HomeMy WebLinkAbout12-070g
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(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.)
(Office Use Only)
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1. Name 2rr
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2. Mailing Address 1016 Pl d HA
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3. Telephone: Home
Other:
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4. Prior experience in transportation of passengers:
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �y
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?y10
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? Y P S
T e oer f offense WhWhen
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8. Has your drivel's 11c nse or chauffeur's license been suspended or revoked - the last five years? 09
Type of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name'*lff 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)
clerR Widrivbad9 09/2010
I hereby if that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license's umber
0
12 QAC 3� Fl . 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 Date Fe i "`" y 7 2 012
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swom to before me by Fej4jr Veze_rnan On this aT day of
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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).
Signature of Police Chtkar designee
Signature of City Clerk or designee
/9/.y-•-� g, lois
Date
-y-/.7-
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
cleMk id vbadgeapp2010 do 09/2010
Iowa Department of Transportation
Office of Driver Services (Toll Free) 500-532-1121
PO Box 9204, Des Manes, IA 5030&9204 515-244-9924
FAX: 515-239-1837
Inquiry Date: 2/22/2012
Name: Wezeman, Peter Jenkins
Address: 1016 DIANA ST
City/State: IOWA CIN, IA 522404627
Mailing Address: 1016 DIANA ST
Mailing City/State: IOWA CITY, IA 522404627
Convictions
Certified Abstract of Driving Record
DL/ID #: 012AA3346 (IA)
Class: D
Audit #: 3318758
Issue Date: 05/19/2009
Expiration Date: 05/18/2014
Endorsements: 2L
Restrictions: Corrective Lenses
Date of Birth: 5/18/1951
Sex: M
Citation Date Conviction Date ACD
05/04/2007 ;05/30/2007 592
10
History Information
Bus
Customer #:
3632089
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
County J_U_R
IA
52. .._.._ ......._.tIA .... _,
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
12/01/2007 _411398 - _ - IIA
Name: Wezeman, Peter Jenkins DL/ID: 012AA3346
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 certlfy.
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/V.'p,
. 2/22/2012
IOWA "'I;e�
Office of Driver Services
Iowa Department of Transportation
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(UCI use onty)
As Of= _1 a search of thoVYb'V!ded name pird data o T�ixElza'ewealcd;
No ibwa cuiruinal Hfatory record fbiwd with 1) CT
p 1'ow4 Ctaminal lfb(oxy Record attacleed, DC1 #
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Received Time Feb. 17, 2012 4:58PM No -9587