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Home My WebLink About15-251�r"lll�®ps + 11WIm1®f7 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. 15— 9 jC (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 3n Middle J G Last Cc k'�V 3. Contact Information (REQUIRED) Email: ' �,b d ;1 t it /�ITf >>�=til L Q n'1 Cell Phone: 3312 2.5- el 2.4 95 (All written communication sent via email) 4a. b. 5. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Tvne of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? -d& y![s iF-12 to the charge? Circle one KvSm6f T- 4 V 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? a y(`y Type of offense Where t1 CD . 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro, W ry 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 issued to me by the Iowa Depart ent of Transportation a v lid C auffeur's license number r^ AN_�s 5' '> issued on expiring on C 17 Z ' ccr .51 understand that if I falsely answer any questions in this application, that this appli tion may be denied. I agr a tha 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 21 f the City Code. (Needs to be siggned in front of a Notary Public) Signature of Applicants '✓ Z + Date1 STATE OF IOWA ) COUNTY OF JOHNSON } Subscribed and sworn to before me by : rf g \ A jLIC rr), P wN on this 1-2) day of 0Z + ';Lli . \ n c^ J1 A in anfilfor the State of ££££££k££££££#££££k£££££££££#£££##*##*#*****kkkkkk£k££######k#kkkk*kkkkkkk**#£££k£££££££*££££####£#*#**#k**##****k*****kk##*##*###*#*#**######## 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). �1 Expiration date of Chauffeur's license C9D L L lb l) oK Signature of Police Chief or desig ee Datei 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. 7e t� Sgna are of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ate n c � 7t 8 cied0IoRivenocF,PPr92014aTended.00c 03/2015 WENDY S. MAYER commission Ngmiiar y om asi n Expires in anfilfor the State of ££££££k££££££#££££k£££££££££#£££##*##*#*****kkkkkk£k££######k#kkkk*kkkkkkk**#£££k£££££££*££££####£#*#**#k**##****k*****kk##*##*###*#*#**######## 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). �1 Expiration date of Chauffeur's license C9D L L lb l) oK Signature of Police Chief or desig ee Datei 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. 7e t� Sgna are of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ate n c � 7t 8 cied0IoRivenocF,PPr92014aTended.00c 03/2015 State of Iowa Division of Criminal Investigation 215 E. 71" Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk-in Request Your name� n , e Address: in{ Ci /State/Zip: 1,2e G_ Phone#: C— Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apetrao (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) _o r', Date of Birth Fecha,V cfmierao (mandatory). Gender Genero (mandatory) Social SecurityNumber qr ommeaded) {� L) / C �� -Male ❑ Female a, Waiver Signature Flnna(If the request is on yourself, please sign. Ifthe request is on someone else, Finite N/A.) Results As of j y a name and date of birth check revealed: 1] No record found ❑ Record attached DCI # DCI initials A&LL Receipt Number of requests x $15.00 per last name — Total amount $ (,S , Method of payment: cash moneyorder check # Cardholder's name DCI initials Credit Card # DCI -83 (09/09/10; Revised 10/l/10; form reviewed 08/11/14) Exp. Date 00 MasterCard or Visa (Last 4 digits) UCt IISC ONLY _o r', a a, t �o D ZE 1� tri J 00 MasterCard or Visa (Last 4 digits) .wIOWA DOT SMARTER I Sft,`UTER I CUSTOMER (OVEN vvww.iowadC9tgov Office of Driver Services PO Box 9204 1 Des Moines, (A 50306-9204 Phone: 515 244 91241806-532-1123 1 Fax 515-239-1837 wwrr_iawadot9ov Certified Abstract of Driving Record Inquiry Date: 10/2/2015 DL/ID #: 480AF5532(IA) CDL Permit Class: None Customer #: 4964886 Class: D CDL Permit Issue None 07/03/2012 08/21/2012 S92 Speed (10 mph& under in 35-55 mph zone) Date: IA Name: Corneh, Jeff Umaru Audit #: 8877478 CDL Permit None 07/24/2013 08/19/2013 '592 Speed Expiration Date: -IA Address: 1632 HULL AVE APT 301 Issue Date: 02/27/2015 CDL Permit None Endorsements: Expiration Date: 08/04/2023 - CDL Permit None Restrictions: City/State: DES MOINES, IA 503134708 Endorsements: 3 ID Status: None Mailing 1632 HULL AVE APT 301 Restrictions: Corrective Lenses, Left and DL Status: VAL Address: - Right Outside Mirrors Restriction None CDL Status: None Mailing DES MOINES, IA 503134708 Supplement: COL Permit Status: ELG City/State: Date of Birth: 8/4/1960 CDL Cert Status: None Sex: M COL Med Status: None History Information Convictions - Citation bate Conviction Date -- .� ACD . Explanation - County JUR 04/14/2012 05/15/2012 :592 Speed _ - - Palk - ]A 07/03/2012 08/21/2012 S92 Speed (10 mph& under in 35-55 mph zone) -Polk IA 10/14/2012 111/15/2012 S92 Speed _--Polk --- IA 07/24/2013 08/19/2013 '592 Speed '.Hamilton -IA 12/11/2014 01/14/2015 S92 ,Speed (10 mph & under in 35-55 mph zone) ;Kossuth -IA Name: Corneh, Jeff Umam DL/ID: 480AF5532 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: """•.X%" 10/2/2015 IOWA "•.... Office of Driver Services o®Afi—'` Iowa Department of Transportation Name: Corneh, Jeff Umaru OL/ID: 480AF5532