HomeMy WebLinkAbout17-154� r 1
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
Q 19) 356-5040
Q 19) 356-5497 FAX
1. Name (REQUIRED)
IDENTIFICATION NO. 17— /5,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
Middle
2. Address (REQUIRED) �T-C>--Zoic W$3_ Lon�E TefQ,�a 527s45-
3. Contact Information (REQUIRED) Email: C!AM Cell Phone: 3l`v-q310-oi5$7
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) 12-) 22- )` U Z.0
b. Taxicab Business Name (REQUIRED) N t lkow 0—",6 0I;7 --r
5. Prior experience in transportation of passengers: W'J Vt*.Pb 'Tf1Xn "DP %11.9
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? T40
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? D
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? :�l -No
Type of offense Where YhePdr —n
Tr C>
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pr a ti; na
_No *- co
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CER7AED
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
I hereby certify that I have issued to me by the Iowa Department of Transportatigqn a valid Driver's license number
05AC.L' 2W -S issued on l io 14 expiring on \�c2o . 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 55, Chapter 2, f the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant 11pra�L�' 10 = Date o;�INoV Z.o /r/
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by K -e u n t 4:A,� 33..ren on this 'Z_ Z day of
A)mO Z-01 -7
* # * * * * * * * * * # # * * # * * * # * * 1 * # * * * # * # # * * # * * # * * # * * # # * # # # # * * * * * * * * # * * # # * # # # # * * # # * # # # * * * * * # * * * * # * * * # * * * # # * # # # * # * * * * * * * # * * * * * * # * * * * * * * * * * * * # * * * # # * # * * # *! # *
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 1::?
ZZ//Z�
Signature of Po ice hief or designee
--r 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.
ell, C
Signature of City Clerk or designee
Date
GeWTAXIDRNBADGEAPPL92014am ded.DOC 07/2016
Office Use Only
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Approved application
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DCI report
State certified driving record
Website
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GeWTAXIDRNBADGEAPPL92014am ded.DOC 07/2016
iiivov. 14. iul/;t Y:q9 lCabUly ofGrlminal Investigation No. 6111 P. 1/8
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STATE OF IOWA
Criminal History Record Check
Request Form
To: IOWA Division orCrlminal Investigation
Support Operations Bureav, I" Floor
21S E. 7" $treat
Das Molnef,low& $0319
(515) 725.6066
(S1S)'725-6080 Fax
IJM11
DCl Account Number: _9967-F
(If oppiieabie)
From: YellowCab or Iowa CI
P.O. Box 420
Xown CIty,IA. 52244
Phone: (319) 338-9777
Fax: (3X9) 339-7302
.q:) -"DSO- zo l- . JAlMale ❑Female I Xi SI —OZ-- t -i 1,59
Waiver lVormafion. Without a signed waiver from the suhJegt of the request, a eomplgte grlminal history record may not
be releasable, per Code of Iowa, Chapter 692.2. For cornnlete, criminal historyrecord information, as allowed by law, always
obtain a waiver slanaturc rrnm she auhr..r rn.... . _..
Waiyer Releasee hereby give patminlon for the above raque=tlna ertlolel to conduct an Iowa odmln■I history record check with the Dlvldon ofCrhnlnd
Inves11ged9n(DCq. Any almloal history dolaceneeml melhothma�nc4bybyt�yberelemodas allowed bylaw.
Waiver Signature,
Iowa Crimin.al History Record Check Results
=``
(DC,ryee
only)
As of a search of the provided name and data of birth ravoaCa}lI '
:"r!�i
�— No Iowa Criminal History Record found with DCI
a;.:.
❑ Iowa Criminal History Record attached, DCT #
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DCI initlels��.
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DCI -77 (08125/10)
Received Time Nov, 10, -2017— 4:12PNLNo. 9901.—•. -
Iowa Department of Transportation
(Mice of Us vw Services (Td! Ffee) ODO-532-1121
P€] Box 9244, UBS Moines,Ido 543D6,D204 515-244-9124
FAX: 515-2391837
Certified Abstract of Driving Record
Inquiry Date: 11/10/2017 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
Issue Date: 12/19/2014 CDL Status: VAL
City/State: LONE TREE, IA Expiration Date: 12/22/2020 CDL Cert Status: Excepted Intrastate
527559321
Endorsements: Double/Triple CDL Med Status: None
Trailers
Mailing Address: PO BOX 183 Restrictions: Corrective Lenses, Restriction None
CDL Intrastate Only Supplement:
Date of Birth: 12/22/1967
Mailing LONE TREE, IA Sex: M
City/State: 527550183
History Information
CLEAR DRIVING RECORD
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: -
11/10/2017
V IOWA 1.
D. O. T .Iftv +
i�h1880 Office of Driver Services
Iowa Department of Transporatlon _
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Name: Lathrop, Kenneth Dean DL/ID: 082CC2468
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