HomeMy WebLinkAbout12-017r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319)356-5497 FAX
1. Name
Authorization Number �a_ 1I
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
2. Mailing Address
3. Telephone: Home %I / — P U 7- ' r " Z— —Le I I Other:
4. Prior experience in transportation of passengers: Ca 1) Or iv -et/ I 14NI, D rt V$✓ ov CG( FGi
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 4)4,)
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? YP S
When
91
Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
To
Where
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im
GC -k 6 Pr '2r/ /
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)
cleNtl idrivndg 09/2010
I h reb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurnumber
license numbe
�C/ �j A G `6 cf q I understand that if I falsely answer any questions in this application, that this
application may be denied. Yunderstand 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, 1 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) 9
Signature of Applicant Date / / /2'
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STATE OF IOWA )
COUNTY OF JOHNSON
r seribed and sworn to before me by On this day of
�Z--
v�i� KELLIEK. TU El
z;on N'M 221a1s Notary Public in and for the State of Iowa
ICS
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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).
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 businpcses are regvired to provide Driver Identification cards.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
denn.dnw d��2010.d« 09/2010
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Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Boat 9204, Des Moines, IA 50300-921)4 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 12/29/2011
Name:
Ludy, Mark Andrew
Address:
1205 LAURA DR UNIT
1.
j\
103
City/State:
IOWA CITY, IA
522451528
DL/ID #: 156AC8945 (IA)
Class: D
Audit #: 5712794
Issue Date: 12/29/2011
Expiration 10/04/2012
Date:
Endorsements: 3
Mailing Address: 1205 LAURA DR UNIT Restrictions: NONE
103 Date of Birth: 10/4/1976
Mailing City/State: IOWA CITY, IA Sex: M
522451528
History Information
Convictions
Customer #: 5283367
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Citation Date Conviction Date ACD Explanation County IUR
02/04/2011 03/16/2011 N50 Improper Turn 52 IA
Sanctions
Type Effective End ACD Explanation Occurrence 7UR 7UR
Suspended 10/04/2011 ,10/05/2011 D53 ,Non -Payment of Iowa Fine IA IA
Name: Ludy, Mark Andrew DL/ID: 156AC8945
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:
...........?'%'V
12/29/2011
IOWA '?"%
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Office of Driver Services
Iowa Department of Transportation
Name: Ludy, Mark Andrew DL/ID: 156AC8945
Jan. 6. 2012 10:56AM Div of Criminal Investigation
Dec, jU, all I1:I7PM Elly Werk -laity OT towa City
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Received Time Dec, 30. 2011 12:14PM No. 4415