HomeMy WebLinkAbout18-009r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name (REQUIRED) .
2. Address (REQUIRED)
IDENTIFICATION NO.
(Office Use Onl )
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
3. Contact Information (REQUIRED)
sent via email)
4a. Driver's License expiration date (REQI
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers:
00 r- 1\p[ �)vl
Cell Phone: 315 4,,71-6 00 6
U()1— (iol
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? )JA
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
Have you been arrested / charged with any traffic offenses in the last five years? S t/ 1 2a 14
Where
N
When
What happened to the charge? (Circle one) n-< "' f—
�n � m
Convicted Dismissed Deferred Suspended lead Guil S er -n
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five year0 k
Type of offense Where WWn .a
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
C]
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereb cert' that I have issued to me by the Iowa Depa ent of Transportati n valid Driver's license number
�� (o iSfSSI issued on t2 expiring on 2 rY 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 Title 5, apter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Date / Sf
1.11MMf..}1Hf111t111fN1HH.1H,.11H111HHH,11f.l1RfYlffrfy}}yeHH.,1tHkH1ff,1H,1111f.fYf,H,1f11Mf,11llh4lli}f IYfi.fifyry ��lH1HHHH,H
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by KC-Q.�_on this _75 day of
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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 Z�T { �� 16
Signature of Police Chief or design
2 &��// 43
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.
a
Signature of City Clerk or designee Date
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Office ce use only ��,
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a
Approved application �� N
DCI report > —
State certified driving record ^�
Website update
oWTAX RNSADceAPPI-9201" �.000 07/2016
CIowa Department of Transportation
Office of Dmeef Servrces (Tal Free) OW532-1121
PO Boli 92D4, Dos Manes, W 503D6-9204 515-244-9124
FAX 5152391837
Certified Abstract of Driving Record
Inquiry Date:
1/18/2018
DL/ID #:
196ADS857(IA)
Customer #:
3646257
Name:
Kacer, Geoffrey Neil
Class:
D
ID Status:
None
Address:
2110 N DUBUQUE
Audit #:
7518587
DL Status:
VAL
ST
Issue Date:
11/12/2013
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
12/04/2018
CDL Cert Status:
None
522451624
Endorsements:
Chauffeur
CDL Med Status:
None
Mailing Address:
2110 N DUBUQUE
Restrictions:
NONE
Restriction
None
ST
Supplement:
Date of Birth:
12/04/1975
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522451624
History Information
Convictions
Citation Date
Conviction Data
ACD
Explanation
Coun
JUR
105/06/2014
105/2312014
S92
Seed
Johnson
IA
Name: Kacer, Geoffrey Neil DL/ID: 196AD8857
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 Iej Department
of Transportation to so certify. ao
L
3> -1 z
In witness whereof, I have caused my signature and the seal of the Department to be set upon this dortuyteCt, ats9nkeninMa
this date:��o ,11rq�f
7
�ylic(f yl h� 1/18/2018 70 N
i
IOWA '
D. 0.
��4•�i�' Office of Driver Services
4��.�....,-
Iowa Department of Transporation
Name: Kacer, Geoffrey Neil DL/ID: 196AD8857
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an. 19. 20184: 1:26PMC,b Div of Criminal Investigation
STATE OF IOWA
Criminal History Record Check
0 Request Form
Toe Town Division of Criminal Investigation
Support Operations Bureau, l" Floor
215 E. 7a Street
Dee Moines, Iowa 80319
(615)726-6066
(618)726.6080 Fax
T am rem,egtinvan fnwa Criminal Mlernry Ttannrd Chanle nnr
(FAx)3193392?No. 1269 P. 1/11002
DCI Account Number: 9967.>r
(Ifsppaable)
Fromi Yellow Cab of Iowa City
P.O. Boa 428
Iowa City, IA. 52244
(319) 338-9777
Phone:
Fax, (319)339-7302
Last Name mendaeoey)
First Name tnandmop7
Middle Name rocommendetl
��6
e
Date of Birth (mudam
Gender menden
social 6urity Number (neommanded
/ 17 S -
Malo Memale
0& 955 3
WalverlWorMallon; Without a signed waiver from the subleol of tha.request, a domplete criminal history record may not
be releasable, per Code of Iowa, Chapter 692.2. Forgomalete criminal history record Inlbrmetlon, as allowed by law, always
obtain a waiver sl nature from the lutlect of the request.
N
Wal ver Release: I herby alve peenMan mr the obeys toqueulna oracle) to conduct on,Town admiral hlatoryrceerd dhook wieh,ha blvlft of CY1m(nel
Inwitiamion(I)CI). Any mimind hinory dote conaming albs, h a Ine�11,1101 ay benleusd as allowed by taw. cy o
WaiverSfgnaluree
Iowa Criminal'H1story,RecQrd Check Results �� lUFO ealYL
As of a search of the provided name and data of birth revealed:
ro
No Iowa Criminal History Record found with DCI R
Iowa Criminal History Record attaohad, DCI
DCI initials ➢�C ;: ;.-
l.J
ur
DCI -77 (08/15/10)
Received Time Jan, 18. 2018 1:59PM No. 1156