HomeMy WebLinkAbout12-076sIII
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name S'7,e///'
2. Mailing Address L11733
3. Telephone: Home �/�
4. Prior experience in transportation of passengers:
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Other:
s0�/1/
3 i2 y,P
(Office Use Only)
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?nZ
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? 0
Type of offense Where When
8. Has your driver's license or chauffeur's 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)
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)
derhn=Wvbadg 09/2010
I herby r,rt thakI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license "lbimber
73� J� !r . I understand that if I falsely answer any questions in this application, that tk;s
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) 1_? I / )
Signature of Applicant �� �— Date() Wd 14,2V/,-,?
STATE OF IOWA )
COUNTY OF JOHNSON )
scnbed nd sworn to before me by ��e f 11 ��Y� On this Z1 S� day of
�,��,
KELLIE K. TUTTLE ry Public in and for the State of Iowa
My coissi n iree
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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).
Signa re of Pyf c C lief or designee
Signat re of City Clerk or designee
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
cied widdvbadgeapp201 0da 09/2010
P:r
State of Iowa
Division of Criminal Investigation
215E7"St
Des Moines IA 50319
Ph. 515-725-6066 Fax 515-725-6050
Iowa Criminal History Record Check
Walk -In Request
Your name
Address oro o f
eK-
Ci /State/Zi /
Phone# jf/57
Reauestine an Iowa criminal history record check on:
Fill in all shaded areas.
Last Name Apetlido (mandatory)
First Name Primer Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
3 -Al- 0-17 p.
S1 -e- r//, ?-
090
Date of Birth FechaNachniento (mandatory)
Gender Gene o (mandatory)
Social Security Number (recommended)
Odll� // �
Male ❑Female
J 3 S — 702. r7/ Ye
Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.)
LCIUSEONLY
Results
As of 3 —a / — / a , a name and date of birth check revealed:
#No record found
❑Reattached, DCI #
DCI initials u l%
Receipt ,l
Number of requests��cash
x $15.00 per last name = Total amount $Method
of payment: ❑money order ❑check # ❑MasterCard or Visa
Cardholder's name Last 4 digits of MC or Visa
DCI initials
Credit Card Number # Exp. Date
On' S�e�� Soil' ems
-; _ a
.I s r
(Toll Free)
.r.r
Office ,p .. lox 9204, . e r fiver ict i = :372
Inquiry Date: 3/13/2012
Name: 'Strang, Sterling Douglas
Address: 4733 TORONTO ST APT 4
City/state: AMES, IA 50014
Mailing Address: 103 LINCOLN ST
Mailing My/State: WEST BRANCH, IA
523589410
CDL Medical Examiner's Certificate
Certified Abstract of Driving Record
DL/ID #:
563AG3876 (IA)
Customer #:
5899630
Class:
D
ID Status:
None
Audit #:
5854604
DL Status:
VAL
Issue Date:
03/13/2012
CDL Status:
VAL
Expiration Date:
02/16/2016
CDL Cert Status:
Non -Excepted Intrastate
Endorsements:
3
CDL Med Status:
None
Restrictions:
Commercial Instruction"`
Restriction
CDL Instruction Permit
Expires 9/3/2012
Permit
Supplement:
Date of Birth:
2/16/1982
sex:
M
Certificate Specifics....._..........._____.._.____......_................. ...............
History Information
CLEAR DRIVING RECORD
Name: Strang, Sterling Douglas DL/ID: 563AG3876
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I al
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 1
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:
o' '•;Udj"v,
3/13/2012
IOWA
).0.L:i%
Jam%
c'•• ••• 5�=
Office of Driver Services
Iowa Department of Transportation
Name: Strang, Sterling Douglas DL/ID: 563AG3876