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Home My WebLink About16-130-Av`r '°� Mi011 '441. -ft*% CITY OF IOWA CITY 410 East Washington Streel Iowa City. Iowa S2240-1826 Q 19) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (IREOUIRFD IDENTIFICATION NO. /( _ )'' n (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between S a.m. to 3 p.m., Monday — Friday) fafax�e d aarw �fp(g, fir e.,."."ner s xae " aarfaasaur atd an a x�C ao-w,� l ace_clenaa1 of me sr pia p p are 3. Contact Information (FtEClUIPF_D) Email: it�,m Cell Phone 3(ct"-AOU —3 Q (All written communication sent via email) 4a. Driver's License expiration date (FdEQUIRED) Z1p2- /� 7 b. Taxicab Business Name (REQUIRED) .. f)U t Ler 1- 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When err) NIP, 1I? 5� 77— What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspende Plead Guilty4 Other Have you been arrested / charged with any traffic offenses in the last five years? n Type of offense What happened to the charge? (Circle one) Where When 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? h O Type of offense W here When -- 9. hen -- 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transpor i n a valid Driver's license number _ r g- 12, : �i 3-�? issued on expiring on 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 provisIns of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date js -/ J STATE OF IOWA ) COUNTY OF JOHNSON ) i _ Subscri d- and sworn to before me by ncle % s c 7 i on this day of c l;P &/ I .eldz Notary Public in and for the State of Iowa KELLIE I have reviewed this application, DCI report, and the State certified driving record of this applicant and hav det rmined the there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of�1 City of Iowa City (Title 5, Chapter 2, City Code). license %r Z L[ j or 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 ure of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update - 7-/_51-4� Date Clerk/TAXI oemenocEAPPre2oiaamended.00c 07/2016 C 101" 0 OT wwwiowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN �"" = '-- --- - Inquiry Date: 7/6/2016 Customer #: 1473593 Name: Anderson, Craig Robert Address: 320 2ND ST APT 110 Office of Driver services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-112fI Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 185CC7937 (TA) Class: D Audit #: 1129339 Issue Date: 07/06/2016 Expiration Date: 02/02/2017 City/State: CORALVILLE, IA 522412659 Endorsements: 3 Mailing 320 2ND ST APT 110 Restrictions: NONE Address: Restriction None Mailing CORALVILLE, IA 522412659 Supplement: City/State: Date of Birth: 2/2/1961 Sex: M History Information CLEAR DRIVING RECORD Name: Anderson, Craig Robert DL/ID: 185CC7937 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, CDL Permit Class: None CDL Permit Issue None p Date: Office of Driver Services CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None 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: Name: Anderson, Craig Robert DL/ID: 185CC7937 7/6/2016 IOWA D. D. 0. T.;�s DRIVER,=- Office of Driver Services Iowa Department of Transportation Name: Anderson, Craig Robert DL/ID: 185CC7937 fitatr of inwa Requestinz an IoNva criminal history record check on: Fill in all shaded areas. Last Dame Ipelkdo (mundator),) )First Name Primer Nomfi-e (mandatory) Middle Dame Segundo ,Nombre (recommended) Lto vr� Date Of Birth Fethat acimjenio (mandatory) Gender ero (mandatory) SOClaI Security Number (rewmntendad) Male ❑ Female Waiver Signature F4r11¢a (if the request is on yrnnself, please sign. Il'lhe request is on somemte else: write NIA Al',�LLtl tN Dc[ use OM v As of S f c , a name and date of birth check revealed: No record found t✓� ❑ Record attached DCI # i• r_, DC l initials A Receipt Number of requests x $15.00 per last name —Total amount $ � 5. 0 () Method of payment: cash money order check # MasterCard or Visa (Lost 4 digits) Cardholder's name DO initials Credit Card # Exp. Date DCI -83 (09/09/10; Revised 10/1 /10; form reviewed 08/11/14)