HomeMy WebLinkAbout12-261CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 3S6-5040
(319) 3S6-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
la-- a6f
(Office Use Only)
^^'' First1 le Last
1. Name /n� ew 1Vvtt I��F2�eh
2. Mailing Address 2 a 11 Myge A4e Aire. to Ir # 7
3. Telephone: Home 1`319% 6 31- r% r{ 13 Other:
4. Prior experience in transportation of passengers: Lei C : df
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
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6. Have you Been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? /U v
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
When
Type of offense Where When
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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 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)
uen�.idriwaay 09/2012
I hereb`� certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number y
6 U %a�! ,,, 2g . 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 ApplicanAWA"t Date [012%112
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STATE OF IOWA )
COUNTY OF JOHNSON )
b cribed and sworn to before me by I r tCC'44^-eLA-'��C �Cce�GxP ll . On this 2-0te" day of
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Nntary Puhlin in and fnr fhe State of Inwa
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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).
Signature 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
denNaxidnMadgeap MIOd 09/2012
Oct.23. 2012 10:12AM Div of Criminal Investi;ation
�ucl.l(. [U12 C:ULrM Lily Clerk - City at Iowa City
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Received Time Oct. 17. 2012 2:02PM No -5444
i
4 Iowa Department of Transportation
Office of Dfiver Sefvices (Toll Free) 800-532-1121
4 120 Box 9204, Des Moines, IA 5O3D6-92U4 5155-244-9424
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
10/26/2012
DL/ID #:
960AA8821(IA)
Customer #:
1832136
Name:
Mcfadden, Matthew Duff Class:
D
ID Status:
EXP
Address:
2217 MUSCATINE AVE
Audit #:
6421678
DL Status:
VAL
APT 7
Issue Date:
10/26/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
02/14/2014
CDL Cert
None
522406634
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
2217 MUSCATINE AVE
Restrictions:
NONE
Restriction
None
AFT 7
Date of Birth:
2/14/1977
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522406634
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
12/22/2007 01/31/2008 'M14 jFall to Obey Traffic Sign/Signal X52 'IA
Name: Mcfadden, Matthew Duff DL/ID: 960AA8821
Pursuant to Iowa Code §321.10, I, Kim Snack, 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:
>.�•...... �' N
D. 0.1
ff,.��$
10/26/2012
Office of Driver Services
Iowa Department of Transportation
Name: Mcfadden, Matthew Duff DL/ID: 960AA8821