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Home My WebLink About17-141CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 J3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. — (Office UseOnly) 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: Jo,�jan"taKiCnb4hao t,'(co,k,Cell Phone: 31a936`SAQ1U (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) I- 1 Z -q- 1 202y b. Taxicab Business Name (REQUIRED) (' (T XAJOI1n 5. Prior experience in transportation of passengers: P5 V 62 CS. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? _ A10 0 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? A) 0 Type of offense Where When What happened to the charge? (Circle one) 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 D Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide 12 name A I/) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTtFIEDj l"j DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW-, ry 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 Depa ment of Transportation a v lid Driver's license number L-AO?��2 1 (I6) issued on o o expiring on �. I understand that 'rf I falsely answef 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 n 01 � Date 16—t 1ff44HHf#Mff1Hf*rHY#+#}}+}f f f!r*MflHffH4Y#HMR+llfflff YHY#}+}MfHflH4lH}+++f i}f f!f f*H1flHY##*1MlHHH#fYY}flfllrf!!fY*-k}++f }R1H STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by l.3 :I � f e.tO f kc\ b Te on this �� day of RRNe**M****Y,f1HRH****ff**HffHRHRHRH*H****Hf4f IRRHRH*M*HfMRfHR*H****4}fHfHRHR*H*f***f*ffHR*Irt*MflfHffHR*R*f*fYY+Mfffltli* 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. �c C� /0 // / /( -7 Sign ture of City Clerk gi designee Date !f HH+1f}+rMMMrrrrrrrHrHrrrr}}MrrrMrrrf rrrHHrrrrrMHHrHrrrrHrrHMrrHHRHrrrrrrrMlMrrrMrrrrrrlrrrrfrrrrrrrrr4r*rfMrrHrrHrr Office Use Only Approved application DCI report State certified driving record Website update Geri✓rAxIDRN94DGEA 92014e dW Doc 07/2016 'J ,.5 o -n 1r -o N O Geri✓rAxIDRN94DGEA 92014e dW Doc 07/2016 FOct:�4� 2017�10:02AM,,oDiv of�Criminal ,Investigation No. 2737 P. 1/1 �•s "'•' -+'y enm •' 10/03/2017 11:10 w26es 1...2/002 STATEOF IOWA �rrb>riibtaE x-8i>:,tary Reco:rrd Check Request Form To: lows Division of criminal )ln•estigafion Support Operations ])nregu, 1" Floor 215 E. Ta Street Des 11/0//95, Iowa 50319 (515) 725-6066 (515)'125.6080 Fax 1 aln requestinz an cc) �< 2—`�� K) %k Gender o1 DCI Account Number: (if applicable) Front; City of lows City City CleriPs Office — —'—� 410 r, Washington fstreet Iowa CIt�A 52240 Phone: 319.356-5041 Fax: 319-356-5497 BiOaie ❑female e)69-ga._�g23 n arver 1nJormahon: without a signed waiver from the subject of the re be quest, s complete criminal history record may not obtain sin A per Code o[Iowe, Chapter 692,2. For cow criminal history record Information, as allowed by law', always A waiver from 1139 subject of the reouest. Waiver Release: I htfcby give permission fa the above requuling emcial to MIJutl an IOwa Criminal history recerd cheek with 111tDivision of Criminal btvesligation (M). My "imine! history dna coneeming me That is maintained by The DCt may be released as allowed by rasr. I- n As of 0 `4— 1:L a search of the provided name and date of birth revealed: 10— No Iowa Criminal Histor)r Record found with DCI 13 Iowa Cruninal history Record attached, DCI DCT initialscia., 1XI-77 (08/25/10) Received Time Oct. 3. 2017 10:49AM No, 1841 CIJ10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN vvww•lowadogov Inquiry Date: Customer Name: Address: City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Sanctions 10/3/2017 5593215 Moore, Wilfred Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1637 www.lowadotgov Certified Abstract of Driving Record DL/ID #: 409AF8021 (IA) CDL Permit Class: None Class: D Audit #: 2199694 2018 WATERFRONT DR Issue Date: 10/03/2017 TRLR 26 Expiration 12/28/2024 Date: IOWA CITY, IA Endorsements: Chauffeur 3 522404422 Explanation JUR PO BOX 2532 Restrictions: NONE 17 Restriction None IOWA CITY, IA Supplement: IA 522442532 4 12/28/1980 3 r"uraf�w !' 10/3/2017 11 History Information CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None VAL None ELG None None Type EffectiveEnd ACD Explanation JUR Occurrence JUR Cancelled '01/28/2p 17 106/13/2017 ;W00 Not Entitled to Issuance IA IA Name: Moore, Wilfred DL/ID: 409AF8021 (IA) Pursuant to Iowa Codel§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. J In witness whereof, I have caused my signature and the seal of the Department to be set upon this documep�fl at Ankeny, Iowa this date: , CD CJ"C 4 3 r"uraf�w !' 10/3/2017 m % 41. cc V Office of Driver Services Iowa Department of Transportation 10/3/2017