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CITY OF IOWA CITY
410 Last Washington Street
lona City, Iowa 52240-1826
(3 191 356-5040
(3 19) 356-5497 FAX
IDENTIFICATION NO. —
Office Use Only)
APPLICATION FOR TAXICAB I 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
1. Name (REQUIRED) \)ayA(�ep i -}PiCE
2. Address (REQUIRED) -�Q
3. Contact Information (REQUIRED)
4a. Chauffeur's License expiration date (R
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of pa
(All written communiEafion sent via email)
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? b
Type of��offense Where When
1r:�t� MPavti��1\ J�hSV\ Qc 6
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead
�, Guilty Other
7. Have you been arrested I charged with any traffic offenses in the last five years? x1b
Type of offense Where When
What happened to the charge? (Circle one)
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? C -
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 theame(s)
C�
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEMERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHtE,FREVJJEW
You must apply for an individual Department of Criminal Investigation Report (form available
upon—
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ro
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
hereb}( erti�Y th t I have issued to me b the Iowa Department of Transportation a v lid Chauffeur's license number
_ffli ltl `e y issued on( 1 /J/)ly expiring on(� 1 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 ontkyp, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant e Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by J o v e S _ zlnrrµc. � n on this 25 day of
P,IL,r-, 9- Zl',1 Lo.
v ••—;;Dy g u,.ven Notary Public in nd for the State of kgwaa
cornet w Nwet �r
. * commas= giros
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 �! �f Z 01 g
��- 3�z5 2016
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.
Signature of City Clerk or designee
3 a.�5` ,�
ate
rJ
CJ
tRl
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk(rAXIDRNBADGEAPPL92014amended DOC 0312015
Inquiry
Date:
Customer
Name:
3/25/2016
1845805
DOT
wwwiowadot.gov
SMARTER 111MPtF I (W OM1 F PRIVD4
Office of Driver Services
PG Bon: 9204 Des Moines. IA 5030E-9204
Phone: 515-244-9124 1800-532-1121 1 Fait: 515-239-1837
www.iawadot.gov
Certified Abstract of Driving Record
DL/ID #: 249AD7128 (IA) CDL Permit Class: None
Class: D
Behrmann, James Patrick Audit #: 7873890
Address: 320 2ND ST RM 218
City/State: CORALVILLE, IA
522412677
Mailing 320 2ND ST RM 218
Address:
Mailing
CORALVILLE, IA
City/State:
522412677
Date of
8/6/1981
Birth:
Sex:
M
Issue Date: 03/12/2014
Expiration 08/06/2018
Date:
Endorsements: 3
Restrictions: Corrective Lenses
Restriction None
Supplement:
History Information
CLEAR DRIVING RECORD
Name: Behrmann, James Patrick DL/ID: 249AD7128
CDL Permit Issue None
Date:
COL Permit
None
Expiration Date:
None
COL Permit
None
Endorsements:
CDL Permit
None
Restrictions:
�pfN
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit
ELG
Status:
CDL Cert Status:
None
CDL Med Status: None
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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 documeOt; at Ankeny, Iowa
this date:
CLf �`
L
�pfN
3/25/2016 T,
IOWA
rrriif',_
Office of Driver Services tV
Iowa Department of Transportation
Name: Behrmann, James Patrick DL/ID: 249AD7128
F,,N!,a r,2,. 2ll10, jIJ2 ivicI.'tUly 0T GriminaI 111 v i5t lgat ton 03/22/201e: ,z s No. J01aae F', .j�jroo2
�TATE OF IOWA
(Criminal HiEtory Record Check
Request Forni
'fur lova Division ot'Criminal Invehigatloa
SUP11 t Operations 1111r0au, V, F1001-
216
loor315 C. 71° street
Des Moines, Iowa 50319
(516) 7Z5.6066
(515)725•GUAO Fax
I Rill requestiele an
DO Aecmmt plumber: Yt c^2 <�
(if spplioable)
From: C:ifv of luaa City — -- Y
City Clerk's Office - -
410 !r. Rrashingiun street
I 1Ou'n CIX, 1:A 52240
Phone; _319-356.5041
Fax: 319-356-5497 �� --"`
i usr tvan>e (niandamry) Middle Name (recommended)
���i�w�o tnh JIB c PC i c
Date
/ofl3irfh�(/mflndaior-) Gender/(meauamg) Socialsecurip Number ceceumended)
f�ltla)e ❑Female �-50-�73_OJ�sj
W'alver' II1f0rMtntlOn: -IW--
ilhaut a signed waiver from IhesuUJet 0f B,c request, a Complete criminal history record may not
be releasable, per Code of locea, Chapter 692.2. For complete criminal history record information, as allowed by Jaw, always
obtain a waiver signature tt-om the subieet of tho ,-t•n'."f
-waiverIC', (D C:gSeN hercUygive ory ditsion-Corlhr above lcyaestlno otnciel to coAdvTloiva Criminal -Gum record tGcc Witl�eision ofCommal
IIIVB51a5nOn (DCQ. Afq' trim L,a 11iStOry data C9!{�$Min.- nie 11101 ismoimain0 by ILe VCI may be released as allotvcd by law,
lya%ver Sign
Yo�� a �rilnbiai I�isCo�y Record Check Results
(UCI use onyx)
As of _ 3 a Search of the provided nanie and date of birth revealedt
rih
NO 7o\,a Criminal Hisimy Record found with DCl
r,.7
Cl
In�ara Critnintil Flistory Record a(taehed, DC1 #
DCT
Received Time Na r. 22. 2016 12,46FM No.0114