HomeMy WebLinkAbout12-008„ Authorization Number
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(Office Use Only)
CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday– Friday.)
Iowa City, Iowa 52240-1826
(319) 3S6-SO40
(3 19) 356-5497 FAX
First Middle Last
1. Name P] AtjdoLj2 Iif?n)L
2. Mailing Address IJn5 Gre<r1.6r;AQ. I -A3. 5.c4), diy; o CesIAR 9A�,eJi,
Eoa) t 5-A464
3. Telephone: Home ,3 f 9 — Other:
4. Prior experience in transportation of passengers:/6 71/y_S
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in
the last five
years? ,U O
Tvpe of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? A10
Type of offense Where When
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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 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) 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)
cleNJtaxitlrivbatlg -
09/2010
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number,
/!7 AA 44 g� , . I understand that if I falsely answer any questions in this application, that this
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 ApplicantDate / ' -2, " )�
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STATE OF IOWA )
COUNTY OF JOHNSON )
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Subscribed and sworn to before me by V",qn-jz�_ On this 12 day of
WtaryNblic in and for the State of Iowa
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).
At'�
Sgnatur of Police Chief or designee
�%iCL�c-� s.i PC 7ClIiL
Sign ure of City Clerk or designee
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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.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
deddladdnm dgea,2010.a« 09/2010
CIowa Department of Transportation
AO Office of Driver Services (fall Free) 800-532-1121
PO Box 9204, Des Moines, IA 503DB-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
1/10/2012
DL/ID #:
117AA9482 (IA)
Name:
Kane, James Randolph
Class:
D
Address:
6305 GREENBRIAR LN
Audit #:
5656517
SW UNIT B
Issue Date:
11/30/2011
City/State:
CEDAR RAPIDS, IA
Expiration
12/09/2013
524046217
Date:
Endorsements: 3
Mailing Address:
6305 GREENBRIAR LN
Restrictions:
Corrective Lenses
SW UNIT B
Date of Birth:
12/9/1935
Mailing City/State:
CEDAR RAPIDS, IA
Sex:
M
524046217
History Information
CLEAR DRIVING RECORD
Name: Kane, James Randolph DL/ID: 117AA9482
Customer #: 1933866
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Pursuant to Iowa Code §321.10, 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, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
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1/10/2012
IOWA *
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Office of Driver Services
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Iowa Department of Transportation
Name: Kane, James Randolph DL/ID: 117AA9482
Dec.21. 2011 2:09PM..., Div of Criminal Investigation
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:r. STATE OF YOWA.
l '.. Criminal History Record Check
A Request Form
No. 4091 N. 4,'4
Mig 1A 6A1 'i P 2/3
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search Of the pioyided naino and date ofbictic rc eased:
NO Towa Cominal History Record found With DCI
❑ Tows C4iminsf FlIstory Record attached. DCI#
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eceived Time Dec.16,
2011 1:34PM No.3656
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