The URL can be used to link to this page

Home My WebLink About15-236►III CITY OF IOWA CITY 410 East Washington Street I�13 52240-1826 (356-504 (56-5497FAX 1. Name (REQUIRED) (Police ?DICAB VEHICLE DRIVER 8 a.m. to 3 p.m., Monday — Friday.) Failure to complete the "reguired" information will result in denial of the application le 0 2. Mailing Address (REQUIRED) I I I -� "1 , C. f r .., ,.. . /11/, . 3. Contact Information (REQUIRED) Email: S * + r , ? G r_ Cell Phone: t ` 3-30 6?a7 (f 4. Prior experience in transportation of passengers: �( �, .,•r 1--� r'j ,.• , - 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?� Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 17 4 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Y . 5 06'" it Type of offense Where When e P _ r/ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When t" a I P. 4 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please prmvjoRhe nagne(sv DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIE 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I ereb%y certify that I ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number h4t6 `S . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 andall records a ocuments relating to this application, and I further agree that, if a license is granted, to comply at all times with all of visio of a Notary Pubic} of Title 5, Chapter 2, of the City Code. (Needs to be signed in front l " Signature of Applicant _ Date Z YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTYOFJOHNSON 1 Subscribed and sworn to before me by I _g =e U Ids ii beat. On this L_ day of -j,ev--4no-�r 2af4/_ I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). " V IIfs1 /y Signature d hief or designee Date YOU AR£'NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signature or designee (C l Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/:" (width) and 5'/:" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update c:e,k TI IDRIV9ADcEAPRL92014zmendedDOG 0912014 � DST IAAN-Iv lowadot, 0v SMARTER I 511APHU I C ST(''AE19,, PFIVFN Otfice of Dslver sefolces PO Eo92.04 Cies manes, I✓, 50301-9204 Phcne:515-294-41241 I&CI-532-1121 f FaR_'f15-239-1837 wvew faa,'a of gov Inquiry Date: 11/4/2014 Name: Willberg, Lee Marinus Address: 1115 SAINT CLEMENTS ST City/State: IOWA CITY, IA 522456111 Mailing Address: 1115 SAINT CLEMENTS ST Mailing City/State: IOWA CITY, IA 522456111 Convictions Certified Abstract of Driving Record DL/ID #: 760YY4065(IA) Class: D Audit #: 8284854 Issue Date: 07/23/2014 Expiration Date: 07/17/2022 Endorsements: 3 Restrictions: NONE Date of Birth: 7/17/1980 Sex: M History Information Customer #: 1827411 ID Status: VAL DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: '.Speed Citation Date Conviction Date ACD Exclamation County 1UR 05/31/2010 _. j08/09/2010 515 Speed - IL 10/29/2010 (11/02/2010 -. S92 '.Speed Linn IA 04/07/2011 04/07/2011 S92 Speed Johnson 'IA 07/14/2012 _. :07/25/2012 iS92 _.. ;Speed (Johnson IA 08/04/2012 _09/05/2012 M14 Fail to Obey Traffic Sign/Signal Johnson -'.IA 02/12/2014 -03/12/2014 M14 Fail to Obey Traffic Sign/Sig nal _ John son ![A Name: Willberg, Lee Marinus DL/ID: 760YY4065 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: .,.......;.v/,p �p 11/4/2014 • IOWA••• �'k ,ff •D. O. T.; W% CD rrrr �F,•• r41�OfUBIVER$�`l _; Office of Driver Services ��--o;, I ..,.—. Iowa Department of Transportation r�r., rn w i. P Name: Willberg, Lee Marinus DL/ID: 760YY4065 Oct.2'0. 2014,11_,43Ah4 Div ofCr':minal Investigation f1o.2211 P. 2/6 u'cl-. 14. /Ulq ]:gorjvi 1,11y t,IerK - iIfy 0 Iowa l,I(y No.91UY P. L STATE OF OV'V A gi`me ��IIv II�IIiilii History C:oly j `1 Chee,6 Request Forlin �Q•�' IeV1A ,� • p```1rFp; rrJ�P�/ To: Iowa )Mvislmr ofCrlminol Investigation Support Operations 9ureau,l"Floor 215 F. 7" Street I)cs Moines, Towa 50319 (515)725-6066 (515) 725-6080 Fast Tam VIAl1Ae}itln n� Tnuva Criminal TTistnry ltennrd Cheokou: C ' .r' DCI Arzountgulober; Y063i—F (if appllcablo) From: City of Iowa City City Clods's Office 4101;. washtn ton Street Iowa City, TA 52240 phone; 319-356-5041 Fax; 319.356-5497 DnstlVaM- a uandamry) Mrst Name nlendmo N1iddleNara®(rccammcnd,d) J �t Ib �-t L'e-t Mltrinw f Date of Birth (mandato Gender (mandatory) Social Security Number reeommeaded % //1 X maze []female yea_ ap-3 `l 0 Wfliverinformaflon: 'Without a signed Walvar from the subject of the request, a complele criminal history record may not be releasable, per Code of Town, Chapter 692,2, For comnletg criminal history record information, as allowed by law, always obtain a waiver sign store from the subject of tha re Uast. WaIVer Release: i hefcby give pumission Por the above regecsIIng ofliclal to conduct on Iowa orlminaI historyrecord check with tho Division of C7iminal Yovssllgarlon(DCh. Any criminal hislosydata roncemingmodist Ismernaoinedby11 DCTmayberel 'bylaw_ - Wniver Signaiare: \\ l� Results As of f O �_3,0 1 P � , a search of the provided name and date of birth revealed No Iowa 0.1minal Tdistory Record found with DCL ❑ Iowa Qiniinel history Record attached, DCT # DCI initiais_p' Received Tim00cl, 14.12014 3:42PM NO. 2B57 PCliise only)