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Home My WebLink About17-060IDENTIFICATION NO. r 1 (Office Use Only) 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 aoolication (3 19) 356-5040 (319)356-5497 FAX First i Middle Last 1. Name (REQUIRED) JcSE 41 II,�LT Q— aS�-()L 514-x 2. Address (REQUIRED) W4LA) VT s7- IoWA c'T TY SAF 6-,2,xyO 3. Contact Information (REQUIRED) Email: .lWI goS0 kAtAlc%; 1, 40,44 Cell Phone: 3)p 59y-2 05' RI written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 05--oZ/--20 7 Oeu4,o r�U b. Taxicab Business Name (REQUIRED) MA✓W 5 U /,'I 5. Prior experience in transportation of passengers: FIVE, Ye&V--� w, 440VLeS TWOyeu�S wt W(AIjOc.SL� COL& ltijitilt 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /J 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? VC -5 Type of offense Where When SPAL .Zovt, C;4y 4./3.2013 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? {V Type of offense Where WhenMn c y 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please pr8vt�de the nam s _—.. rTt Z. Cj� 3 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTJgIED 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 hereby certify that I have issued to me by the Iowa Department of Transportatign a valid Driver's license number x,17 fIC�'7,2 issued on Cg.,7/,2 /7 expiring on 05 •�/-��/7 1 understand that id 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_ U�/ Date O/ 21,2101 N1ff1f1f 1f 44}f}Hf}}}1�HHf'1fH}Yiiif}#}Y}}}HffH}ff1HHHHf-,1ff11H1HflHHlHflif4if!#flYflHYYfMYYYYY{fffHfH}H1f HHf11HfHffllHH STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed an7 �r� to before me by 05 L t� . (�rx Sr w51C1 on this Z- day of 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 Icy )-- G 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. Signa\ tur of City Clerkc ` d designee Date „H„ff„f,HHHH,H1f,,,,,H,,,,,,H„H,H,,,HHH.HI,f f f,ff,HH,H„Y,Y„Yf,I,YYYY}yHH„}}H,H1fHH}ffffYllH�'f�1,HfHffff,lf,flf, 0 Office Use Only =,—, v 70 i N Approved application r- �r+l m DCI report State certified driving record ? =° Website update = `D Cs ro ClerkrrAXIDRIV94DGEAPPL9Wl4aman .DOC 07/2016 C,IOWADOT SMARTER I SIMPLER 1 CUSTOMER DRIVEN WVVW'IOWBdOt gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phare: 515-244-9124 800-532-1121 1 Fax: 515-239-1837 www.iowadot.gov Inquiry Date: 4/21/2017 Customer #: 5231945 Name: Laskowski, Joseph Walter Address: 836 WALNUT ST Certified Abstract of Driving Record DL/ID #: 127AC8472 (IA) Class: D Audit #: 5981226 Issue Date: 05/15/2012 Expiration Date: 04/25/2017 City/State: IOWA CITY, IA 522403340 Endorsements: 3 Mailing 836 WALNUT ST Restrictions: Corrective Lenses Address: Restriction None Mailing IOWA CITY, IA 522403340 Supplement. City/State: Date of Birth: 4/25/1973 Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: Iowa Department of Transportation CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 09/13/2013 10/02/2013 S93 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/07/2012 703362 IA 09/13/2013 757141 IA Name: Laskowski, Joseph Walter DL/ID: 127AC8472 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: k.l...... ~`'', 4/21/2017 1 Office of Driver Services Iowa Department of Transportation Name: Laskowski, Joseph Walter DL/ID: 127AC8472 •04iAP,�_19,, MA —:17PM U Div of Criminal Investigation ., DCI IOANo,8660 STATE OF IOWA Criminal History Record Check M Request Form ' Toe Iowa Dlywoa alcrimiod loveetipanon 8opportOperations Hureea, 1"Floor 115 e.7"SOW Pa Molnet, Iowa 50.919 (615) 7156066 (Sig) 7254M Fat DCI Aocount Number. 3gy' OAA (e From: OAAVT,S 'txl 116'5'6v&%s Or. phone, .(31R 338- pat, .. 319 351 0 Last Name (=ndww First Name ( Middle Name AkLW�}LT Date of Hirth Gender seolltl Lk Number O t( . L5'—/973 Aluxie ❑Female e, 197 WaiwAt(ornmtion- witbeat a rlpoed wilver from theanbJoet olthe requeey a complete orlmtaal h4tory record maynot he roeamble, per Code of Tawe, Chapter 691.2. For mmolete edminat Wary rerard luformatim, As Allowed by taw, Always alaA waiver gmtura from A a sublool of the request WalperReteam:I bwft give Pmnbdon1bY ofto�toommm �ww°°d`��'dnalwofCrin" doPow bylLw- ,nYopl•n(UCQ , WalversignatareSz As of "e— (c_). (: a maroh of the provided name and date ofbitth revealed: 04�`No Iowa Criminal Iiistory Record found with DCI ❑ Iowa Criminal history Record altacitod, DCI tl DO mIttal5� Received Time Apr. 17. 2017 12:44PM No. 8414 ma%wmph (,;