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Home My WebLink About12-117� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Authorization Number la — // 7 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Last i�:F 1i1- 2. Mailing Address 3. Telephone: Home Other: 4. Prior experience in transportation of passengers: ei.016 (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N0 Tvoe 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? WD Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? G>J a Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i✓0 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) der twidrivbadg 09/2010 Ireby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number LO ? Z / / I 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) D/n/ ///7 Signature of Applicant 4 h'.� i{( Date ++ar++rrrrxrrrrrrrr+rarrrr++aa+aa+a++++xrrrxrrrrrxrrxrrrrr++rrr...r+.rr+r».+rrr+r...rr+rrr:rr.rrrrrrrr.rr...r+rr+rr»+.rr.....rrr.r...rr++++.++ STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by -A-+ h..v r e ss h d r On this day of 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). �'. Date /C9— 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. ++a++e+r++rrr»rr+rrrrrr+rr++ra+a+aa:a+++a+aa+«ar+++awr+rarr.aarrrr+r+rrrrrrrr+rr+rrrrrr+++r+rrrrwm+rrr+rrrrrrrrrrrr+rrr+rrrrrrrr+rrrrrmr» Office Use Only Approved application DCI report State certified driving record Website update deMtl iwtl dgea,2010.d= 09/2010 Mayo!May.14. 2012 3:24PM;abJiv of Criminal Investigation 319-338-2708 No. 4815 P. 1/1 N, ArSTATE, OF 1 i t� 1041st � • Criminal History1 1Check 4equestForm , To: Iowa bivision of Criminal Investlgatlon Support Operations Bureau, l" Floor 215 B. 7° Street bas Moinas, Iowa $0319 (515)725.5066 (515) 725.6080 Tax I am reauestine an Iowa Criminal History Record Check on: AGI Account Number; _9967-F (if applicgble) Brom: Yellow Cab of Iowa City P.O. Box 429 Iowa Citya IA. 52244 (319) 338-9777 Phone• I+ex- (319) 339-7302 Cast Name -ntNauory)Y First Name (mandatory)' MiddleName (ruommcisdad) Date of Birth (m.odata ) Gender (maadarory) • Socia6Securi • Number racanwended /�- — /J _ ��+P .. 1 �1117a1e ❑Female say Waiverbtformadon: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code or Iowa, Chapter 692.2. For epipplete criminal history record information, as allowed bylaw, always obtains waiver sl nature from the sub ectof thar uest. WaiverRelease; I hereby Elva pctmimion for oto above rquesting omciol co conduct m lowa criminal hlpoEy woord check with [he Division of Criminal .nvatlxation(DC). My eriminai himq• data roue/ammin�n sao that is maintained bytho Del may ba released K allowed bylaw. Waiver Signature: !� Iowan Criminal History Record Check Results (DO ow only) As of a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCC 1 0 Iowa Criminal history Record attached, DCI # -'• r DCI initials Q `U , izr DCI -77 (08/25110) Received Time May, 9. 2012 3:42PM No. 4031 Iowa Department of Transportation Office of Diner 8elvices dull Free) OM -632-1121 PO Box 9204, Des Moines, !A 503015-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 5/29/2012 Name: Dresden, Arthur Anthony Jr Address: 4219 Lloyd Avenue Se City/State: Iowa City, IA 52240 Mailing Address: 4219 Lloyd Avenue Se Mailing City/State: Iowa City, IA 52240 Certified Abstract of Driving Record DL/ID #: 960ZZ6211(IA) Class: D Audit #: 2875102 Issue Date: 12/31/2008 Expiration Date: 12/11/2013 Endorsements: 2L Restrictions: Corrective Lenses Date of Birth: 12/11/1954 Sex: M History Information CLEAR DRIVING RECORD Name: Dresden, Arthur Anthony Jr DL/ID: 960ZZ6211 Customer #: 1024572 ID. Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code 4321.10, 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: .........ZIPoN 5/29/2012 IOWA *� D. O. T. S: Office of Driver Services Iowa Department of Transportation Name: Dresden, Arthur Anthony Jr DL/ID: 960ZZ6211 .