HomeMy WebLinkAbout12-047or"
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 3S6-5497 FAX
1. Name
Authorization Number i D-- y'I
(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 `t 117I�� 4- �[Wrr� ^RI) T h 4-OCLt Ci J-ff 7 TO- tb
3. Telephone: Home 3 I'7 ` � � p Other: h �q
h
4. Prior experience in transportation of passengers: CC. OW t X% Y �r1 (t}e tM fo
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 0e)
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? )o
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? l)b
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)
cicWlmidriWadg 0912010
IYr nrfilthyt I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
ii �� CC�� hh . 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 Applicant r` 1 Q{'A Date 3-1 94/ a
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by �Sr �!=e�+r L« ��\L\dc _ On thisday of
Notary Pu in and for the State of Iowa „u
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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).
Q-
- 'Z�04�"'9 Signatu of Volice Chief
,6[,d sign/eeee
Signatt, a of City Clerk or designe
�fi3 0l�7, i4/o7
Date
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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
dern .,mvb og pp2010ao 09/2010
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Feb Oo .l eyy.aoa r snow Cab of iowa uty 319-338-2708 p.2
STATE OF IOWA
Criminal History Record Check K
Request Form(0 }%-9
r t
TO: loWa Division of Criminal Inveatigolion
Support Operations Bureau, I" Floor
215 E. 7' Street
Des Moines, Iowa 50319
(515)725.6066
(515) 725.6080 Fax
I am reauestim an Inwa Criminal Xitatnru narn.d rhnnlr
DCI Account Number; 9967-F
(irspplicable)
From: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, IA. 52244
(319) 338-9777
Phone:
Fax: (319)339-7302
Last Name manda(o)
I First Name (ma,dmoey)
Middle Name (recommended)
I AMP9
rlr5�j�
Cise
Date of Hirth (maim
Gender mendmory)
Social Securi Number (noommenaea)
G6 ! � l�8
�vtale ❑Setnale
'192 -a8 --
�va'� � 3�-,'�. ,��
W1119er 1lrlafirrafianr Without a signed waiver from thesubjectof the request, a complete criminal history record may not
be releasable, per Code of lows, Chapter 692.2. For complete criminal history record information, as allowed by law, always
obtain a waiver sl nature from the subject of the request
Waiver Release; t haebyglvc permission for the abave rcqueating omcial to cdnduet an lows aiminat historyeecord eheck with the DivisionoTCominel
Inveulgadon(DC')t..%nytdmind hiaary daa emmmingme that is mainiWned bythe DCI may bet imcd m allowed by hw.
Waiver Signature: _
Iowa Criminal History Record Check Results
As of a search of the provided name and date of birth revealed:
_4 No Iowa Criminal Flistoty Record found with DCS
❑ Iowa Criminal History Record attached, DCI if,
DCI initials
DCI -77 (D8/25/10)
Received Time Feb. 8. 2012 9;58AM No. 8485
Iowa Department of Transportation
llru Office of Driver Services (Tai Free) SM -532-1121
PO Box 9294, Des Manes, IA 503013-92134 515-244.9124
1*0 FAX: 515-239-1837
Inquiry Date: 2/22/2012
Name: Meade, Kristopher Lee
Address: 411 HIGHWAY 1 W APT 6
City/State: IOWA CITY, IA 522464207
Mailing Address: 411 HIGHWAY 1 W APT 6
Mailing City/State: IOWA CIN, IA 522464207
Convictions
Certified Abstract of Driving Record
DL/ID #: 044SS8716 (IA)
Class: D
Audit #: 4792486
Issue Date: 11/02/2010
Expiration Date: 08/27/2014
Endorsements: 3
Restrictions: Corrective Lenses
Date of Birth: 8/27/1982
Sex: M
History Information
Customer #:
4498277
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County 7UR
_ _ . --.
11/26/2009 1_2/16/2009 S92 Speed (52 SIA
12/08/2010 12/20/2010 M34 Fail to Obey Traffic Sign/Signal 152 ,IA
Name: Meade, Kristopher Lee DL/ID: 044SS8716
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:
...........`��4
2/22/2012
IOWA"..
D. O. T. rV,%
t
�i
F...... �
Office of Driver Services
Iowa Department of Transportation
Name: Meade, Kristopher Lee DL/ID: 044SS8716