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Home My WebLink About17-163r f � r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. _ tuffice 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 First Middle Last 1. Name (REQUIRED) _;xA^-SS .SAM OC i_ /'oa-Sege 2. Address (REQUIRED) M/ 5. -7441 A ✓C /OtJ piny 0 S.924v 3. Contact Information (REQUIRED) Email: c,rsonseses w/ Cell Phone: 314-51/i-y4a'? Ail written communication sent via email) 4a. Driver's License expiration date (REQUIRED) _ ca/la Azo /8- b. Taxicab Business Name (REQUIRED) _ '?C --L f o W C fO 5. Prior experience in transportation of passengers:l6N `r�/2-S 4s --7--}Kr 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? AA9 Type of offense Where When What happened to the charge? (Circle one) cow _ m Convicted Dismissed Deferred Suspended Plead Guilty��ther Q Have you been arrested / charged with any traffic offenses in the last five years? it1rJ r a t� Type of offense Where j" Nhen� N 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?/ham Tvce of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED 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 Transportatioqq a valid Drivers license number YS/ZZo5—,?8 issued on 02/23/73 expiring ony2/'z/lr 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 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applica� Date S 18 I 1ttNN11f1ftfNNNtt11H1ff11f ftHHHf Ntlltift1N1R111NHf11ffN11fft11fHHHHINtttNffftf11f1f411f111H1MffffHffNfHtHtIfHH1HHf STATE OF IOWA ) COUNTY OF JOHNSON ) T ubscribed and sworn to before me by �I �r v�tS Q I Son S on this day of �J� K I K. FµRU�w 22iti to Public in and for thdState of Iowa RH1fHfHIHf1f ffffllfifiRHHHHYff 11111ltlf 1RHfHf1HHHf H1ffiH1HHHHiH1f41f1111fHfiff 11fH1f fff 1NMN11fIr1f1f1'f IflffflfHHff1HH 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 Drivers license "Zi r Signature of Police Chief or designee g11e44 7 Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOW"FTY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. o w� y • 1 Sign`atu f City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date '' rn a M r=r = 0ahJfAXI1jRIVDAMEAPR22014am-dW.D0C 07/1016 06io'May. 01724PM sulU0r I* - Div of Criminal Investigation i DCI I06ae 0652 P. 1/1 STATE OF IOWA Criminal History Record Check ti P ` Request Form 1� 1b: Seim Division ofComWII1106 UPtIOm soppmrt Operatic" amremty VFloOf 20817° stmt DN Matney 10" 60319 (515) 713.6060 Fa oClAccount fMIMrg_ 3'R- l ware " Frolat �4YGSTRXI ' 4 SkweN lmone• ,(9i4 338- m:•_. 319 SSI tem en en lewQa.nao ll Mslw futNnne -- - First Name ftmd=PAMlddleName nm P,4RrSoilS s S fi�M v6e— DaharBirth ftwhiew Gender 600lalSeeori Numb 42�IrZ /19 rf ❑lfemale S6$1 113 -S/21 Wahrafl'R/bmwRpnl 99hour a 11pimd *mfrs. how 4e mob)M Of lbs «quest, a ter>t9101e cAM10A1 bbWrr rward plrynmt bepleanbla,perGodooflow, Cbapter60AFor "InDIUMOimWlbAtetyr"tdInf0tr 0012,asa00waWWI mtwe" olAmW amt e ri e Deeta[Ibe AQelllda®otComLV1 Im((<ICCq. '�rQ>od6r sard►tiommeroaemdmt mlramraoag' DQnrydenAwdYmaOad®mdcbxk waimrstriatar Town rimind Hi tow Record Check Results ==OEM Asof a search of she prnvlded name and date of birth favaeied: Nowa Criminal Rlstaq Record found with DCI ❑ I0wa Crimieal $10* Record nMhcd, DCf # r DCS Initiel 1 ' DM77 (06/25110) so Received Time WOO, 2017 9:21AM ho.8981 A C4JIOWADOT. SMARTER 15IMPLER I CUSTOMER DRIVEN WVnv' wadO gOV Office of Driver Services PO Box 9204.1 Des Maines, IA.50306A2D4 Phone: 515-244-9124.1 8110-M-1 121 1. Fax: 515-239-1837 www.lawadoLgov Inquiry 5/18/2017 Date: Customer #: 4732685 Certified Abstract of Driving Record DL/ID #: 434ZZ0578 (IA) CDL Permit Class: None Class: D Name: Parsons, James Samuel Audit #: Address: 801 S 7TH AVE Issue Date: City/State: IOWA QTY, IA 6719710 02/23/2013 Expiration 02/12/2018 Date. Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement - History Information CLEAR DRIVING RECORD Name: Parsons, James Samuel DL/ID: 434ZZ0578 CDL Permit Issue None Date: CDL Permit 522406205 Mailing 801 S 7TH AVE Address[ None Mailing IOWA CITY, IA City/State: 522406205 Date of 2/12/1981 Birth: None Sax: M 6719710 02/23/2013 Expiration 02/12/2018 Date. Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement - History Information CLEAR DRIVING RECORD Name: Parsons, James Samuel DL/ID: 434ZZ0578 CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: Office of Driver Services CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: Office of Driver Services CDL Cert Status[ None CDL Med Status: 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: Parsons, James Samuel DL/ID: 434ZZ0578 pt0�'��°yam * OWA aI 5/18/2017 .7 •'�^xipt'�r Office of Driver Services 4 �� Iowa Department of Transportation Name: Parsons, James Samuel DL/ID: 434ZZ0578