HomeMy WebLinkAbout12-121i �III�
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
First
1. Name ,-,I M M'
Authorization Number \Dl" (aA
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
2. Mailing Address �/ �w 5 P �U c co 4 `' b y Sou, .5 l F r
3. Telephone: Home fS 7 57 5/,4' Other:
4. Prior experience in transportation of passengers: 5 h u `T t 1 -�-- b c , v P —
C_
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A,
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? c D
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? %
Type of offense Where When
J
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
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)
derMY dnWadg G942 o
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbers
I understand that if I falsely answer any questions in this application, that this
application may be enied. 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��
STATE OF IOWA )
COUNTY OF JOHNSON ) _I
Subsv,O
cribed and sworn to before me by J 'IPA C I II '/ C On this 5W�-- day of
KELLIE K TUTTLE aR otary 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).
Signature of Police Chief or designee
Signatu f City Clerk or designee
7 S / Z
Date
7-.5- /"3 -
Date
NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names 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
clay "dmb wappMl0 doc
7p -7lL
4&1
Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Baa 9204, Des Manes, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
6/27/2012
DL/ID #:
096DD2168 (IA)
Name:
Cline, Jimmy Dale
Class:
D
Address:
318 SWISHER VIEW DR SW
Audit #:
5385796
Restriction
None
Issue Date:
07/21/2011
City/State:
SWISHER, IA 523389533
Expiration Date:
07/25/2013
Endorsements:
2L
Mailing Address:
318 SWISHER VIEW DR SW
Restrictions:
Corrective Lenses
Date of Birth:
7/25/1936
Mailing City/State:
SWISHER, IA 523389533
Sex:
M
History Information
Convictions
Customer #:
2031916
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County JUR
03/16/2009 03/19/2009 S92 Speed (10 mph & under in 35-55 mph zone) 66 IA
Name: Cline, Jimmy Dale DL/ID: 096DD2168
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
��i
6/27/2012
IOWA •
i1--4�a 000�4
r Q S`
Office of Driver Services
Iowa Department of Transportation
Name: Cline, Jimmy Dale DL/ID: 096DD2168
Criminal History Check
Iowa Division of Criminal Investigation
QDE
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oe mN
STATE OF IOWA CRIMINAL HISTORY RECORD CHECK
Date: 201216125
Request ID: 201
SEARCH CRITERIA PROVIDED
Search First Name: Jimmy
Search Last Name: Cline
Search Date of Birth: 193617/25
SEARCH RESULT
No DCI criminal history record found based on information provided.
Your session will end after 15 minutes of inactivity.
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