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HomeMy WebLinkAbout12-260�r"III CITY OF IOWA CITY 410 East Washington Street Io a 52240-1826 319) 356-5040 GALL- Fcrnny (319) 356-5497 FAX First 1. Name r-Li�l Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) , Middle se, Last 2. Mailing Address //Y/131' Y7 /fa2o2 /�W�6i l� 1 44 _5 &;"q 3. Telephone: Home 3/9- > %2- s/>Lr Other: 4. Prior experience in transportation of passengers: 1110"4' d i'1�✓� �^ 0-- ie i.7 /Zo/,/ P� )'0- 4-r /� LPiO"%�S �L-,. a -('D (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? //0 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? IV/2 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? �ItId 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) de Mmiddwedg 09/2012 I hereby certify that I haXe issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ®> „> C i��> if . 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 ApplicantDate STATE OF IOWA ) COUNTY OF JOHNSON ) t �Q �T S pribe nd sworn t�oj �b�efore me by 7�(� f'>`-vL / x On this day of TUTTLE My 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). S' ature df Police Chief or designee -.7!5— /Z 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. 11. 'Signkure 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 -.12 9 - /a_ Date derMa idriv adgeapp2010 doc 0912012 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 %W0 PO Box 9204, Des Moines, IA 503069204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/25/2012 DL/ID 7f: 058CC9854 (IA) Customer A: 4197936 Name: Sogard, Karen Louise Class: D ID Status: None Address: 11912 HIGHWAY 99 Audit #: 5166085 DL Status: VAL TRLR 22 Issue Date: 04/19/2011 CDL Status: None City/State: BURLINGTON, IA Expiration 04/23/2016 CDL Cert None 526019100 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 11912 HIGHWAY 99 Restrictions: Corrective Lenses Restriction None TRLR 22 Date of Birth: 4/23/1954 Supplement: Mailing City/State: BURLINGTON, IA Sex: F 526019100 History Information CLEAR DRIVING RECORD Name: Sogard, Karen Louise DL/ID: 058CC9854 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: '••��• 10/25/2012 ).0. T �1�i�►! Office of Driver Services Iowa Department of Transportation Name: Sogard, Karen Louise DL/ID: 058CC9854 Oct. 25. 2012, 3:24PM Nb L. LL. LV IL J. JOI III Div of Criminal Investigation ulir uICIh ulrr ul luva elry No.1462 P. 1/1 Irv. 1941 f. ZII STATE0I IOWA ... A 11614(1?104a'o�; (�r1minaMstory Record Check To. Iowa btolslohdGriminalYtmAttgarioh Support operations BureAu, Vl Woor 2Y5 E, �°' Sheet nesmulnav,rcwa S09Y9 (413) �as•6aG6 (575) 725-609(1 Bax ->- 61 I 'Y -e--7-) , - a.3-- i9s-y . I EIM416 DGIAccoUritgumber; oDa - ?�2- fapplioab1o) From; MTy 00 'roi•Y6, am—. OXTX ct7(t Ef oinxcs 4.70 tt. 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