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HomeMy WebLinkAbout16-263IDENTIFICATION NO. 6 —7-1 o,_ l I (Office Use Only) it"III��� APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the `required" information will result in denial of the application (3 19) 3S6-SO40 t3 19) 356-5497 FAX 1. Name (REQUIRED) ITL6-t--RLI/ 3 2. Address (REQUIRED)'?e O. v%& V6-:!> Ly,)I- 7QgciII S2-'755 3. Contact Information (REQUIRED) Email: '5%IaOnALdu&A�P4W MAJ.Cun'm Cell Phone: 3tQ-q-9%�'b98% (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) os-, LCa2q4f b. Taxicab Business Name (REQUIRED) !4ulow cob Oc,--r-"06 G"M1/ 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? V30 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? N E� Type of offense Where When e)N-id - tw &.Aoxt (VAV/ZLq12 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Gut 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 Q, 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provfd%thegwme($1�, DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE-CLRTII�ED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RRIEWI You must apply for an individual Department of Criminal Investigation Report (form available up�n req &t). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby c''ert__if�yj' ��th t have issued to me by the Iowa Dep ment of Transportation a valid Driver's license number aB-GL-L'o 4 issued on Q-1 19 1&)Lfexpiring on I understand that if I falsely answer any questions in this application, that this application may be denied. I'agre6 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 Chapt 2 f the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant �� � Date ) 1"7 M &)2P ##!*iif#ffiiiiii##i#i#lllfiYllf!!!+**!*###ii##iiiiilllfl,!!!!!!flflif#!!f##**i++####*#ii#iifi,ff!lf.11f,l11111:!l,llf,fYf!!!f!'###+i######i###i#fi STATE OF IOWA ) COUNTY OF JOHNSON ) cribed and sworn to before me by K P1. A � � a� Lp_ on this � day of 44� Co o r 7 sir 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). license or designee 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. S gn re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update /J -Z/ ate ti `N r N3 rq Clerk/rAXIDRNBADGEAPPL92014am ded.DOC 07/2016 . Iowa Department of Transportation AW Office of Oaww Semces (Toll Ffee) 800-532,1121 FO 6 -ax 92114, Des Nlan9s, to 50306-9204 515.244-3124 FAX- 515-239-1831 Certified Abstract of Driving Record Inquiry Date: 12/1/2016 DL/ID #: 082CC2468(IA) Customer #: 2931188 Name: Lathrop, Kenneth Class: A ID Status: None Dean Address: 4763 HIGHWAY 22 Audit #: 8705197 DL Status: VAL SE City/State: LONE TREE, IA 527559321 Mailing Address: PO BOX 183 Mailing City/State: Convictions LONE TREE, IA 527550183 Issue Date: 12/19/2014 CDL Status: VAL Expiration Date: 12/22/2020 CDL Cert Status: Excepted Intrastate Endorsements: T CDL Med Status: None Restrictions: Corrective Lenses, Restriction None CDL Intrastate Only Supplement: Date of Birth: 12/22/1967 Sex: M History Information Citation Date I Conviction Date ACD I Explanation lCounty IJUR 10510812012 106/06/2012 S92 5 eed I Polk IIA Name: Lathrop, Kenneth Dean DL/ID: 082CC2468 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: IOWA D. 0. T Name: Lathrop, Kenneth Dean DL/ID: 082CC2468 12/1/2016 �1 Office of Driver Services Iowa Department of Transporation ...,ay j.a +"'.`X j rT� I.aa 11/No va 21. 20163: 3: 03 PM Cab DIV of Cr lml nal lnvestlpatlon (FAXW933827No. 8577 P. 101/002 lop 11/Nov, 18, 2016213;43PMo,b Div of Criminal Investigation; (Fut)clea3ex1No.7831 P;,1os/oo2 �r�le , a STATE OF IOWA CrIminal History Aecord Check. )Request orm DCI Aoeount Number 9967 -Fr (thpplllab el ) TO Iowa Divltlon orCrltnlnal tnvatlgallon ireomlYe11oW Cab 0rXowa Clty support operattons Bureau, 11, Moor TO, BU 426 Ile u. 7"stroll Da Molnu, Iowa 60!190 AV ID PING FOR j Iosvx.. Ity, IA. 52244 — '(515)729.6066 "-- ,HIS U. T-ALnAJI�! — (97bj7tC:60Bo Fox PE SE TURMRN FA9I9 998.9777 Phoney 11 %� l C)NDv1 � l+axt (919)999-7902 e:Pa Dz0- I_[$llylalo ❑p'olpalo 1481—VZ-Lk 159 rWalverInfirmatlanr Wlthouta elgned walvertrom theaubleatoriho ragUasl,acompttla gramtnol hbtory record moy no be ralouabb,,per Code arlowe, Cheppr 692,A, 8oro eta erlminnl htatoryrecorp Inrormatfon, at. eilowad by law, alwoya oblaln a walyer eJOaetura lro(n the tubleaI at tha roauut, — Waiver Beleaset I hmby Ilya parmlulon ror the above Invudtallen (OCs. Any arlmloal hbm,y data con<ro)n me l t�alvarSlpnolure, to ooadJai m lorya 011mtnal hbloty, rnotd ahtal{ wI(h the Dlvt,lon of orl'MID0 y,ayaal ay bauleauduallowWbyIAM w As of 1 a search of the provided name end dato of birth revoolodC" - I No Iowa Criminal History Record found with D61 © Iowa Criminal History Record attached, DCI dl I DCI lnidals—c-r=— DCI.77 (06/95/16) Received Time Nov. 12, 2016 1:37PM No.7981 Received Time Nov. 21. 2016 9:42AM No.8530 (DO[ uaa only)