HomeMy WebLinkAbout17-088IDENTIFICATION NO. —7 —0
Fr.,' t 1 (Office Use Only)
CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(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
(3 19) 356-5040
(319)356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
Failure to complete the "required" information will result in denial of the application
First
Middle
Last
3. Contact Information (REQUIRED) Email: IJ,yAi-;AQgwlkf,Phone: ��a-Zoo2�2
(All writt n communication sent via`email)
4a. Driver's License expiration date (REQUIRED//)'' -3/&
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b. Taxicab Business Name (REQUIRED) ell0 . C . � r-� l o e; � r
5. Prior experience in transportation of passengers: 4u r S'C� c o ��u.� Gtr O' 344 eQ b
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? U_
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? &) U
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? N
Type of offense Where hen
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Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STA4 CER W--
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
If APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
la y - Pw issued on /2%`/ /S— expiring on /0/-L3//:?- . 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
v/offTitle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant G (!2/ Date lz 7� 7Z
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me byy1itjrl..t-." A on this —7 day of
-i. ,1 .. -7 .,r7
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
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 C c or designee /
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DCI report
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State certified driving record
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Website update
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C iowA DoT
SMARTER I SIMPLER I CUSTOMER DRIVEN wwwJowadotgov
Inquiry Date: 6/20/2017
Customer #: 5223692
Name:
Address:
City/State:
Mailing
Address:
Mailing
City/State:
Date of Birth:
Sex:
Hunt, Michael Anthony
1913 TAYLOR DR
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837
www.lowadotgov
Certified Abstract of Driving Record
DL/ID #:
Class:
Audit #:
Issue Date:
Expiration Date:
IOWA CITY, IA 522407054
Endorsements:
1913 TAYLOR DR
Restrictions:
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Restriction
IOWA CITY, IA 522407054
Supplement:
10/23/1978
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Name: Hunt, Michael Anthony DL/ID: 124AC2612
124AC2612 (IA)
CDL Permit Class:
B
CDL Permit Issue
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Date:
9616167
CDL Permit
Expiration Date:
12/04/2015
CDL Permit
�.
Endorsements:
10/23/2017
CDL Permit
Restrictions:
PS
ID Status:
No Class A Passenger Vehicle DL Status:
None
CDL Status:
CDL Permit Status:
History Information
CLEAR DRIVING RECORD
CDL Cert Status:
CDL Med Status:
None
None
None
None
None
None
VAL
VAL
ELG
Excepted Interstate
None
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:
Name: Hunt, Michael Anthony DL/ID: 124AC2612
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6/20/2017
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Office of Driver Services
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Iowa Department of Transportation
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Fr -Ju 1. 5. 2017„ 1:12PMC1efDiv of Criminal Investigation
06/27/2017 10:Ao. 4545,,.J. 1/1./0112
STATEOF IOWA
/d -
0riminalHistoryRecord' d
< Iowa
Request Form
DCI Account Alwnber: (Inn? -'r M
(irapplicab e)
To: Iowa Division of Criminal Investigation From: City of Iowa City
Support operations Bureau, 1" Floor City Cleric's Office
215 E. 7" Street 410 B. Washington Street
Des Mouses, Iowa 50319
(515) 725-6080 Fax
Phone: 319-356-5041
Fax: 319-356-5497
I am reauestinir an Iowa Criminal liistom Rennrel Check
Last Name (mu,da ory)
First Name(mandatosr)
Middle Name (recommended)
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Au�l-
lirl(lC`?��(
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Date of Birth (mandatory)
Gender (mandatory)
SocialSecuri Number (recommended)
/6/Z31/9�ZV
Mmale ❑Female
-SIBS` -72— 7C 0 S
Waiver rnformarion. Without a signed waiver from the subject of the request, o complete criminal history record may not
be releasablo, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always
obtain a waiver signature from the subject of the request.
IfIttiver Release: I hereby give permission for the above requesting official to conduct a -Iowa criminal history «wrd check with the -Division orCriminal
Investigation (DCO. Any criminal history data eoneeming nu shat is maintained by the DCI may be released as allowed by law.
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Id/aiverSignalm�e: /r' Q `
Iowa Criminal History Record Check Results
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use only)
As of �'s I a scorch of the provided name and date of birth reveale
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No lova Criminal History Record found
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with DCI
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Iowa Criminal History Record attached, DCI tt
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DCI initials
DCI.77 (08/25/10)
Received Time Jun, 27. 2017 10:06AM @o. 2082