HomeMy WebLinkAbout12-0857► �III�
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
0-- F.5
(Office Use Only)
3. Telephone: Home - l<- Li(nl- 5gU2 — Other:
4. Prior experience in transportation of passengers: Vi (La6_; ( �4 ( -
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? VeA
Type of offense Where When
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? I_
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? n Q
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 11
Tvoe 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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I herebx certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
h L. AID 6)44<$� . I understand that if I falsely answer any questions in this application, that this'
application may be denied. I unde staff 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" 7
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by CIOs SL .0 T (— On this )_'J_t�_day of
i
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).
_Siiggnatu a of Police Chief or designee Date
/ kR�� 11-/-2 -/o-L_
Sign re of City Clerk or designee 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
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Apr. 12. 2012 9:56AM
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Div of Criminal Investigation
City Clerk - City of Iowa City
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Received Time "AP r. 9. 2012 9:44AM No.3815
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(DCluroonly)
Ag of
a search df the provided namo tared data ofbirthaevealed:
iso Iowa a-h-ijlnal9,lstory.RecoYd i'obnd with DCT
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Tom Criminal Hfatoxy,lteoordattached, DCX#
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Received Time "AP r. 9. 2012 9:44AM No.3815
Iowa Department of Transportation
Office of Driver Services (Toll Free) WD -532-1121
PO Boer 9204, Des Manes, !A 5030M204 515-244-9124
'Uwt FAX: 515-239-1837
1*0
Inquiry Date: 4/6/2012
Name: Switzer, Corey Michael
Address: 17 METRIC RD
City/State: IOWA CITY, IA 522403003
Mailing Address: 17 METRIC RD
Mailing City/State: IOWA CITY, IA 522403003
Name: Switzer, Corey Michael DL/ID: 268AD6458
Certified Abstract of Driving Record
DL/ID #:
268AD6458 (IA)
Class:
D
Audit #:
5905192
Issue Date:
04/05/2012
Expiration Date:
10/31/2013
Endorsements:
3
Restrictions:
NONE
Date of Birth:
10/31/1977
Sex:
M
History Information
CLEAR DRIVING RECORD
Customer #:
5431187
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
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:
.•••""...!* 11 4/6/2012
IOWA¢"
D.O.T.' ag.
Of ...VER $ ` Office of Driver Services
Iowa Department of Transportation
Name: Switzer, Corey Michael DL/ID: 268AD6458