HomeMy WebLinkAbout16-129,4 MIIM®i��
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-SO40
(3 19) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
IDENTIFICATION NO. ! a
(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
Last
3. Contact Information (REQUIRED) Email: ��� suw.-,'I �( 6da,pil. (t D� Cell Phone _�8
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) ] 9- /)-luo
(I
b. Taxicab Business Name (REQUIRED) _ ELLOw 6pb ?*wo t4i�rl
5. Prior experience in transportation of
S
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?_
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
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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 names)
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
h eby ce tify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
�� +issued on icl-Y�xpiring on J,-�7-c�Dk� I understand that if
falsely answer any questions in this application, that this application may be denied. 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 provisic s o Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant 0 .,d Datesp/h
w+w++++++wx++xxxxxxxxxxxxxxxxx+xx+++++++w+++++wwwww+w++w+w+++xwxxxxxxxxxxxxxxxxxxx++++++++++++w+w+ww+ww++w++xxxxx+xxx+xxxxxxxx+++++w++w+wwwww+++
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by
j�1 aot�
, v.z.s N , S Y..
on this { 31 day of
Iowa
www:t+wwww+wwwwww:xxxwxwxxxwxwxwwwwwwwwwwwwwwwwwwxwwwww:twwwwwwwwwwxwwwt:rxw:xxxxwxwxwnwwwwwwwwwwwwwwwwwwwwwit+,r,r++ww+wxxxxxx:xxxxw+wwwxww+wwwwww<ww
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).
i _;
Expiration date of Driver's license 2-�ll �2ici
Signature of Police Chief or esi nee 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.
Sign re of City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
7I -3
ate
Gerk7IDRIv6ADGE PPL92094amended.00c 07/2016
Iowa Department of Transportation
Mce of Driver Services
CPO Box 9204, DOS Moines, IA 50306 9204 0011 Ffee1800-5321121
515-244-9124
I -AX: 515 239 1937
Certified Abstract of Driving Record
Inquiry Detel 7/5/2016 DL/ID *j
Name: 9bOZZb2i1 (IA) D #i 1024572
Dresden, Arthur Class:
I Status
Anthony Ir D D Status: None
Address: 4219 Lloyd Avenue Audit ft:
Se 7593269 DL Status: VAL
Issue Date: 12/08/2013
City/State: Iowa City, IA 52240 Expiration Date: 12/11/2018 CDL Status: None
CDL Cert Status: None
Endorsements: 2L CDL Med Status: None
Mailing Address: 4219 Lloyd Avenue Restrictions: Corrective Lenses Restriction
Se None
Date of Birth: 12/11/1954 Supplement:
Mailing Iowa City, IA 52240 Sex:
City/State: M
History Information
CLEAR DRIVING RECORD
Name: Dresden, Arthur Anthony Jr DL/ID: 960ZZ6211
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 TTkinsp4rlatigr t9 59 Sgrhfy.;
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:
'IOWA
D. 0. T
Name; Dresden, Arthur Anthony Ir DL/ID: 96OZZ6211
7/5/2016
Office of Driver Services
Iowa Department of Transporation
q ' v°'°ICab uiv of Criminal Investigation
(FAX)3193382,N0• 7866 P.
DO Account Number: 9967-F
To: Iowa Division of Crlmin I Invosileallon fr(`appneabie)
Support Operations Butjeau, P, Floor From; Yellow Cab of Iowa Clty
218 E, 711 street I I',O.71ox 428
Day Moines, Iowa 50319
(515) 725.6066 Iowa Clty, TA. $2244
(515) 725-6080 Fax
Phono: (319) 338-9777
Fazt ---
(319) 133-9-4302
�Jt�►SQ� t--� - - � .ua rccemmandAd •.
Date of Birth andna Ciendor (ma duo Pv
'8oc•.la�hG$ocurly Nurnbar taaetnme,
IQ— //-g- �.. Male C�Feraale Jp�,-�0 ��c37`
Waver I►(/arrnafI0a, without signed waiver from the subject of the requost, a cotnpleto grimi
be ralaseable, par Code Of IOWA, Chapter 692.2, For cemotete criminal history, nal history record may r
record info ,
obtain a waiver al nafurn hoht thrmation, ea allowed re b sub Act of the re quest, taw, al y
Walvelon (DCO.
M I hereby give permtlalon brthe Above requesting oalalal to eondut an law• erfmtnl history record ohwk with the Dlvbfon ofCrlminal
InvsltlgeRea {DCq. Any txlminoi history data "neenpt ma tis nulnad by the DCI MAY be rcloa7N ee attowvd by law.
Waiver SfgnafuY , �"111"'iiiJ/`
—i
A.8 of
No Iowa CrimI10WIL Crim
Iowa Criminal
DCI -77 (08/25/10)
a search of the provided name and date of birth revealed:
d History Record found with ACI
C— t -
story Record attached, DCI # `_. -U 'l c
DCT inttiala_—Q
Received Time Jul, 6. 2016 9:530 No, 8933
(DCI use only)