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Home My WebLink About12-241r -4 �r'llat l� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX - I First 1. Name —� e.? 2. Mailing Address 7 3. Telephone: Home Authorization Number /,Qz — a (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) o S 7a �7 Z✓r Last ,,Z "/G-,, Other: 3 % 5-5-'+ `1- G 39 / 4. Prior e� perience in transportation of passengers: }� i m /y �� e- 7& � r «� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type ofoffense Where /I I When t (�ecrfle55 Use oFA ivnjPvh l �`'SN:hslcti �4 "tj c 6. Have you �,en 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? /VO 1 s 4 r e Tvge of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe 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) GeV.iddwbadg 09/2012 g56 AGOG' S� 1 herby certify tha I hav ss}� d to me by the Iowa Department of Transportation a valid Chauffeur's license number .) "e < - 77 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 +++#*####+####*#k#F#***F*F*FFFR#FRFFFFFRFFFF*RFFFFFRRFFFFRFFF*FFF*FF***F**R*F*F*F**********R****#***#*#########*#H###*##+4*##4#*+######4+#*#*## STATE OF IOWA ) COUNTY OF JOHNSON ) cribed and sworn to before me by \i Cc On this �day of V I .2 u�R KELLIE K. TUTTLE {o LIT7. cI , Number221 tary 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). - � " - PA', 4 �14 �, Sign Lure of Police CV or designee f ,9A/1 .�L_ 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. Akctcll�t/ Sign re of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update Date derkR dni adgeepp=0tl 09/2012 Iowa Department of Transportation (roll Free) MU --112-1 Office of [Ida Services 515-239 1837 pp 13ox 9204. Des Moines, to 543E1is J2i)4 FAX 515-39-1&�7 VM03 Certified Abstract of Driving Record History Information CLEAR DRIVING RECORD Name: Fuller, James Abraham Matthias DL/ID: 556AG0056 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 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of office of DrlvEr Services, Iowa Department of Transportation, c hereby certify that I am the custodian said office, and that I have been authorized by the Director of the Iowa Department of Transportation so , at Ankeny, Iowa this date: In witness .whereof, I have caused my signature and the seal of the Department to be set upon this docc umenntt, L. 10/4/2012 IOWA ).0. •....•• office of Driver Services f ORIowa Department of Transportation Name: Fuller, James Abraham Matthias DL/ID: 556AGO056 556AGO056 (IA) Customer #: 5887420 10/er, DL/ID #: ID Status: None Inquiry Date: Fullers lames Abraham Ja Class: D Name: Matthias 5586068 DL Status: VAL 967 BOSTON WAY APT 4 Audit #: 1022/2011 CDL Status: None Address: issue Date: CDL Cert Status: None CORALVILLE, IA 522411241 Expiration Date: 04/28/2016 CDL Med Status: None City/State: Endorsements: 2 Restriction None 967 BOSTON WAY APT 4Restrictions! LensesSupplement: Mailing Address: Dateof Birth: 4/28/1990 COPALVILLE, IA 522411241 Sex: M Mailing City/State: History Information CLEAR DRIVING RECORD Name: Fuller, James Abraham Matthias DL/ID: 556AG0056 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 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of office of DrlvEr Services, Iowa Department of Transportation, c hereby certify that I am the custodian said office, and that I have been authorized by the Director of the Iowa Department of Transportation so , at Ankeny, Iowa this date: In witness .whereof, I have caused my signature and the seal of the Department to be set upon this docc umenntt, L. 10/4/2012 IOWA ).0. •....•• office of Driver Services f ORIowa Department of Transportation Name: Fuller, James Abraham Matthias DL/ID: 556AGO056 J Oct. 8. 2012 9 35A Div of Criminal Investigation, •�V •C�4V� LV IL L�LVi�r. I/,\) IVDU Vl l) a —8—MATE OF WWL.- 4 tom' xgecord CheckRequest F4 O)VM To; UVADIvI9lohorCrlmillallhVesflgAtlon SlIpport Operationsl3urenu, V Floor, 2�g171n s(l'aot Doalkipinas,'Zowa 503]9 (519)125.6066 (513)12$-dano tau 0%8138 UVIPP. X6/7 ACZAccounC%Iumher: r "�a �� (Ifapplicabte)� CITY OF IOWA CITY CITY CLMI.9 0MCli T Ain R WA SHE GTOTI S rrrrBT TOWA Offf 111M 57740 .phone, 3I9..956--5041 _ (7aXi X79-3 Sri -.5497 [�//z�Y 1 -3�Mz55 1 A r4b9P, ' � A � n'raTe • 1711 atnareiLL�' WaIPC)°.rf$/o)'Y M'on,'Wffftovf Aligned �Sr0.1`Yol'ri'aln fhesufijoct affho 1'egnesQ,A tohrrlofeorfM(nA(h[*ry record Aloy not hoi'eleMAb(e, per Code oFYow/q,lhaallovredbyld%v'nlrrays o15ta4hpwAiversl nalureltonitho,enb dotofYhore uesb: 615'2i'.ti6tCf!lS6; ihcrcby$No parral"(op lbr Illoaboyorequsungofrioio(lo conducf mlo\Ya cdm(nal hlsloryreaofd ohoAwnik NeMislaq of Grmrnaf rnYastigadon 1pOp. AnyodmN11114mly &314 60 1 UM61hadayb a lcosodnvnllo,yadbylAlK t7/.rAiea G�..wnhwn- 14•8 o — ��) a. , A septoh bf thnpyovfded name and date ofbvth.,roveAd., No TbwA Cir mines HfsforyRecord rolmd wffi,DC): d YorveCilminal TiafioxgRocordattachEd, Da# Received Time Sep, 28. 2012 2:28PM No.4289 V