HomeMy WebLinkAbout12-044r
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CITY OF IOWA CITY
410 East Washington Street
2240-1826
(319) 356-5040
(31 X
First
1. Name n'5- xz
Authorization Number 42 — 7 q
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
3. Telephone: Home �tq-L.2i —04 S(c _ Other:
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
C� Fci It _ 4ur 1 {y 0--w &Ae( TIrrA 260(^ _
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? y- (
ype of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
Ale 5e.., h4/l AP14L //0-' _e2o 12
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8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? tJD
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)
d.Wt. a ,vbadg 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 numb-er .,
3Fr£�Ar- til Ck-,S 1) 1 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 Applicant <+ Date? -2
COUNTY OF JOHNSON )
b7'bed and swom to before me by —1 0-S k",— On this 2—JS-7L day of
•Zn 1 Z � r .C�-� � I t�r�-�-f� .
KELLIE K. TUT E Notary Public in and for the State of Iowa
My C isy Ex fires
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 businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
JgbtaxidmmeCpeep 101 09/2010
Iowa Department of Transportation
,,,Or Office of Driver Services (Toll Free) OW -532-1121
Nm
PO Box 9204, Des Moines, IA 503fffi-9294 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/15/2012
DL/ID #:
388AE2919 (IA)
Name:
Peavy, Joshua Lorne
Class:
D
Address:
927 APADANA CT
Audit #:
5799038
Restriction
None
Issue Date:
02/15/2012
City/State:
CORALVILLE, IA 522411400
Expiration Date:
09/24/2014
Endorsements:
3
Mailing Address:
927 APADANA CT
Restrictions:
Corrective Lenses
Date of Birth:
9/24/1981
Mailing City/State:
CORALVILLE, IA 522411400
Sex:
M
History Information
Convictions
Customer #:
5568438
ID Status:
None
OL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County JUR
................:........................... ..... .............._. �.. ... ...........,. .., .......... ......... _.. ...... .. .... _.... .._:_Y.... . ... ..
10/26/2011 ,12/19/2011 ,F04 ;Seat Belt Violation .52 ;IA
Name: Peavy, Joshua Lorne DL/ID: 388AE2919
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:
1""'• :��%,��Ir
2/15/2012
IOWA Na,ti
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Office of Driver Services
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Iowa Department of Transportation
Name: Peavy, Joshua Lorne DL/ID: 388AE2919
Feb. 20. 2012 4: 11 PM Div of Criminal �Investi�gation �No.L4754 PP. X3/6
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Received Time Feb, 15. 2012 2:26PM No -4146