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HomeMy WebLinkAbout12-046� r • rrr®rm� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5ZZ40-18Z6 (319) 356-SO40 (319) 3S6-5497 FAX 1. Name 2. Mailing 3. Teleph Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) /2 - 4 (� (Office Use Only) 4. Prior experience in transportation of passengers: _/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ///O Type of offense Where When 6. Have you bee convicted 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? 1 Type of offense Where When 3 .2PO.9 so %ZS ;Zo1fJ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /1/0 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) Wbada 09/2010 I 6cerr" I ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 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, it 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 provisj ns of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant `�— Date^ STATE OF IOWA ) COUNTY OF JOHNSON ) e ,� l ri and swom to before me by c CTY\. Iv On this day of _ K ! - Turn e Footary Public 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). 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 aenw,;&MmdPgV2010.m 09/2010 �1 Iowa Department of Transportation OC]Office of Driver Services (Toll Free) 80U-532-1121 PO fiat 92134, Des Maines, LA 50305 9204 515-244-9124 FAX 515-239-1837 Certified Abstract of Driving Record Inquiry Date: Name: Address: City/State: 2/17/2012 Nguyen, Son Minh 2557 INDIGO DR IOWA CITY, IA 522406824 Mailing Address: 2557 INDIGO DR Mailing City/State: IOWA CITY, IA 522406824 Convictions Citation Date Conviction Date 08/02/2009 DL/ID #: 662YY1237 (IA) Customer #: 1895748 Class: D ID Status: None Audit #: 5413758 DL Status: VAL Issue Date: 08/03/2011 CDL Status: None Expiration 08/01/2016 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 8/1/1966 Supplement: Sex: M History Information ACD S92 ;Speed ;S93 Speed County JUR order In 35-55 mph zone) -52 U Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. Date Name: Nguyen, Son Minh DL/ID: 662YY1237 Case Number 592868 ]UR 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: �•�......•:�%fV 2/17/2012 IOWA ` D. 0. T. ••.•• '••S Office of Driver Services Iowa Department of Transportation Name: Nguyen, Son Minh DL/ID: 662YY1237 Feb. 17., 2012211:49AMM Div of�Criminal Inv�est�igation(Y lull�, ^``�yyy cilruopL'�. )STATE OF / ' •k 1 f j OriminglMstory Record ���iortHn}w N o. t u yid Pr. 4L 6 _ ACIAocounENum6ar;,�i-=,� • Qfapyl/eaDie) To, 101ya-bbyslouofCrhnina17nVevtlgat(on Pro= CTTr CB '(:p477�. 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Mums s r � 4.� Received Time Feb• 13. 2012 9:17AM No.8897