HomeMy WebLinkAbout12-171r Authorization Number /a—/7/
t (Office Use Only)
7t� �III�
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
410 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 f
First:� Middle �Last /� 1
1. Name c�
2. Mailing Address v__-T-�/
3. Telephone: Home Other: SILO X ��S
4. Prior experience in transportation of passengers: %%D�L
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? %IU
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?
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your driver's license or chauffeurs 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)
cl M1 Akin badg 06/2012
I herebcerjSfy`th��t I as to me by the Iowa Department of Transportation a valid Chauffeur's license number
(o `L I understand that if I falsely answer any questions in this application, that this
application maybe 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) I I ,
Signature of Applicant i Date
#####*f***fffflf#fY#*+#***ifff.lfff#Y##t##1e**.4f...f41kfY#####*########*#**RRYf#.YkYYf#Y##H#*#*f*4.ffffflffkYYY#YYY##*#i#t4ifNf1f11ff#####*R*R
STATE OF IOWA )
COUNTY OF JOHNSON )
Sg4scribed and sworn_to before me by gni S V `C ✓ On this ' V` day of
IZ_ -
Ni KELLIE K. TUTTLE ; tary Public in and for the State of Iowa
� My Co issi s
ow
4ki4 ***
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).
ignatu of Police Chief or designee
i re_1
'Sig re of City Clerk or designee
fig/�_
Date
?-'2a - a -
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.
YfY###*iiffffffflfRf##**t#*f111ff4#4f###!}**Rf41ff11fM4tk###R****!*i*ff#fff41R#H#H#####*f*kffiflfffllffti####***RRRkfflff######R##R*f4Rftlf#Y
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cla-wta.Idnvbadgea 2010.do 06/2012
Aug. 9. 2012 4:17PM
Aug. 6. 2012 12:12PM
Div of Criminal Investigation
City Clerk - City of Iowa City
STATE OF XQWA
r iC< X�fl roa�,lE za�o>r� Record (Cheek
)Regyaeat Form
To, To\va nlywoh of criminalluvestlgation
5upp6Yt 6peration9 au)'onu, Iyl k1aor
215 $. 7'4 Sfreei
ne911'10111e9,1ow, 30319
(51s) lad -6a0
(515) 725-6080 17ax
�
bsrnlaasablcgporCode oE OW,.
YYrdvee keleasal
J4vosilgal)on (DQ. AIE
Y✓rllver
Check on'
No.8240 P. 4/30
No. 2661 P, 2
DC1AcoouITBNbrnbor:4+o() a— r—
(,fapp(tcsbic)
WEr.. 1
l "1 '� NI YI ^
p GYA CITT r09 R224f1
11honk nr< rn/.Y
VaX1
,Male d�'elrisie
p erYet' iti°)n thesu6Jeat of iho request, a complete orlTvNpl history rceord nTnp not
97,yXr°po hr ofacriminal history record infbiraldoh,a,iatlovtedbyfAW1All"N
lhrlhoaboyeregvetlfng olfloiai ra rohQealtylio\Ya oriminnl6GWTy[uordofiock\Klh IheDNlslaa ofCriminel
,raminemelhar7a malnm(ned 6y lhoD0lmaybeTeleacod P9 Alio\YOd bYimv _
t�JLi1V 40� �CCULU. R./1LGV�•1gy,,, µ14V
a search b£tho provided name and date ofbiithsevealed:
Uj- No lbwa CrimA101 Tjistory Recovd fowid withD 01
[] youa, G`riminaY Xllsfory Reeofd attached) D CZ #
• bCXfnifSols
(0
' (D(;) Jiro cni)')
�.,
r
L7
U)-
I
rift
—177
r
�
Iowa Department of Transportation
Office of Driver Services (Toll Free) SEM -532-1121
FO Box 9204, Des Moines, IA 59311ii-9204 515-244-9124
FAX: 515-239-M7
Inquiry Data: 7/25/2012
Name: Jeter, Dennis Leroy
Address: 2434 WAYNE AVE
City/State: IOWA CITY, IA
522402520
Certified Abstract of Driving Record
DL/ID #: 769YY7857(IA)
Class: C
Audit #: 1414613
Issue Date: 08/11/2007
Expiration 09/05/2012
Date:
Endorsements: L
Mailing Address: 2434 WAYNE AVE Restrictions: NONE
Date of Birth: 9/5/1950
Mailing City/State: IOWA CITY, IA Sex: M
522402520
History Information
CLEAR DRIVING RECORD
Name: Jeter, Dennis Leroy DL/ID: 769YY7857
Customer #: 3515473
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
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
7/25/2012
IOWA
. s
`OBQ
Office of Driver Services
NtN
�aDR0
Iowa Department of Transportation
,vame: Deter, Dennis Leroy DL/ID: 769YY7857