HomeMy WebLinkAbout16-201A
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
IDENTIFICATION NO. 11 f,�Q
(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
3. Contact Information (REQUIRED) Email:
4a. Driver's License expiration
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b. Taxicab Business Name (REQUIR 0'511V1202-2-
5.
112U?"L5. Prior experience in transportation of passengers: row s C14✓✓ ou '1 a• T ow, Ci/��U qq't CL) V 7A
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6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 0 0
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? Y =S
w
(Circle one) 4"
Convicted Dismissed Deferred Suspended ead Guil Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
h
Type of offense Where When o
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pri vd thd::Rame(6) V)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
07/1016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
herebx �er1(fyAtty�t �ye�issued to me by the Iowa De nt Transportatio a id Driver's license number
CJ `L.f 1 Ct J j `t issued on 01 xpiring onC� 20� . 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 beesigned in front of a Notary Public)
Signature of Applicant !i � Date q—& -A6
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscri ed a d sworn to before me by/ on this K" day of
�O s C,aZ�C �l / & K l 12G-\
iKELLIE xnis5bn WmDK K. FRUEHUNG �noix
E I Nowt ry Public in and f9f the State of Iowa �T
111l1flflfi,�fi'Y,Y#H91tMFMeffN11H1t#fHHf fifif#f'i#411kf MiHfiftHH1f1H1H11HfHHf#H1'1'1f#i'1##1f1t11ff1tfffHftRffltfflrflfl,#f1H11f4f iH#411tfY
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 L5, L IV
/Z%Y
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.
Sign ture of City Clerk or designee
Date
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Office Use Only
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Approved application
DCI
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report
State certified driving record
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Website update
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Aug.24.._ 2016,12.24PM
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Div of Criminal Investigation IXIlov,No 1433 P-.1/6
STATE OF IOWA
Criminal History Record Cheek'
Request Form
ru: Iowa VIWWM of cY mwd 111*41lldaeoa
Support Opendoua Bureau, l" Floor
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DeaMabne.town 50319
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1Criminal Matory Reco d ChUk ROSUHS
As of a� 1. «O a 'search of the provided mme and date of binh revealed: ^:
No Iowa Criminal angry Accord foaotd with DCT _r
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[] Iowa Criminal History Rword alrached, DCT N
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DCT lnldals
DCI -77 (08/25/10)
Received Time Aug. 19. 2016 9:23AM No. 1048
Page 1 of 2
CiJIUWADOT www.iowadot.gov
SMARTER I SIMPLER I CUSTOMER DRIVEN
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone: 515-244-9124 1 80D-532-1121 I Fax: 515-239-1837
www.iowadol.gov
Inquiry
Date:
Customer
Name:
8/30/2016
3632089
Certified Abstract of Driving Record
DL/ID #: 012AA3346 (IA) CDL Permit Class: None
Class: D
Wezeman, Peter Jenkins Audit #: 8784482
Address: 1016 DIANA ST
City/State:
IOWA CITY, IA
Expiration Date:
522404627
Mailing
1016 DIANA ST
Address:
03/03/2010
Mailing
IOWA CITY, IA
City/State:
522404627
Date of
5/18/1951
Birth:
,No Insurance Card _
Improper Backing
Sex:
M
Convictions
Issue Date: 01/22/2015
Expiration 05/18/2022
Date:
Endorsements: 2L
Restrictions: Corrective Lenses
Restriction None
Supplement:
History Information
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
None
CDL Permit
None
Endorsements:
03/03/2010
CDL Permit
None
Restrictions:
SIA
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit
ELG
Status:
03/03/2010
CDL Cert Status:
None
CDL Med Status: None
Citation Date
Conviction Date
ACD
Explanation
County
JUR
12/16/2009
03/03/2010
M75
Passing School Bus
'Johnson
SIA
02/04/2013
03/19/2013
02/26/2013 _
04/19/2013 _
B64
N82
,No Insurance Card _
Improper Backing
Johnson
Johnson _
IA
jIA
07/24/2014
08/20/2014
No_Insurance Card
'so n
IA
_
07/24/2014
_ _
08/20/2014
_B64
_
�efective Lights
_ 130h
Johnson
_
IA
{IA
08/21/2014
__ _
09/18/2014 _ _ _ _
_
B64
__ —_ __ _
No Insurance Card _ _
;Floyd
02/13/2016
103/29/2016
592
Speed
Benton
SIA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
%ccident Date Case Number JUR
)3/19/2013 730956 IA
Name: Wezeman, Peter Jenkins DL/ID: 012AA3346
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.
8/30/2016
Page 2 of 2
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:
'•w/4�
8/30/2016
IOWA °
r'......
Office of Driver Services
DR10�=
Iowa Department of Transportation
Name: Wezeman, Peter Jenkins DL/ID: 012AA3346
8/30/2016