HomeMy WebLinkAbout12-075CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
,319) 356-5040t��l�{
(319) 356-5497 FAX
First
1. Name
Authorization Number Na _"V�
(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 S ZZ f J- L -,, .n S /hof, G
3. Telephone: Home 31!� W-O'�3LJ Other:
4. Prior experience in transportation of passengers:�� R 7 Cj . f, r(r - t cL r C : }
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? trio
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? V.
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? Y -A
Type of offense Where When
DIGS o��/Zoog
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? /i 7
TVDe 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 ANDS IFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR PJTLICE CHIEF REVIE
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)
clerMt idriwadg 0912010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
1S Lq i -r 11 L4 t{ . 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 � _ Date 3"z -I- 12
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STATE OF IOWA )
COUNTY OF JOHNSON )
,Sybs� ibedd and wom to before me by ��� ����� �L On this ��� day of
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
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
deM1 midn Eadgeapp2010 dm 09/2010
AIowa Department of Transportation
Office of Driver Services (Toll Free) 840-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 3/20/2012
Name: Skaden, Erik Wesley
Address: 522 N Linn St Apt C
City/State: Iowa City, IA 52245
Mailing Address: 522 n Linn St apt C
Mailing City/State: Iowa City, IA 52245
Convictions
Certified Abstract of Driving Record
DL/ID #:
154TF1744 (IA)
Class:
D
Audit #:
2927089
Issue Date:
01/16/2009
Expiration Date:
12/21/2013
Endorsements:
3
Restrictions:
NONE
Date of Birth:
12/21/1982
Sex:
M
History Information
Customer #:
4537425
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 IUR
05/24/2008 07/08/2008 Speed (10 mph & under in 35-55 mph zone) 52 IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 7UR
08/01/2009 522211 IA
Name: Skaden, Erik Wesley DL/ID: 154TT1744
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:
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3/20/2012
IOWA.8
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Office of Driver Services
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Iowa Department of Transportation
Name: Skaden, Erik Wesley DL/ID: 154TT1744
Ma r. 13. 201221_26PMM Div of Criminal Invesfigationty
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