The URL can be used to link to this page

Home My WebLink About15-150CITY OF IOWA CITY 410 East WashinZlon Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX IDENTIFICATION NO. % �1 — / C�U (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 First ddle 1. Name (REQUIRED) _-- e 2. Address (REQUIRED)tAl �S J.. e)-� 'Et -'J, ?/ 3. Contact Information (REQUIRED) Email: �gFercnJ;� �� Mt-:�• (All written ccoo(mmun/ica on sent via e 4a. Chauffeur's License expiration date (REQUIRED) O! � li ! IS b. Taxicab Business Name (REQUIRED) ' e - I to") C I 04 2 ovu- ti E .-1 k 5. Prior experience in transportation of passengers: vE rt v� c J of r f +: ,"-k- 4 (C- a00 I 3-U Cell Phone: 3`q -331 _V3a`I i� ,0ud, Clf7 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? `� S Type of offense V WhereIIII When _ A What happened to the charge? (Circle one) �/] Convicted Dismissed Deferred Suspended Plead Guilty OtherN' r"' 7. Have you been arrested / charged with any traffic offenses in the last five years? 0 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? h 0 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) "0 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 her by certify that I have issued to me by the Iowa De rtment of Transportatio v lid Chauffeur's license number 55 K K �i ti issued on 6� S expiring on / I IS 1 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 / Lz_-- Date -7.(30t `< S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Lir u ' 4? k),?L, on this 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, CCity Code). p�j f em P OIL =rA (c c P Vtf — Expiration date of Chauffeur's license Signature of Poli6e Chief or designee Date AFTERAPPROVAL 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. 9C • z\�fG✓ Signature`'of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 71 _-;7/J Date Cla*frAXIDRIVBAOGBAPPL92014... nd.d DOC 03/2015 C40WADOT WVAV.10Wc'900t g0V SfOiA TO 151MP r A I CUSTOMER RIWB Office of Driver Services PO Box 9204 ,ties Moines, A, 53306"-92fA Phone- 515-244-9124 1800-532-1121 1 Fax- 575+-239-4837 www rawadox,gov Certified Abstract of Driving Record Inquiry Date: 7/22/2015 DL/ID #: 555XX5497 (IA) Name: Stevenson, Daniel Barratt Class: D Address: 115 N 5TH ST Audit #: 9272669 Iowa Departme Department Issue Date: 07/22/2015 City/State: WEST BRANCH, IA Expiration Date: 07/20/2023 523589615 Endorsements: 3L Mailing Address: 115 N 5TH ST Restrictions: Corrective Lenses Date of Birth: 7/20/1977 Mailing City/State: WEST BRANCH, IA Sex: M 523589615 History Information CLEAR DRIVING RECORD Name: Stevenson, Daniel Barratt DL/ID: 555XX5497 Customer #: 1217962 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Cade §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: _�Qr..._.....-.rEp4� 7/22/2015 s; IOWA s' --.D. 0. T.:S eof Driver Services Iowa Departme Department Name: Stevenson, Daniel Barratt DL/ID: 555XX5497 Fru UI,L]cvl7,v J.40rwi viv o ,rilcinai Inv est lgat ion I'o. 1544 N. 1/i ... tier.. _...-_ —.—------. o�is2itoys ys:_, r�y� .._,.ziooz STATE OFIOWA11 i Cl-itllinal History lie(,ard Check 12etluest Foi,131 l gyp, IuavA nIVl5'iUI! 1/f (;k-11111 ilal 111"Cslig tl0n `7uppor[ Operations Idvrtau, f" floor 215 & 7" Street Des Moi)es, Iowa 50319 (515)725-6066 (915)'725-6090 Fax am re uestin an Iowa C?iminal Hislw Record Check o Gast lam"(111", alor>•) First Name (o, D(:j Accomn N1 ntbw-: -- (if apylicylle) ---.- rrom: _CU.offowaCity Cily Clcrh'.v 950 E. washluj l 8treel----- �- - 2uwa Ctty, !A_52240 Phone; 319-356-5041 Fate 319-356-5499 — Sti err„ f j 7W// 2 ��oueaaa uccurity NUmbey (recar mendu 77 �r 77 _ IJIv>ale ❑Female ( ' 560 ffi'aiper iliforry7ali0f)! without as signed wailer from the subject of the request, a cmnplete eriminal history record may nal he relabs asaEle,per Code of Xowa, Chapter 692,2. ror complete criminal history record information, as allowed by law, ahsals ohtatn� a waiver si nalure from Ihesubject of (he request, Waiiver,Release- J), AA1 hncbygive oronisaienfor 11e above regn0sting official 40 co0dacl an Iowa criminal hislory record check wish me piVi;ion 0f Criminal Im•estigalmn (DCI). Any criminal hislory data cawemin° 1c Ihal' mein anud ly ole DCl may he released as allowed by law. Waiver S7gxafare: � i/T/ ri \ _ n n .t Iowa � ilninal Histor Ciectlf d Check Results _ �-- v—� )rte (n(l nsc only) search of the pro%,ided mine and date of birth revealed: No IoTa•a Criminal 1-lisiory Record found with 1)C.y F ' ED Iowa Criminal Iiistpry Record at(aehcd, T)Cl DCj Inillai5,__, 2! r' -------------------- r r. — --- —— — .— — --_ ---- 1]C:G77 (OR/25/IU) -- Received Time Jul. 22, 2015 3:40PN k 3670