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Home My WebLink About12-237+ r — ++ MIW®r�11 CITY OF IOWA CITY 410 East Washington Street tr3 0-1826 56-50 q�2��,ie 56-5497 7AX Authorization Number 1D, S-3 -) (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) First MiddleLast 1. Name %rKIlhtrs 2. Mailing Address 3. Telephone: Home 7 t 9 i S J 6 i L 0 4. Prior experience in transportation of passengers: 2 y1- f Other: — L9 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 9->'C- / D 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five 10 years? 6Q 4% Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Y � 5 e Where When �'gLfv—7�Z51(2 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? n 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) deddraxiddwadg 09/2012 w I hereby certify that I have 's ued to me by the Iowa Department of Transportation a valid Chauffeur's license number n iY S . 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) 7 Signature of Applicant C2' Date � v STATE OF IOWA ) COUNTY OF JOHNSON ) scribed no sworn to before me by Le- W L>e On this a�v1 day of �oj�, KELUE K. Tu7rLE I ,L :Qin Commission Number 221619 Notary 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). A&I > gnatur Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Sign Lure of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. 'y—,7,f'— /oC Date ********F***F****F*F********+*##*#*###*###*+#*#+###+##**#****************+#####+###+++#*****F**FF***#*######+##*###****#*****F****FFFFFFF*****FF Office Use Only Approved application DCI report State certified driving record Website update d�mlddwadpappzoroda 09/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) SM -532-1921 If PO Box 9207, Res Milnes IA 503i1fr92114 515-244-9127 FAX: 515-239-1837 Inquiry Date: 9/26/2012 Name: Willberg, Lee Marinus Address: 935 E COLLEGE ST City/State: IOWA CITY, IA 522405536 =4,,Mng Address: 935 E COLLEGE ST Mailing City/State: IOWA CITY, IA 522405536 Convictions Certified Abstract of Driving Record OL/ID #: 760YY4065 (IA) Customer #: 1827411 Class: D ID Status: VAL Audit #: 4646795 DL Status: VAL Issue Date: 09/02/2010 CDL Status: None Expiration Date: 07/17/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 7/17/1980 Supplement: Sex: M History Information Citation Date Conviction Date ACD 10/_29/2010 11/02/2010 S92_ _ .,•.. _ 04/07/2031 04/07/2011 .2 '592 07/14/2012 '07/25/2012 G92 _ 08/04/2012 09/05/2012 IM14 Sanctions Speed Speed Fail to Obey Traffic Sign/Signal NMI Type Effective End ACD Explanation Occurrence 7UR IUR Suspended =03/20/2006 106/18/2009 `D53 Non -Payment of Iowa Fine IA FJ�me: Willberg, Lee Marinus DL/ID: 760YY4065 Pursuant to Iowa Code 4321.10, 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'41 9/26/2012 IOWA tr' ). 0. T. r P . •- ;" Office of Driver Services a" Iowa Department of Transportation Name: Willberg, Lee Marinus DL/ID: 760YY4065 IIA . .. m. .(.57 ......, (52 ..... _.. �IA _ _.__..._IA . ._ . X52 `52 'IA Type Effective End ACD Explanation Occurrence 7UR IUR Suspended =03/20/2006 106/18/2009 `D53 Non -Payment of Iowa Fine IA FJ�me: Willberg, Lee Marinus DL/ID: 760YY4065 Pursuant to Iowa Code 4321.10, 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'41 9/26/2012 IOWA tr' ). 0. T. r P . •- ;" Office of Driver Services a" Iowa Department of Transportation Name: Willberg, Lee Marinus DL/ID: 760YY4065 a Sep.26: 2012 9:17AM ODiv ofCriminal Investigation, NNo-6221 LVjV PP. X8/8 i v✓ri1T<J;jnaUf3fxstory Record Cheek Requests ]Fora To. Yolv4.rf1V soh of criminalYnvesttgatlan Supp oyt Oporatiow Puro4u, 1" ptloar 219 E. Jih Street DONPrries'lowa 50319 (s1s� 7z�,6o66 (616) 729-6000 Vit ))ClAccounWumber; Z16 1 appi(ee6 0) $roml f,�f1F TnWA -M CITY• cL)3RKt5 OPF.= 410 R. 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([>CToso only) As of G� /) a search o�'tho provided W acne pn(l, date oPbirthso'vealed: �•" ? ,� � '• — - r•I No 16wet Gib)inrtl Histov Record fb))ud wlthDCT > ❑ XaW4CriminalMaiozyRecord attachad, bCX#Ul NJ nr 7') (Wan f/1m Received Time Seo. 18. 2012 3:58PM No.3464