HomeMy WebLinkAbout12-216Authorization Number /,)- —a 16p
r j (Office Use Only)
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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 5 2240-1 82 6
(319) 356-SO40
(319) 356-5497 FAX
1. Name
Firs ,i kMiddle Last
r �
2. Mailing Address Z%_ c ��1 C ✓
3. Telephone: Home
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?y
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
I"\ Ps
7. Have you been convicted of any traffic offenses in the last five years? `Ir
Tvpe of offense Where When
E U 4
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? h
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)
cle&ftaridri,badg 06/2012
I he(ePx cgrti�Y, thaI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
I J S �7 1 2 7 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 1144
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
s granted, to comply at all ti es with the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant all
Date
STATE OF IOWA )
COUNTYOFJOHNSON )
scribed and sworn to before me byw.w.i S �dC-re f On this day of
ab-1�2_ /
fKELLIEK.T57—LE ��-Lf�' /�
Vkc0mmI661on Number 221 819otary 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).
zZ -
Signs ure of Poli Chief or designee /
Signat re of City Clerk or designee
Date
9 -/el /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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkflaxidriWadgeapp2010.dw 06/2012
Iowa Department' of Transportation
Office of Driver Services froll Free) OW -532-1121
FO Box 9204, Des Moines, IA 503069204 515-244-9124
FAX: 515-239-1837
CCAO I
Inquiry Date: 8/17/2012
Name: Doderer, Dennis Woods
Address: 3212 HASTINGS AVE
City/State: IOWA CITY,'IA 522454021
Mailing Address: 3212 HASTINGS AVE
Mailing City/State: IOWA CITY, IA 522454021
Convictions
Certified Abstract of Driving Record
DL/ID #:
153BB2737 (IA)
Customer #:
4101693
Class:
D
ID Status:
None
Audit #:
4420862
DL Status:
VAL
Issue Date:
06/09/2010
CDL Status:
None
Expiration Date:
12/01/2015
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Restrictions:
NONE
Restriction
None
Date of Birth:
12/1/1948
Supplement:
Sex:
M
History Information
Citation Date
Conviction Date
ACD
Explanation
County
3UR
12/09/2008 —
01/15/2009 �.._.
592 —
Speed,.._
� 52
;IA
12/28/2009
:02/01/2010
_
_ Improper Registration _ _
452
'IA i
09/05/2011
,10/18/2011
iM14
Fall to Obey Traffic Sign/Signal
_ X52:
IA
01/17/2012
,...
:02/02/2012
,. _
iE34
;Defective Lights
i52
SIA
Name: Doderer, Dennis Woods DL/ID: 153BB2737
Pursuant to Iowa Code §321.10, 1, 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:
/'i � 8117/2012
IOWA'yd
3a% r
r'••.... Office of Driver Services
Iowa Department of Transportation
Name: Doderer, Dennis Woods DL/ID: 153BB2737
s
Aug.24. 2012, 4:27PNtl
11"'. I r. LV I L J. V I I Ir
Div of Criminal Investigation
"Ity v,cla VItf v, waa city
STATM (OF IOWA
-Griminal-HistoryRecolyd Check---.
Request Form
To: Iowa Division of Crlmhral Invostiggtioh
Support Op eratlonq DUreaU, l6tFloor
215 E. 70' Street
Des Molnes, Ioiya 50319
(515) 725-6066
(515) 725.60x0 Wax
�Qxt
No.2074 P. 3/6
nV. Li4V r. C/L
MIAceountNumben .
(ifapplietblo)
l+rome CITY OFIOWACITYI
CITY CLERIseS OFFICE
410 R WASIIrrIOTONSTREET
IOWA CITY IOWA, 6ZZ40
- Phone: 319-356-5041_.
V'axe 319-356-5497
Iatnrequesting anlawaGlminaI•liisto RwordCheck an:
Y,astName(mandaforv) I I}r5tName OnandatorA I MiddleName (recommeadcel
I adefe ,r 19e1A 14; f I
.Rafe Of Birth (nwdetotyl I Gc Adex (mendalorO I Social Security Number 6erntmtend di
�� 1 alo ❑Fema10 ZY
WaiVel'.lTnf0l,mas1,Gn: Withoutasignadq'aiYerfromthe subject ofthoraeluest,acornPleteerimtnalblstoryr6CDrdmaynot
be releasable, per Code of Iowa, Chapter 692.2. For comnlefe criminal history record information, ns allowed bylaiv, Always
obtain a waiver simatur a from the sublact of the reuses(:
WalVeP.Refe[G4'e; Thereby givepemtls 6oVo regneslin si@I to mnductenfeWFcr(mfnnf6isforyr4mrdcTiwkWirhrha DfvlsfonotCrimfnn(
Investigation(Dq. Any uimina(hisforyd eonaetningn thatla lntahted by IfipAClmaybo refeesedn9 dlowed bylaw.
wol ve), signalaree
Iowa Criminal Ids olry Record. Check Results
As of lg/,pq a search of the provided natno and data of birth revealed:
F 01
No lova Cdatinal Histofy Record found with DCL
(((EJ Iowa Criminal I-Tistory Record attaohed, DCI #
DQ
Received Ti,meA.U.& 11;„2012 5:01PM No. 1648
(DCCIVooply)
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t:?n: