HomeMy WebLinkAbout12-152. ' r 1
-4
�7lr.,y y�®r�Il
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-SO40
(3 19) 356-5497 FAX
1. Name
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
\-;L--\s-a�,
(Office Use Only)
2. Mailing Address 3x55 Hast'�as v
3. Telephone: Home &s9- 609 Other:
4. Prior experience in transportation of passengers: w o c icy' G o�.'t Sod rk5oh Cour\ Vj
foc a5 yecrs
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
n0
When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? h O
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? nO
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
ho
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
no
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)
derMl iddvAaEg 09/2010
I hereby, certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number °
1�2fa R Co ISS . 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)
Signature of Applicant ti r Date AL�'- 6y �Z C) 1 -2-
STATE
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by "S\o�xr� Jv 5 % •\� s ��^� 4 1e✓ On this day of
in and for the State of Iowa 3114
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).
Y
Sigp a ure Police Chief or designee
J/ I dl-tA
Sign e of City Clerk or designee
GG Date
o lid-�r�
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 recordy
Website update y
tlaNnazidmbadg pp201 0. 09/2010
Iowa Department of Transportation
Office of Drawer Services (Tcill Free) 809-532-1121
PO Box. 9204, Des Maines, IA 503W92134 595-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
7/31/2012
DL/ID #:
126AC0155 (IA)
Name:
Llittschwager, Robert James
Class:
C
Address:
3255 HASTINGS AVE
Audit #:
6108316
Restriction
None "
Issue Date:
07/10/2012
City/State:
IOWA CIN, IA 522454022
Expiration Date:
07/08/2017
Endorsements:
P
Mailing Address:
3255 HASTINGS AVE
Restrictions:
Corrective Lenses, Vehicle
without air brakes
Date of Birth:
7/8/1962
Mailing City/State: IOWA CIN, IA 522454022 Sex: M
History Information
CLEAR DRIVING RECORD
Name: Llittschwager, Robert James DL/ID: 126AC0155
Customer #:
2108144
ID Status:
None
DL Status:
VAL
CDL Status:
VAL
CDL Cert Status:
Non -Excepted Intrastate
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:
•:; ?P
7/31/2012
IOWA
).O.T.WE
Office of Driver Services
Iowa Department of Transportation
Name: Liittschwager, Robert James DL/ID: 126AC0155
Aug. 1. 2012 5:03FM Div of Criminal Investigation
0�/`dii LUIZ A.e:UU FAX
U0
No. 6613/
1 DCI I011'A
STATE OF IOWA
Criminal History Record Check
Request Form =°
Tel Iowa Division orCrlminel lnveatiganoo
Support Operations Human, In Flour
215 L 70 Sirmi
Des Mahres, Iowa 50319
(615) 71"066
(1115) 7256080 Fax
I em re ,"lne an inwn f}Iminar 14141AW VLMroi (`hr lr nn
DC1AccountNpmber:
( rpp(keEle)
Frnml_ MAV%as TaXI
Phone: .t3l4 338-
Paz. . • 319 3fi
saa4
003
LaetNmue nand
FitatN1eme essde 1
M1ddleNltme rccem
L i i -1iCh t✓ a px-
Date Ofairt6 (,WAu*W
Gender nootto
Social Number roan
5'
MIffille Oremple
fSecurl
g7 -%a 73y
u
Wabdr orfs a&n. Without a eigned waiver from the oubjeot arthe regoel, a complete criminal Wetoryrecord may not
be releauble, per Code of Iowa, Chapler692.2. Far naillM criminal bletury record Information, a allowed bylaw, always
obtain a waiver #Ipature from The subject or The Metal,
WWYL'f RelCOSe: l MAY aivep-6slon for dw abow rorrler4na offtW ro weaod wo low akaiml hiaory =rd dark aim do Wvbfoo ofComlool
InreaWon (DCN. Any ubT&AbinorydW wsmniu rte mM it nuevdrW by Tat DCf nay belckuod u glowed b/ law.
Waiter Sigaalafe;
ow riminal MuLoa Record d Check Results (D«ate eNy)
As of a search of the provided name and date of birth revealed: .'
Y4 No Iowa Criminal HistoryRecord found with DCl
�] Iowa Criminal History Record attached, DCI N
DCI initials,
a
:2eceived Time Jul. 11. 7(119 7.64PM Nn I16Q9