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Home My WebLink About12-0931. Name Kre 1 (e- 2. 2. Mailing Address 3. Telephone: Home 31c oil —io G Other: 4. Prior experience in transportation of passengers: -TA x i C) f',y cc ecr V S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Al I 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? Al Type of Offense Where When ` 7. Have you been convicted of any traffic offenses in the last five years? /1''iO Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? A) t') 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 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) clebJ.d,vbatlg 09/2010 Authorization Number /j - 93 1 (Office Use Only) �tJ4_ CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 East Washington street between 8 a.m. to 3 p.m., Monday - Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name Kre 1 (e- 2. 2. Mailing Address 3. Telephone: Home 31c oil —io G Other: 4. Prior experience in transportation of passengers: -TA x i C) f',y cc ecr V S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Al I 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? Al Type of Offense Where When ` 7. Have you been convicted of any traffic offenses in the last five years? /1''iO Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? A) t') 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 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) clebJ.d,vbatlg 09/2010 I herebX certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I `I 6 A D 8 % 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 examineZ/Vith nd all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all a revisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date S 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by On this �S� day of Jai3- SONDRAE FORT i COmmission Number 159791 Notary Public in and for the State of Iowa My rommifirim F. a 6- 4Fii#ltti#iif4f##3*#tH*3*#H**#*tf#Y*t**#*H##Rtffffiflff44*4tttt**#*FRltR#Rffff44f44#f#Hf*#tt*HtRRR#RR4IffH#ft#ft#Ft##Yt##H#RRRRRRff##k#ft 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). a. Signa re of Po Chief or designee Signature of City Clerk or desi nee �a 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. ffffH4#RHlRHH4##4H44Hfitt#i#4##4##H#4#i#i#ff##H#iffltR!!Fi##itk#iH#f#1f HH1ff HlHf4444###fH#YffllHflff fR41fll4ttt4M####Hf#1flHH! Office Use Only Approved application DCI report State certified driving record Website update deNJlaxJdnvWdWapp2010.d 09/2010 f 0 qjj-Aur 12. 2012 12:OOPM Div of Criminal Investigation No.4379 P. 2/6 IWON Wv9i;:01 1102 .01 -Adv awil PaAlaaal STATE OF IOWA W. Criminal History Record Check Y Request Form Tor IowabtvlaonorCrhohnllnrestlsanoo Support Operations Burau, Sn Floor 215 F. 71, street bes Wrote, Tom 5019 (515)745.6066 (515) 7756050 Fax AC(Aceeent Number: 8y3 ( br e) From) ArGS TAXI (,� rj�'GVCwe �(r• OoN CtA4. A 5'34go Fypnp; ,(319 338- �ly 319 551 -UM Lut Name I First Nemo m.,a. Middle Neme ,ao ( e e�e e ' Date of Birth madYo Gender �mdwAZ Sadel Security Number ,mo / 2 ^ y� �� Male OFeraale 7—oG 9t s 3 Walverinjormaflonr Without a rlwred valver hom the lublcct orthe requert, a complete eHmlual D4lory record may out be retearsbte, per Cade of Iowa, Chapter 692.2. For paluoleh etisUdd history mord information, no allowed by taw, always o tslat a walverstieuiture from the sabject of the retnifft. WaiverReleaSe:Ihe%Wj#vnpemhdeefofd,e 1o111cW ounimrolvw ' Inrm*dca(1XQ. loryuimkWhr"daecgqemins IhIrAk, "41 do timeybe a ' gnmidc1cokwilhThe plrhlonorerimiod ty llw-..... WalverSlgWWe: Iowa Criminal History Record Check Results As of a a search of the provided name and date ofbirth revealed: No Iowa Criminal History Rewld found with DCI 70 ❑ Iowa Criminal History Record attached, DCI N DCI initials - M w� Y M W-77(08/25/10) Iowa Department of Transportation ►y Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX; 513-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/1/2012 DL/ID #: 196AD8857 (IA) Customer #: 3646257 Name: Kacer, Geoffrey Neil Class: D ID Status: None Address: 2110 N DUBUQUE ST Audit #: 1968857 DL Status: VAL Issue Date: 03/18/2008 CDL Status: None City/State: IOWA CITY, IA Expiration 12/04/2013 CDL Cert None 522451624 Date: Status: ' Endorsements: 3 CDL Med None Status: Mailing Address: 2110 N DUBUQUE ST Restrictions: NONE Restriction None Date of Birth: 12/4/1975 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522451624 History Information CLEAR DRIVING RECORD Name: Kacer, Geoffrey Nell DL/ID: 196AD8857 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� 5/1/2012 IOWA N q ). 0. T. ss � r'...... $ � Office of Driver Services a�� „�A�'V Iowa Department of Transportation Name: Kacer, Geoffrey Neil DL/ID: 196AD8857