HomeMy WebLinkAbout12-254•r
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name G�
First
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
2. Mailing Address j aoo _o (� . C.� , .; r SY , ,y (?, r„ S w
3. Telephone: Home(,3/9) 99w x38.5 Other:
4. Prior experience in transportation of passengers: ;�,� _Ve /1" ; C tAh .
(Office Use Only)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Il%
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?�oh
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? /i/0
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)
cleNd drivb g 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbed
/.cam/ . 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 ofApplicanLYJ.Adr. L Date,o
RFF*RR**RRifHRf HRH#Y##H#Y####i#R#IRHRHRRFi*R###*Hi*RR#*RH*RHHRIHf##1HHRRHi11Rll11HfH1HRH11fiffHRHRHHifHlfff#H1fnf##YYYk
STATE OF IOWA )
COUNTY OF JOHNSON ) %I
Sups nbed 4nd sworn to before me by G I�T e L}�S On this 73 r6(
day of
and for the
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).
Si a ure of 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.
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
Date
derMtt idnWa geapp2010A 09/2012
CIowa Department of Transportation
AO Office of Driver Services Noll Free) 800-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 10/23/2012
Name: Phelps, Gilbert Allan
Address: 1206 E COURT ST
City/State: IOWA CITY, IA 522403234
Mailing Address: 1206 E COURT ST
Mailing City/State: IOWA CITY, IA 522403234
Convictions
Certified Abstract of Driving Record
DL/ID #:
627XX6064 (IA)
Customer #:
2375713
Class:
A
ID Status:
None
Audit #:
4423124
DL Status:
VAL
Issue Date:
06/10/2010
CDL Status:
VAL
Expiration Date:
05/14/2015
CDL Cert Status:
None
Endorsements:
L
CDL Med Status:
None
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
5/14/1958
Supplement:
Sex:
M
History Information
Citation Date Conviction Date ACD Explanation County IUR
08/19/2011 09/21/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA
Name: Phelps, Gilbert Allan DL/ID: 627XX6064
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:
"'••;��'/Ji �p
10/23/2012
ttiL
J�
P...... $I
Office of Driver Services
-
Iowa Department of Transportation
Name: Phelps, Gilbert Allan DL/ID: 627XX6064
Oct l(Ocl.22. 2012 9:20AM:a6 Div ofvCriminal Investigation , 319-336-270BNo.0618 P�41/1
„ t
1
STATE OF IOWA
Criminal History Rdeord
E Request Form
Ls@z
To: Iowa Division or Criminal investigation
Support Operations Eureau, 1" Floor
215 E. 7d' Street
Des Maines, Iowa 56319
(515) 725-6666
(515) 725-6680 Fax
1 am rem,estina wn [rnnw Cr:minwl t7:or.,... R......A rh -,
DCI Account Number: 9967-F
From: Yellow Cab of Iowa Cit'
P, t7. Box 428
Iowa City, L9. 52244
(319) 338.9777 '
Phone:
Fax: (319)339-7302
Last Name (n,anduo )
First Name (mandwo
Middle Name (recammendaai
I
G16QV
la 1
Date of Birth (mondelo )
Gender (mandelo,y)
Social -Security Number (rewmmmded)
'eWMale ❑Female
i -1g'3 -Qq -N20
i Waiver Irrjorntationr Without a signed waiver tram the subject of the request, a compitte glminal blstory record )nay not
be releasable, per Code of lows, Chapter 692.2, For complete criminal history record iaforma(lon, as allowed by law, always
obtain a waiversi nature from thesub-act of the request
Waiver Releare: l hereby give peanissloo forthe abo,R tegaesliog olflclll to cenducl in Iowa criminal bh(ory record check with the A(vman of Criminal
Invcadgation (DCq. Any uimiml hinory date conaming fie :hat is mafmained by Vic VCl may be released es allowed by law.
Waiver Signafural- t�Q�
Iowa Criminal History Record Check Results
As of f D - a oL - 61 , a search of the provided nstne and date of birth revealed
No Iowa Criminal history Record found with DCI
❑ Iowa Criminai History Record attached, DCI 0.
DCI initials
DCI -77 (06/25110)
Received Tinie Oct. 16. 2012 9:35AM No. 9514