HomeMy WebLinkAbout12-224��.:. —4
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
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(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
(Office Use Only)
FirstI, Middle Last
1. Name '>+ vey,% par � MGYI (u
2. Mailing Address Lt II 1U� Sf (�ral�,Ilc
3. Telephone: Home X19 4(00 6&LO Other:
4. Prior experience in transportation of passengers: T <
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
n 1, 1. 't �Inl�wrr, 0" 1995
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? v z
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where hen
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last a years? '1 -0
Tvoe of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, ple*se provide t_Wname(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)
clarWtaxitlnvbatlg
06/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
00 5 uj;,j 574 ZG 17 k . 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 Date
STATE OF IOWA )
COUNTY OF JOHNSON )
S�
Sybscribed and sworn to before me by e c�O�h; �\ �Q �Q`\« On this at day of
e � t-ew�v,
Notary Publim, in and for the State of Iowa '713 114
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).
'ftnalureebf Police Chief or designee
/lam/9�L/�ycJ %L �4.✓
Sign re of City Clerk or designee
Date
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.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
dad iddwbadgapp2010.dx 06/2012
Iowa Department of Transportation
1! 0 Office of Driver Services (T(Al Free) 600-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 8/30/2012
Name: Melnecke, Steven Daniel
Address: 2111 14TH ST
City/State: CORALVILLE, IA 522411380
Mailing Address: 2111 14TH ST
Certified Abstract of Driving Record
DL/ID A: 005WW8476 (IA)
Class: A
Audit tF: 5677791
Issue Date: 12/10/2011
Expiration Date: 06/19/2014
Endorsements: LNPST
Restrictions: Corrective Lenses, Except
Class A Bus
Date of Birth: 6/19/1976
Mailing City/State: CORALVILLE, IA 522411380 Sex: M
History Information
Customer >r:
4469632
ID Status:
None
DL Status:
VAL
CDL Status:
VAL
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
Case Number
JUR
10/24/2007
399584
IA
11/20/2009
537613
]A
06/08/2011
633488
IA
07/23/2011
639782
IA
Name: Meinecke, Steven Daniel DL/ID: 005WW8476
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:
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8/30/2012
IOWA`
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Office of Driver Services
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Iowa Department of Transportation
Name: Melnecke, Steven Daniel DL/ID: 005WW0476
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Odminufulsiory Re -Cora Check
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(91s) 729.6066
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Received Time Sep. 10. 2012 9:57AM No.2883