HomeMy WebLinkAbout12-242I
.i:sllt
'` 1MIiN®���
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040-
(3 19)
56-5040'(319) 356-5497 FAX
1. Name
2. Mailing Address
3.
4.
Authorization Number
/�L- ay -91
(Office Use Only)
huv.\L,��r
APPL?CATION FOR TAXI DRIVERS
1
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.) \
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
TXW of offense )ere When
.X� e�s;a frF ��r✓% 5.�.,�C� (°l�cn-��1 i%�� /�'/s =l �9�
6. Hav you beparycgnvicted 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 chauffeur's license been suspended or revoked in the last five years?
Type of offense Where When
9. Have yqu 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 REPORTD STATE CERTIFIED
UST ACCONI PLICATION FOR P CtitEF REVtEW--�
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.
clerk/tmdrivbadg
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2012
I here y certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
/"7 -6, 67y . I understand that if I falsely answer any questions in this application, that this
application may be denied. f 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 /a_/O` `Za/.x
#####+####***#**#*****#+++++####*#*******#**+++++######*******************#*###++##+++#+##*#+*#***********#*****##++++##*##***********##**#+##**
STATE OF IOWA )
COUNTY OF JOHNSON )
Sups ribed and sworn`1toA� before me by
�fJ/
'A� m
o °
KELLIE K. TUTTLE
Commission Nu ber221819
OW
i
On this lc ' - day 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).
/0-/G-/r�
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.
Signature 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
/a -le --i a -
Date
cler axidrivbadgea,,2010 doc 09/2012
Oct. 8. 201 ,2[ 12'�7P
v� t�ly
piv of Criminal Invesn�a�""'
• vltY ul tuts vitt
vr�y vlerlt
_-- cC�iauin�a�,.]HGis�ox�l �e�ouf� chepk
�o: iawapSvialonoCCrfminalYnvestlggtron
Sap'port Ogtreot ons RuYontt,l't �i'Io oY
2i5 �• 7 Towa SD�19
17 es 1v(olnes,
(sis) 7aJ�•Ga66
157y)125-fi0B0 Watt
to o1'Dik mpmwlblo )
waxvorsly— oYCodoofXoWA,
born]°P9N6i.—Al."afuY9wo—ml
Waiver-17gla el
Ynv'slfgalloat.DCU• An
pCLAocoonCl�Tumbes: � Oe rvffo
vrem,rw OP-T
aiv C -73F13: 5 OBFICPs�'—
r � n R TXA S'FiTFTG4'07�5_"r'�`�E7!
nAe C7`tR- 'LO'FYA. X2.740
Naxt yn �sr_K4.Ar
Mal�0e_n,.
eer(, a e3np� vY(tur(nAi6isfot-ry r@rortY7ula1
mcptoromJoe*
my
l
as ailnwed b�* Ir,�r alwa:
6Iflo1P1 to oonduaf urtYotvn odminal htrtoty [ecoid oho ok wilft Ihel) +IrJon orComfilr
olnod6y thoP9xmaY born �4ed a° e`I°wod Dy I4W-
�o�ra
Crimma,10 V•--
of tha PYD'116ed nam0 aid clefs oftbilfh seveale
d.
.Aso£ X
1;1.
o Xbwa gritninall9toxy Record fOwld wlth]JC
�] Xo>YtaCziminalvstory'Retoxdattal
pC1 irsiflals
os/z5/io}
4.Me nit. 1. 2012 1:49PNt No. 434
DCI
�-(�1 R o0 onb7
ISi7l •t,�••
.� .•'�
N
C
Iowan Department of Transportation
CON Office of Driver Services (Tali Free) OM -532-9429
PO Bax 9204, Des Moines, IA 59396-92(14 595-244-9124
FAX: 515-239-1837
Inquiry Date: 10/10/2012
Name: Mulligan, Keith Martin
Address: 1121 GILBERT CT
City/State: IOWA CITY, IA 522404528
Mailing Address: 1121 GILBERT CT
Mailing City/State: IOWA CITY, IA 522404528
Name: Mulligan, Keith Martin DL/ID: 617AH5609
Certified Abstract of Driving Record
DL/ID #: 617AH5609 CIA)
Class: A
Audit #: 6175789
Issue Date: 08/01/2012
Expiration Date: 08/04/2017
Endorsements: NT
Restrictions: NONE
Date of Birth: 8/4/1964
Sex: M
History Information
CLEAR DRIVING RECORD
Customer #:
ID Status:
DL Status:
CDL Status:
CDL Cert Status:
CDL Med Status:
Restriction
Supplement:
6000131
None
VAL
VAL
Excepted Interstate
None
None
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:
aOp�.••""••:;T/�,y
10/10/2012
4 IOWA a',
►
�. D. 0. T tom'
yl
'���f
SPo"S'
Office of Driver Services
. DalYE4
fiTransportation
IowaDepartme t
Name: Mulligan, Keith Martin DL/ID: 617AH5609