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Home My WebLink About15-289r 4It ,¢t �r"1111�lp� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) - IDENTIFICATION NO. / 1!j---- F') (:) (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 Middle Last 75Gr � 2. Address (REQUIRED) 461 l7lWP5f 5 Qr.. ve 7cyt ,� TA) 22.4 t 3. Contact Information (REQUIRED) Email: �lLLAAAYhAY/./° 9N0f/XA7 ,oj6ellPhone: 3i�- y34-2?60 (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) I X12 -f /I �' b. Taxicab Business Name (REQUIRED) _ ` 1 w,v of J,,Y 5. Prior experience in transportation of passengers: S. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Nu 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? / () Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other I 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V Q' Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provi*4� nathL(s)/ r°, r DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED: DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIP- REVtEW �f You must apply for an individual Department of Criminal Investigation Report (form available upon rrN3equest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby cer(ify that I have issued to me by the Iowa Depa tment of Transportation a valid Chauffeur's license number I Ar 5 53 issued on rr expiring on 12l2�tll<- . 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 (-(4F h5' ln( _s Date—, :A11 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ! P - zE t 5 c< , on this day of WENDY S.MAYER` .,.,m , 71CAIRP NotaroPublic' andfor the 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license /L)ho(2oZc7 Signatur hief 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. s lL�.cllir, gnat e of City Clerk or designee aeM1 MIDRI B DGEAPPL92014arnended.DDG 0312015 Office Use Only Approved application �( S DCI report State certified driving record c cT rn ) Website update aeM1 MIDRI B DGEAPPL92014arnended.DDG 0312015 4 iU DOT d ov WARIER I SI'hIIPL-F I CUSTON''iER DRIVEN �..-,��.,-: " ro-'. - Office of Driver Services PO Box 9204 Des Maines.. IA 50306-9204 Phove. 515-244-91241800-532-11211 Fax: 515-234-1837 vrww.i0wadot.9ov History Information Convictions Citation Date Conviction Date ACD Explanation County TDR 09/16/2014 09/26/2014 S92 Speed (10 mph & under in 35-55 mph zone) Iowa IA Name: Tsai, Heng-Tser DL/ID: 416AF3153 Pursuant to Iowa Code §321.10, 1, 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: ............. y+l 12/3/2015 Certified Abstract of Driving Record Inquiry Date: 12/3/2015 DL/ID #: 416AF3153 (IA) CDL Permit Class: None Customer #: 5601353 Class: D CDL Permit Issue None Servicesiver of rrtment Date: Iowa Transportation""'—� Depaeof Name: Tsai, Heng-Tser Audit #: 9595195 CDL Permit None Expiration Date: Address: 461 WESTWINDS DR Issue Date: 11/24/2015 CDL Permit None d N Endorsements: Expiration Date: 10/10/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522462749 Endorsements: 3 ID Status: None Mailing 461 WESTWINDS DR Restrictions: NONE DL Status: VAL Address: Restriction None COL Status: None Mailing IOWA CITY, IA 522462749 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 10/10/1985 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County TDR 09/16/2014 09/26/2014 S92 Speed (10 mph & under in 35-55 mph zone) Iowa IA Name: Tsai, Heng-Tser DL/ID: 416AF3153 Pursuant to Iowa Code §321.10, 1, 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: ............. y+l 12/3/2015 r.a 1II�®7�.� cad Office � _ M Servicesiver of rrtment +f Iowa Transportation""'—� Depaeof Ci -••� Name: Tsai, Heng-Tser DL/ID: 416AF3153 co d N Dec, 2. 2015 11.080 Div of Criminal investigation 8'0 2147 P. til F•_....-'-. — - 1-M _..-y CIO'.. _-- _ --.- 1 11/24/2016 14:6a naau .-,uu2/002 STATE OF IOWA Criminal History Record Cheek DC7 Account Nomber: (i f apyllcGblo) To; Iowa Division Of Crimhlal Investigation Froin; CifY Of Iowa City Support Operations Ctureatl, 1" Floor City Cleric's Office ---- 215 E. 70' gtiecl 410 1s. Washington Street Des Moines, Iowa 50319 l,SLS) "1 066- Y11-11011- ra a»An (515) 725-6090 Far .. I ai requesting li Iowa FLast Name (nandaloo) �Sct; Date of Birth (mmldala� Phone: 339-356-5041 Fa X; 319356.5497 w Record Check mrs't iValne 1-1e11� -- lseY Bendel' (n sndalory) dmokle ❑laemale 7 - 1`7- oB2�/ Waiver Information. Witbout a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Fox•a, Chapter 692.2. For complete criminal history record Information, as allowed by low, always obtain a waiver signature from the subiect of the rcouest. llwcsiipation MCI), Any Ili nil113Iislory dalo concerning nit thaj is rnaitiained by rhe UClmaybt released os all oired 6v law. N'aiversionatnre: 1011a Criminal History Record Cbeck Results As of \ aha ` \`t- , a search of the provided name and date of birth revealed; No lova Criminal ldistoiy Record found with DCI Iowa Criminal History Record attached, DC1 DCl inttials __ 1XI.77 (0S/25/10) Received Tim Nov 24. 2015 1:45PM No, 2660 I (LCI LI$e (1.11)) — Z ti 1ri''I P — `U ea »'