HomeMy WebLinkAbout12-006r �f� -4
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-182
(3 19) 356-5040-- 010m 1
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number i �— -
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. Telephone: Home 3�(,74—d Z7 Other: 3Pr=7 NU
4. Prior experience in transportation of passengers: In (A ( �A C�A4� J� n�ie I I'Q
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Tmp of nffpnm \A/harp When
6. Have you onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years?
Type of offense Where When
9. Have you ever applied to be an, I a i taxi driver using a different name? If yes, please provide the name(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND D
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derMt dnvbadg 09/2010
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I hereby ce av�,s�sued to me by the Iowa Depa tment of Transportation a valid Chauffeurs license number
07 J . I understand that if I falsely answer any questions in this application, that thit.
application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
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 a license
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_ // Date y/L
STATE OF IOWA )
COUNTY OF JOHNSON ) /9 / -
Subscribed and sworn to before me by ,k /, / d" Aa On this �day of
ZDi-a_
KELLIE K. TLITME _ AL(
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Signatur6of PoliceChief or designee
aN� 7�
Signature of City Clerk or designee
/--�2,1 z
Date
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dad ddw WaM2010.d« 09/2010
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/ Page 1 of 1
ACIowaDepartment of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Box 9204, Des Wires, IA 50305-9204 515-244-9124
OFAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Dare:
1/4/2012
DL/ID #:
160AA7723 (IA)
Customer #:
2869597
Name:
Armstrong, Nell Sterling
Class:
D
ID Status:
None
Address:
5144 OAKCREST HILL
Audit #:
5722442
DL Status:
VAL
RD SE
Issue Date:
01/04/2012
CDL Status:
None
City/State:
RIVERSIDE, IA
Expiration
12/27/2014
CDL Cert
None
523279309
Date:
Status:
Endorsements:
3,
CDL Med
None
Status:
Mailing Address:
5144 OAKCREST HILL
Restrictions:
Corrective Lenses
Restriction
None
RD SE
Date of Birth:
12/27/1976
Supplement:
Mailing City/State:
RIVERSIDE, IA
Sex:
M
523279309
History Information
CLEAR DRIVING RECORD
Name: Armstrong, Neil Sterling OL/ID: 960AA7723
Pursuant to Iowa Code 5321.10, I, Kim Snook, 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
Name: Armstrong, Nell Sterling DL/ID: 960AA7723
http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord. aspx
1/4/2012
1/4/2012
IOWA :;
D.O.T.' i
;`
9f ••••••''WY
Office of Driver Services
DRIVER,='
Iowa Department of Transportation
Name: Armstrong, Nell Sterling DL/ID: 960AA7723
http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord. aspx
1/4/2012
Jan. 11. 2012 3:56PM Div of Criminal Investigation No.5954 P. 1/2
!an. 4. 2012 2:12PM City Clerk - City of Iowa City No, 2001 P. 2/2
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