HomeMy WebLinkAbout12-065Authorization Number
l 1 (Office Use Only)
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APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
41 0 East Washington street between 8 a.m. to 3 p.m., Monday — Friday.)
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
First Middle Last
1. Name TAi IES Ss+rlU6G_ P.f190yS
2. Mailing Address / S L AV-9 Aa.14 c rrV 1A S2--2 YO
3. Telephone: Home .3 /g-Sys- Ll1-ZOther:
4. Prior experience in transportation of passengers: G t GAK of
tow4 CI,Y
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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? AJy
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? +"
Type of offense Where When
SPF<DInJc� 80,E 31b /0/31 /OF
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? n10
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)
deM✓ dnWadg 0912010
I hereby�(( certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
L4 N ZZ OS 78 . 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 ApplicantDate—,Z //,;,7�//,;,7
STATE OF IOWA )
COUNTY OF JOHNSON )
bscri�ed and sworn to before me by YIPS f /1� On this 1 '' day of
)-Z-�-H k
Ja71 . KFI IIF K TI ITrI tary Public in and for the State of Iowa
My
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).
S i g n aXr(;'ol Po I Chief or designee
/o//LLC< X 7G 1�)
Signelture of City Clerk or designee
1a
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
aeon tdnwadaea�201 0 d« 09/2010
I
Iowa department of Transportation
- VC1Office of Drfvef,Services, (Tcfl Free) OW -532-1127
PO Box 9204, Des Manes, [A 5D30&9204 515-244-9124
1 FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/29/2012
DL/ID #:
434ZZ0578 (IA)
Customer #:
4732685
Name:
Parsons, James Samuel
Class:
D
ID Status:
None
Address:
801 S 7th Ave
Audit #:
1852963
OL Status:
VAL
Issue Date:
02/06/2008
CDL Status:
None
City/State:
Iowa City, IA 52240
Expiration
02/12/2013
CDL Cert
None
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
801 S 7th Ave
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
2/12/1981
Supplement:
Mailing City/State: Iowa City, IA 52240
Sex:
M
History Information
Convictions
Citation Date Conviction Date ACD Explanation _C_ounty JUR
10/06/2008 .10/31/2008 592 ;Speed 152 iIA I
Name: Parsons, James Samuel DL/ID: 434ZZ0578
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++
2/29/2012
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Office of Driver Services
Iowa Department of Transportation
Name: Parsons, James Samuel DL/ID: 434ZZ0578
o2.iFeb.20. 2012910:OSAM Div of Criminal Investigation
-1. DCI IOxNo. 4648
STATE OF IOWA `'"��
Criminal History Record Check
Request Form
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DCI Aeeount Number. 4381 ^ Fc-
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Last Name pro -_ --
First Name omm&bMiddle Name ram=zoded
Date ofOirth
Gender cw* Social Security Number L=Mmqa
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ablala a wotwersLgetury Imin the gabled of the 18001,
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As of ,y�, a search of the provided name and date of birth revealed:
4CJ No Iowa Criminal History Record found with DC1 ,
/❑ Iowa Criminal History R000td attached, Oct AL -
DO
Received Time Feb, 14. 2012 2:17PM No -9179
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