HomeMy WebLinkAbout12-077� r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
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2. Mailing
Authorization Number 1a" ?Z
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. Telephone: Home I?lr- S" 9 .9569 Other.
4. Prior experience in transportation of passengers: X ` P 6 F ' ?
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /VCi
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? 42
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8.
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 1 /yo
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)
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09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
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)() U SI G C c . 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,(//.f"�,� of lt/� Date3-aa'/,2
STATE OF IOWA )
COUNTY OF JOHNSON ) \ p
$, b cribe� andIn to before me by )Cti V\,-)� 1 e C t� On this Z2 day of
$_KELLIE K. TUTTLE Notary Public In and for the State of Iowa
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).
SN
gnature of Police Chief or designee
Signature of City Clerk or designee
Date
3
2.z - / z
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
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CIowa Department of Transportation
AO Office of Driver Services (Toll Free) 800.532-1121
PO Box 9204, Des Moines, IA 50305-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/16/2012
DL/ID #:
327UU8600 (IA)
Customer #:
447773
Name:
Dietrich, Darren Lee
Class:
D
ID Status:
None
Address:
2414 J Street Sw
Audit #:
5074778
DL Status:
VAL
Issue Date:
03/11/2011
CDL Status:
None
City/State:
Cedar Rapids, IA 52404
Expiration
03/24/2013
CDL Cert
None
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
2414 J Street Sw
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
3/24/1936
Supplement:
Mailing City/State:
Cedar Rapids, IA 52404
Sex:
M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
05/07/2009 05/12/2009 Speed (10 mph & under In 35-55 mph zone) 22 IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
11/21/2005 5258041 IA
Name: Dietrich, Darren Lee DL/ID: 327UU8600
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:
."..... '4
3/16/2012
IOWA
D. 0.
PBIVEF,'
Office of Driver Services
Iowa Department of Transportation
Name: Dietrich, Darren Lee DL/ID: 327UU8600
Mar. 20. 2012 3:18PM Div of Criminal Investigation
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STATE OF IOV4rA
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Received Time Mar.16, 2012 12:08PM No.1162
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