HomeMy WebLinkAbout16-127.rrlllMkp��4
CITY OF IOWA CITY
410 EasI Washington Street
Iowa City, Iowa 5 22 40-1 82 6
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name(REQUIRED)
IDENTIFICATION NO.
(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
�ri,� 1 Cti
n
Middle
Last
2. Address (REQUIRED) /3 %cc, 6"r Cld 4,' 1 12 (2 �� Z y
3. Contact Information (REQUIRED) Email: L ES 4 / r / n� e 35 04 y4"Ic Cell Phone: b?z-zu z -z-�-7-2
(All writtenc( omimunication sent via email) Y
4a. Driver's License expiration date (REQUIRED) _- /L /023 / 2
b. Taxicab Business Name (REQUIRED) ye //010 (1'6) ur 1 a - r ("4 V
1 �
5. Prior experience in transportation of passengers: C a b b r, v c: «< i r/ C 4 u / A c s
�/ ✓ 1 1) J —
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? E`v c"
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? __ Aj 0
Type of offense
What happened to the charge? (Circle one)
Where
When t",?
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? L; 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 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)
0712016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
.�- L issued on /' c 15- expiring on I96234 71L . 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 �y --
9 PP — Date
STATE OF IOWA )
COUNTY OF JOHNSON 1
andWrn 9 before me by /L:f1 +L ,. on this �'day of
K. TUTTLE ^� /�.-C'_,�... (,-fes j'\ 11,6 tt
Public in and for the State of Iowa
wwwwwwwwxxxxxxwxwwwwwwwwwwwwwwwwxxwxxwxwwwwwwwwwwwwww,tw<wwwwxxxxxx+xwwwwwwwwwwwwwwxxx=xxxwwwwwwwwwwwwwww,t�xwxxx=x>wwwwwwwwwwwwwwww:texxxxxwwwwwww
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 Driver's license
J,5h
Signature ot,PcflicChief or designee
L/
/6
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.
tii/s 1y,� y(/. ` sC
Signat re of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
7/,//C/,
Date
ciendrnxioaroenoceAPPL92014amende DOC 07/2016
C4'10WAD0T vvwwJovvadflt. ov
SMARTER 15[tAPLER 1 CUSTOMER DRIVEN
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone: 515-244-9124 1 800-532-1121 I Fax 515-239-1637
WWW . owadoLgav
Certified Abstract of Driving Record
Inquiry Date:
7/5/2016
DL/ID #:
124AC2612 (IA)
CDL Permit Class:
None
Customer #:
5223692
Class:
B
CDL Permit Issue
None
Date:
Name:
Hunt, Michael Anthony
Audit #:
9616167
CDL Permit
None
Expiration Date:
Address:
1913 TAYLOR DR
Issue Date:
12/04/2015
CDL Permit
None
Endorsements:
Expiration Date:
10/23/2017
CDL Permit
None
Restrictions:
City/State:
IOWA CITY, IA 522407054
Endorsements:
PS
ID Status:
None
Mailing
1913 TAYLOR DR
Restrictions:
No Class A Passenger Vehicle
DL Status:
VAL
Address:
Restriction
None
CDL Status:
VAL
Mailing
IOWA CITY, IA 522407054
Supplement:
CDL Permit Status:
ELG
City/State:
Date of Birth:
10/23/1978
CDL Cert Status:
Excepted Interstate
Sex:
M
CDL Med Status:
None
History Information
CLEAR DRIVING RECORD
Name: Hunt, Michael Anthony Dll 124AC2612
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 document, at Ankeny, Iowa this date:
:•••••••.?vjd,'ry/
7/5/2016
IOWA :s',
D. 0. T.:g%
Jul. 8. 2016 3 : 0 7 P M Div of Crinlnal Investigation No. 7865 P. I/2
pr_.v.,.J. ,� ,,, ...w� .. ,.� clerk „. uo-- I 07/0a/2gy0 15;3a rr670 r.v /002
STATE OF IOWA � ¢�
Criminal History Re4°otrd Check
Request Forin S,
+3
Tol Iowa Division, nfCrimPnal Investigatlen
Support Opera lions Bureau, L" Floor
215 E, 7,h Street
Des Moines, Iowa 50319
(515)725-6066
(515) 725-60190 Yak
12111 ve.n1lct tl'ia nn Iowa Criminal tdi[Imv li nnn.,i 01-1, —...
DCI Account Nunibar: u Ub L'r
�(irApplicnblo) ---
rroln: City of Iowa Ciiy
City Clerk's Office x,. --
41.0 G. Washingfon Street
Iowa City, 1A 52240
Phone: 319-356.5041
rax: 319-356-5497
Last Nance (inandatory)
First Name (nlandato) �
Middle Name (recommended)
Date Of Birth (mandatory) �,..
Gender (nlandalnry)
Social Securf Number (recolnn,en den)
3 O -Male ®Female
Waiver Xiljormallon: Without n signed waiver from the subject of the request, a complete criminal history record may not
be releasable, per Code 000va, Chapter 692,2, hod' complete criminal history record Information, a5 9)1011'Cd by law, ahvays
Obtain a waiver signature from the sub eel of the re uest.
Waiver Release-: I hereby give permission for the above requesting orrmial in conduct an lona criminal history record check wills dle Division Of Criminal
lllvesligawn (DCI), A,ty ulnlina1111510s)' data c0l)UMillg me Ihnl iS M*tzhled by the DCI may be released as allowed by lalp,
Whitler Signature;� _� . •�.-Com.•......--�':,.....�1 � dS'`t�1. 1�\
r
As of a search of the provided Dante and date of bir(h revealed:.
No Iowa Criminal Histoly Record found v,'ith llCl
® law it CI iminal History Record attached, DCI #
DCI initiols
DCT -77 (08/25/10)
Recaived Tine Jul. 5. 2016 4,I6PM Ne.090
Cr