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Home My WebLink About12-095� r III • Alva ®0QIl CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 _(319) 356-5040 (319) 356-5497 FAX 1. 2. 3. First Name ?�M Mailing Address 610 N Telephone: Home 4. Prior experience in transportation of passengers: we 2r[< d t0 Ih a C.q7 P�'iK o, I) L,? dW f• 11 . Authorization Number Ig -q5 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle L ec ,SS Hc.0 -`y T4 .5'11;L4 �ast Other: C01 all�f- �i3G 167% �2 S4CC655Y...) L%Jn} �(kr ria Ci74>•1� '10 bJ an K _1— F 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N 0 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? too Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offenseWhere When pp 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? /lIJ 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) 14) J 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) Gerk/taxitlrivbatlg 09/2010 hetebv grti eat I aye issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �l L7 / t S `/ . I understand that if I falsely answer anv questions in this aoDlication. 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 HHHifHit*****Hf ff 1fHHHfff#i#i#!#M'1#H*#HH*HHH1fMlfHMHHM#HHfH#HHHHHHfHf##iifiiiif #H*#f *iYO#HH*Hf#*fHf11f lf1lHH STATE OF IOWA ) COUNTY OF JOHNSON ) i Subscribed and sworn to before me by V(1 ,2141' On this 2 Y day of dv o r ONDRAE FDRT ,,rrte� I; � commission Number 159791 <<fn d A[ C_Xr my commissar Expiea 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). Si na ure of P lice of or designee Sign'ature of City Clerk or designee 4k-� S. ,?o/e2 Date 5--3 - /',� 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. flifHfHH1111f1**...ii.*11111H1..HHHfiHfHH1HH1H1HH11H1111f11fefH#HHlffffHHHHHfHffHfiHi}#iHHH#i##f.*.*HH1f.HHHH Office Use Only Approved application DCI report State certified driving record Website update dark dnW dgea,2010dm 09/2010 Iowa ,.# Office of Driver F0 Box 92D4, Des Moines, [A 5U30&9204 Inquiry Date: 4/19/2012 Name: Klopfenstein, Kim Lee Address: 404 N ELLIS ST City/State: KEOTA, IA 522489708 Mailing Address: 404 N ELLIS ST Mailing City/State: KEOTA, IA 522489708 Convictions Transportation (%11 Free) "-532-1121 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record DL/ID #: 263AD6654 (IA) Class: D Audit #: 5931614 Issue Date: 04/19/2012 Expiration Date: 10/13/2013 Endorsements: 3 Restrictions: NONE Date of Birth: 10/13/1958 Sex: M History Information A4� 6c�vt 9 Customer #: 3212193 i IOWA ID Status: None DL Status: CDL Status: None / CDL Cert Status: None Iowa Department of Tansportation CDL Med Status: None Restriction None CA/0 Supplement: Citation Date Conviction Date ACD Explanation County IUR .. _. ..........._.._._.. .... ....... 07/12/2011 .... _.._....... - _.:_-_ ;Improper Registration .......... ..__ .._..._ .._; A ..._. .... ..I .. 06/03/2011 _ _ _ _� _ 09/10/2011 ,10/11/2011 ; :Improper Registration IA Name: Klopfenstein, Kim Lee DL/ID: 263AD6654 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: ......... p�9� 4/19/2012 i IOWA 5� 4g o ServicesOfflce of Driver Iowa Department of Tansportation Name: Klopfenstein, Kim Lee DL/ID: 263AD6654 hay. 3. 20 12212 Div of�Criminal Investigationty Nio 5882 Pr V2 U um, rC>rImr Ina>l'astory ptecord check .; Request 7N'oraa) , _ _ bClAccovnENumber: `y9O'� J�' ` ' QPoppff4uD o)L To; Xotya.bbyalon,From! G= DF Toon creno Support,1'IFlooe OZTZ CLERK'S OaBXGX 2�6L�.7�Slreafi 41f),_� IIA5�7prGTO17 STtLBRT loaylv>!gittos,xn�va So3i9 , (91s}Ia56a68 IMA Cars' rows Kpgrm (515a 72!"Ofto Nal A OEW, iY9 5�i SP4r , $9xl a19,�RSr;,5497 G P 4&s , x/ I Yll L lac l3 /�S �I P(MaIB �J6cinaXo/,yrs'- �0 571 / tfiaiver i{io)maY�/171; TVIthnutaslRnedW9IYe1�tYomthesu6jensotthoYequevl,atomplotectlt4fnAlTtisfor reoorau,QynoC boYafeaiu6je Vecola 69:.3..r01 otn iota'criu�fnp)historyeecoytiMfolthnttoN,agaltoWB�byldwi,plways FYIIGi/2NRef6!%SfY7 IAerabygrvaI NOWAY(o wrtdueI m toxvaMmIndAIsto1yocoid cht4wd11 die DM Ion grNmind YnYoslTgalfod (pCp, ,u�y edminslh(aweydulg dpncomtng nm�haC/laM/alalaln/�y�iho D�O7m.;y 6utafessadae elfewcC Dylaw. Lowa CAW >asZMoto oc&M CheAtmultg : ,0000sniy) As o CD a soarCh oftbeprovided name and data oibirthsevealed: cs _, No.Ybwa WMIndFistorykecordfolmdwithDCZ -. XovmaiminalUlatoxyPetoxdaitaohed,]701ii ?3%g[(O% bC1; iraitlals Received Timeghr.26. 2012` 2:50V -No. 540 May. 3. 2012 12:10PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00376167 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/05/03 DCI:00398167 NAME: XLOPFENBTEIN,XIM LEE DOB SEX RAC NGT WGT EYE HAIR SKU POD 19581013 M W 511 185 BRO BLK IA ADDITIONAL IDENTIFIERS CCH RECORD www O1 ARRESTED 19880807 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE XA123-47 SUPPLY DEER -MINORS . TRK#: L34552201 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA122-47 AIDINd & ABETTING CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L34552201 SENTENCE DISP EFF DAT FINE $100 190B0819 02 ARRESTED 19910624 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA321A-32 DRIVING U/SUSPENSION TRK#: L34552301 COURT DISPOSITION AGENCY: IA0920151T WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA321A-32 OPERATING WITHOUT LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L34552201 SENTENCE DISP EFF DAT FINE $1S 19920204 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO MON-LAW ENFORCEMENT AGENCIES BY TER DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.5882 P. 2/2