The URL can be used to link to this page

Home My WebLink About15-288IDENTIFICATION NO. 15 1Z f ! (Office Use Onfy)� APPLICATION FOR TAXICASI MOTORIZED PEDICAS VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 P.m., Monday – Friday) 410 Cast Washinykon Street Iowa City, Iowa 52210-1826 Failure 1 CCo (3 19) 356-5040 mpfefe the "required"information will result in denial ortlre a �Ilcation —�L-- (319) 356-5497 FAX 1. Name (REQUIRED) [ Q `P( �N�t "s Last 2. Address (REQUIRED) ( V ( 6 'tam {5 O �n C 3. Contact Information (REQUIRED) Email: (All written Corr municcation sent via email) S 4a. Chauffeur's License expiration date (REQ(JIRED) 0 1 �/ /2 0Z 2 hh�� b.Taxicab Business Name (REQUIRED;_ lXlafrc05 I of icjlI tv'r U I 5. Prior experience in transportation of passengers. rro1i,e s c k 1 'J/,L) y . 0a" �'( •{.wJ , Cts J DwK f a Ef �ar0 tACI l�v p��d 1 Pw V :Qin otkU l . ,/^ tal,� .a WFJ pl�i�evt C,( Ov fY �G1v�aJ it VV � t`S i 6. Have you ever been arrested f charged with any misdemeanors and/or felonies in this State or elsewhere?_�! Type of offense Where When to the cha ge?�(°irde` one) Clay T Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license of chauffeur's license been suspended or revoked in the last five years? y p Tvoe 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(si In n DEPARTMENT OF CRIMINAL INVESTIGATION (DCf) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH IFF REVIEW You must apply for an individual Department of Criminal Investigation Report (norm available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 R?9 c-• Wha; happened to the charge? (Circle one) N. Convicted Dismissed Deferred Suspended Plead Guilty t 7. Have you been arrested 1 charged with any traffic offenses in tie last five years?�� 4 `t -- T e (offense 1 W� . here1L •✓ey 'Kt 44 Conna(.a� i3 14Y l h ✓. �. to the cha ge?�(°irde` one) Clay T Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license of chauffeur's license been suspended or revoked in the last five years? y p Tvoe 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(si In n DEPARTMENT OF CRIMINAL INVESTIGATION (DCf) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CH IFF REVIEW You must apply for an individual Department of Criminal Investigation Report (norm available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify t�� hat I have issued to me by the Iowa De _ rt t of Transportation n valid Chauffeur's license number I 3 `[ - ssued on 0 �Zi'I expiring on 01511w?_ aL2- 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 ApplicantJ� ✓ Date V" 1 STATE OF IOWA ) COUNTY OF JOHNSON ) �L 1 `1 , S cribed an sworn to before me by �C 1 E_rfY+� on this CG r`� day of o�l;1Srv�nrs Y.ELLIE K. 7UTTLt /`--P--f�-(I I- ' ; Cc:mmis.-d::y Number221619Notary 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 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). Signature of Polt6e Chief or designee g�� Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN 1OIVA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR. Sijnatu of City Clerk or deses igneee� Approved application DCI report State certified driving record Website update cle;arnxiDkmsnocsNIPLu.514annrdsd DOC 022015 - T) Office Use Only c' �- -.4f" o, r 3 r I pu cle;arnxiDkmsnocsNIPLu.514annrdsd DOC 022015 .� F "AV iciwcdflt goo �r1.tAlEh i ^I I -F I l_.111O.: PIn1 v"'�.._"__._.... Office of Driver Services PO Rnn: 9204 Des [dance. 1,4 50306-9204 p140r.e_ 515-244-9124 1 8(0-632-1521 1 Fae: 515-239-1837 ways itrNadet Dov Certified Abstract of Driving Record Inquiry Date: 7/17/2015 DL/ID 4: 012AA3346 (IA) Customer N: 3632089 Name: Wezeman, Peter Jenkins Class: D ID Status: None Address: 1016 DIANA ST Audi It it: 8784482 OL Status: VAL Issue Date: 01/22/2015 CDL Status: None City/State: IOWA CITY, IA 522404627 Expiration Date: 05/18/2022 CDL Cert Status: None Endorsements; 2L CDL Med Status: None Mailing Address: 1016 DIANA ST Restrictions: Corrective Lenses I Restriction None Date of Birth: 5/18/1951 Supplement: Mailing City/State: IOWA CITY, IA 522404627 Sex: M History Information Convictions "tica L' -_re "onvicrion Date ACE'Ex Planation County )UR 12/16/2009 03/03/2010 M75 Passing School Bus Johnson lA 02/04/2013 02/25J2013 B54 No Insurance Card Johnson IA 03/19/2013 04/19/2013 N82 Improper Backing Johnson IA 07/24/2014 08/20/2014 B54 No Insurance Card Johnson IA 07/24/2014 08/20/2014 Detective Lights Johnson IA 08/21/2014_ _ 09/18/2014 B54 No Insurance Card Boyd IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. 1. -._in ent DatF Case Number JUR 03/1.9/2013 730956 IA Name: Wezeman, Peter Jenkins DL/ID: 012AA3346 Pursuant to Iowa Code §321,1q 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 offlcibl 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 antl the sea! of the Department to be set upon this document, at Ankeny, Iowa this date: 7/17/2015 4 Of ....... Office of Driver Services �N�� Iowa Department of Transportation State of Iowa Division of Criminal Investigation 215 L 7" Street Des Moines, lova 50319 Phone: 515/725-6066 Fax: 5151725-60HO lo1a Criminal History Record Check Falk -]n Request jYour name: Address: City/Statelzip Fill in all shaded areas. Phone #: Requesting an lova criminal history record check on hastName .4px,l (,(,det.u) Date of Birth FPen"r.Nm_maten,o (1n,:ndsmly) First )lame)rimer A'omb>e imatdatory) Gender cel ,o(n,aadatorvl r - Mlddle lVanle S"egarain hbmbn: trrco•tmtendedl S(o�ci'al Se tdcd 'j/ Umbe'�r jj ��I MAI (8 (({ 5 / [-I11ale ❑ Female �curii ',Ir�onmi i f ! � -1(�704' Waiver Sign atllr Firn1a(If the m;, yourself Tease sign If there qucst is on snulwoe 9se. anlclJL1) ,[ogquues(is L: Results R'I C6t ONLS' b As of -1-30-6 , a name and date ofbirth check revealed: L: r - r C'�1 No record found ' = Uj o .CD Record attached DCI # va TJ o v sir'! initis! ;y \l ki —6 1 � n Receipt Number of requests ` x $15.00 per last name = Total amount S 1,J -- Method of payment: cash money order check # Cardholder's narne� DC1 initials 1 V" Credit Card DCT -83(09 09/10;Revise.d10/1/ 10; form reviewed 08/11/14) Exp, Date MasterCard or Visa (Last 4 dlg1,$)