HomeMy WebLinkAbout12-053CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 5 2 240-1826
Q112) 6-5040 �
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
iC� -s-13
(Office Use Only)
Firt ' __—Middle2 Lgst
1. Name J ✓I� GaQ I vin*� o �nS ✓.�
2. Mailing Address Z l o U S .5 CQ�v d � r, 1 pg ifs 1 fj S Z ZY 0
r
3. Telephone: Home 319 S I Z 0 LIZ-/ 3 Other:
4. Prior experience in transportation of passengers: ( y C o rS +c, K. byS, n G sS
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? V1 0
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? /L 0
Type of Offense
sercyc d
Where
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7. Have you been convicted of any traffic offenses in the last five years?
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4 r 1 v� i
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Where
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8. Has your driver's license or chauffeurs 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)
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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)
der. mddwadg 09/2010
I hereby certify that I hay ssued to me by the Iowa Department of Transportation a valid Chauffeurs license T%mber
% 1 S yY % ��Y 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 Applica Date ? 2 L I Z
STATE OF IOWA )
COUNTY OF JOHNSON ) 1 6
bed and sworn to before me by 0 /1 t f �v a -d 706 i'1 S 0"rt On this (a ' ` day of
2O1�_ K`C, (-I-- Ell.Ltt(P
KELLIE K. TUTTLE Notary Public in and for the State of Iowa
##Rfffllfffffffflfff#f#####RR#####h
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
derW mex be gee p2010,E 09/2010
Iowa Department of Transportation
Office of Driver Services (Toll Free) BM -532-1121
PO Box 9204, Des Moines, [A 5030&-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/24/2012
DL/ID #:
775YY1494 (IA)
Name:
Robinson, Michael Turner
Class:
D
Address:
2100 S SCOTT BLVD LOT 46
Audit #:
3160119
Restriction
None
Issue Date:
03/27/2009
City/State:
IOWA CITY, IA 522403017
Expiration Date:
03/28/2014
Endorsements:
3
Mailing Address:
2100 S SCOTT BLVD LOT 46
Restrictions:
Corrective Lenses
Date of Birth:
3/28/1976
Mailing City/State: IOWA CITY, IA 522403017 Sex: M
History Information
Convictions
Customer #:
2394989
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 3UR
06/17/2007 -07/09/2007 _ :592 `•Speed52 IA
02/09/201003/31/2-01O `.M14 (Fall to Obey Traffic Sign/Signal 52 IA
Name: Robinson, Michael Turner DL/ID: 775YY1494
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:
Name: Robinson, Michael Turner DL/ID: 775YY1494
'••:;N"oy 2/24/2012
IOWA .
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Office of Driver Services
saw
Iowa Department of Transportation
n Oodlz Ul.1ya Ili enownCab rr toowe u yf lml ndl investigation 319-338-270b e'OCUJ r.p �(I
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STATE OF IOWA
Criminal History Record Check
Request Form;. 3
r
Ta: IOWA Dlrlaion of Criminal Investigation
Support Operations Bureau, I" Floor
215 E.711 Street
Des Moines, Iowa 50319
(515) 725-6066
(515) 725-6080 Far
I am remnestine an Iowa Criminal History Record Check nn -
DCI Account Number: 9967-F
[Irappficebic)
From: Yellow Cab of Iowa City
P.O. Box 428
Iowa City, Lk 52244
(319) 338-9777
I'honec
Far: (319) 339-7302
Last Name(randamry)
First No me mendaro
Middle Name frwmmwded
2t n
ICh (
r- 11 e
Date olf Birth (mandNary)
Gender mandarary)
Social Security Number (recommended)
3 Z S 19 -7
Tale ❑Female
8 6 9 9 z z
WaiverinfOrnwlion: Without a signed waiver from the subject of thorequest, a complete criminal bistory record may not
he relearrable, per Code Of Iowa, Chapler 692.2. For complete criminal history recur¢ Information, as allowed bylaw. always
obtain a waiver ei nalure from the subject of the request.
Waiver Release: l fimby give pemiaslon ar she abase requesting ammo ra mmocl as lawn cdmmd hivnry record chadC Wim rba Divnioa ofCriminN
lrnadi;"m(W), Any criminal hinory dalf mnmmingme alai ism moan ed by the DC) maybo o1mced a allowed bylaw.
l
Walver Signafare:
Iowa Cr*_'_minal History Record Check Results ` cost roe-�Y)
As of 1 //a -, a search of the provided name and date of birth revealed:
low No Iowa Criminal Risiory Record found with DCC
❑ Iowa Criminal History Record attached, DCT
DCI initials
DCI -77 (oe125119)
Received Time Jan. 6. 2012 9:13AM No, 8806