HomeMy WebLinkAbout15-280CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3191 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)D
IDENTIFICATION NO. I S -2?e
(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
3. Contact Information (REQUIRED) Email:
Sl,00radUAhW14 MA;I.CPVCellPhone:319-936-0887
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) tL 2Z ZoZO
b. Taxicab Business Name (REQUIRED) _ �E 1�OW Cf�b c�I
5. Prior experience in transportation of passengers:__ t:Ab ]7Q-1UE12- =QU.)i� C��( SirJLE 2-
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? No
Type of offense Where When
What happened to the charge? (Circle one) c
Convicted Dismissed Deferred Suspended Plead Guilty `:Gtl erc
7. Have you been arrested / charged with an traffic offenses in the last five ears? E S -'
Y 9 Y y L(_
Type of offense Where --When -o i
w
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended ead Guil Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Al D
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)
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 hereby certifij that I have issued to me by the Iowa Depart ent of Transportatio a v lid Chauffeur's license number
f�f32CC Zq(v9 issued on IZ 1 Zo expiring on ( ZZ 20 . I understand that if I
falsely answer any questions in this application, that this applic tion 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�Chap� 2Af the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant �/}as¢!�i�� Date (t 13 zpl7
STATE OF IOWA )
COUNTY OF JOHNSON ) pp f
bscribed nd sworn to before me by ,'�rli 1�� Lz+ � (—b on this � J day of
Zo)6
1<ELLIE K. TUT7LE -L. c_('e—-
TbU l N' ry Public in and for the State of Iowa
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— 212 2/ Zn Z 0
yl�"p?l 1( 20 S
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.
Signat re -of City Clerk or designee
Date
W
Office Use Only
Approved application N
DCI report W
State certified driving record
Website update '''
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5'd�Ahi€R I `I�APL,F I Ci'S1�3".`i_}� L+�l'aE°:
Office of Driver Services
PO Dox 9204 Des Moines. IA 1030641204
1 515-244-0124 1 K0-532-1-21 1 Fa;c. 515-239-1837
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Inquiry Date: 11/12/2015
Customer #: 2931188
Name: Lathrop, Kenneth Dean
Address: 4763 HIGHWAY 22 SE
Certified Abstract of Driving Record
DL/ID #: 082CC2468 (IA)
Class: A
Audit #: 8705197
Issue Date: 12/19/2014
Expiration Date: 12/22/2020
City/State:
LONE TREE, IA 527559321 Endorsements: T
Mailing
PO BOX 183 Restrictions: Corrective Lenses, CDL
Address:
Intrastate Only
CDL Permit
Restriction None
Mailing LONE TREE, IA 527550183 Supplement:
City/State:
Date of Birth: 12/22/1967
Sex: M
History Information
Convictions
CDL Permit Class:
None
CDL Permit Issue
None
Date:
CDL Permit
None
Expiration Date:
CDL Permit
None
Endorsements:
Iowa Department of Transportation
COL Permit
None
Restrictions:
ID Status:
None
DL Status:
VAL
CDL Status: VAL
CDL Permit Status: ELG
CDL Cert Status: Excepted Intrastate
CDL Med Status: None
Citation Date Conviction Date ACD Explanation County ]OR
DS/08/2012 06/06/2012 S92 Speed Polk IA
Name: Lathrop, Kenneth Dean DL/ID: 082CC2468
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:
11�.. "••"•:�3,p�ir1,
`
11/12/2015
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D.. 0. 0. T,;:%
991'
Office of Driver Services
Iowa Department of Transportation
Name: Lathrop, Kenneth Dean DL/ID: 082CC2468
ii Nov, 10, 2015,, 1:25PM CabDiv of Crlminal investigation
(FA%)31933e2N 0, 0669
STATX
, IOWA
Criminal History
Chea e(y
Request ' r
'fat Iowa Division of Crlminal Investigation
Support Operations Bureau, I0 Floor
215 E. 71h Street
Des Moines, Iowa 50319
(515) 725.6066
(515) 725-6080 Fax
T - .eliw r...- T-...- _1 w.
P'1 501/002
DCI Account Number; _9967-F
(If appl4able)
From; Yellow Cab oflowa City
k'r0. Box 428
Iowa City, IA. 52244
(319) 338-9777
Phonal
Fax: (319) 339-7302 - -
-^...._-__.... .... .r..r ..uuuuu,+see Wl Y
Last Name (mndalow
AUUUFU unaOK On;
I First Name mandatary)'I
Mlddle Name reaammanded
20�
�aETij
Q2/0
Date of Birth (mandeto)
Gender (mandomy)
'Social•Seeuri Number rccommended
l7ti- AZ- 190-7
lawale ❑Female
41Q/ -•0z_ t�/fir
Waiver ifi/'Orfnatlan: Without a signed valvar from the Subject of the request, a oempleto criminal history record may not
be releasable, per Code of Iowa, Chapter 692,2, For complete criminal history record lnfol'matlon, as allowed by law, always
obtain a waiver sl natpra ham ha Sub ect of the r uost,
Wafver Release; I hereby give permisalop for the above requesuog oalclal m conduce an IowA criminal historyrecord oheck with the Divialon ofCrlminel
lnveatlgadon(DCq. Any edminslhinarydataeonoamingmethAlism I InedbylheDel m ybaralcmadssallowedbylaw,
Waiver Signature;
(DCI we only)
As of _- 0 `� 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 # 1E 7-1
DCI initials - t_
DCI -77 (08125110)
Received Time Nov, 9. 2015 11:49AM No.0501