liittschwager, Robert James DL/ID: 126AC0155 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: Name: Liittschwager, Robert James DL/ID: 126AC0155 8/1/2015 Office of Driver Services Iowa Department of Transportation Certified Abstract of Driving Record Inquiry Date: 8/1/2015 DL/ID #: 126AC0155 (IA) Customer #: 2108144 Name: Liittschwager, Robert Class: C ID Status: None James Address: 3255 HASTINGS AVE Audit #: 6108316 DL Status: VAL Issue Date: 07/10/2012 CDL Status: VAL City/State: IOWA CITY, IA Expiration 07/08/2017 CDL Cert Non -Excepted 522454022 Date: Status: Intrastate Endorsements: P CDL Med None Status: Mailing Address: 3255 HASTINGS AVE Restrictions: Corrective Lenses, No Restriction None Air Brake Equipped CMV Supplement: Date of Birth: 7/8/1962 Mailing City/State: IOWA CITY, IA Sex: M 522454022 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. �,.:4:::.. •0.-fe i •s R,l aon�3er assts 08/30/2014 ,814876....... :IA Name: Liittschwager, Robert James DL/ID: 126AC0155 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: Name: Liittschwager, Robert James DL/ID: 126AC0155 8/1/2015 Office of Driver Services Iowa Department of Transportation -„,Jul. 24. 2017 4:43PM Div of C(iminal Invesh anon No 1611 P. I/I Dcl 101, STATE OF IOWA Criminal History Record Check h' Request Form ;W Tel Iowa DtyWon of CWminal rovyR�atloe Support Operatbar aureaa, 1” Floor 216 & 7a street Drs MOWN, Iowa 66319 (SIS) 72&6066 (316) 775-M Fill ,,,t. RCI Account NtLmWr33-FC- Pram: frta'fC+s f �•XI � sk��s Or• ow A 5x3'10 31a 338- Fasi .. 319 551-U-1 tL Name tnw Vint Name Mldd iV.me Cl ee Rab+ t aa.es Date otHirth Gender Social geentrify Number nos :: j eq MMale ❑Female 4 S l2- 2-a— 73 N i� WoiverWvrvr aWp,, Whhow a signed waiver from the aabJect of the request, a cmtpkte cridah"d hLtsry rtrmrd may not be releasable, per Code of law■, Chapter 692-2. For CJI, erimtnat history record Information, as etlowed by law, always obbin a waiver adnature from the subject of the EMaL Waiver Release: ! hmay dw pmebsi n for tbaabors rwutsw salald to CUP" as 10" OmW hk" taora d•mk w"h k IXv1elW orcdmw jmwtaps e(Dq. Anywwu albWwY dW emcaolnrmrd:aY md,r.kdhy"a DClnuybr rofaredn dlaxed bylaw, Walver Slgmtore; j�4-s- ow r,Crimillal ffistery Record Check Results (D(:1 06 oNy) As of __-i `I r• ,�—• a search of the provided name and date of birth revealed; No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI q DCl initialsT� DCI -77(08/25110) r J N Ret:ived Time Ju1.23. 2015 11:12AM No.3746 �h 1