HomeMy WebLinkAbout12-266� r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing Address t
3. Telephone: Home
Authorization Number Pa - 36ra
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
bq/c IS -3 LeN
Last
75s
Other. 319 - (Q31- Le 12(0
4. Prior experience in transportation of passengers:—DRoU E a Mrpjr+c)4.c1 �j £ llow C,e�t3 77,-Owh C!,%IT
F,�ir� Zoo'/To ZDId
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A90 �Z�Cs
Type of offense
Where
n
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? Aly
Tvpe of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Al J
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)
AJd
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)
dwM.yid&badg 09/2012
I herebycertify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�iloR' 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 eAJjL102,91a
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 14nne4k b. %9,4-k .n On this S day of
A16+. aois-
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).
Signaty a of P iq Chief or designee
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERICS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
AriGc.�/ A" - 2�al�
SignaNm 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
da Wt ddvbacNpa,2010A. 09/2012
State of Iowa
Division of Criminal Investigation
215E 7`4 St
Des Moines IA 50319
Ph. 515-725-6066 Fax 515-725-6080
Iowa Criminal History Record Check
Walk -In Request
Your nameF010( LI
Address -5bl Ma I>V•
City/State/Zi Low -TP E E TA . sa755-
Phone# 3)9- 3 ) -(el
Requesting an Iowa criminal history record check on:
Fill in all shaded areas.
Last Name Apellido (mandatory)
First Name Primer Nombre (mandatory)
Middle Name Segundo Nombre (recommended)
EAAIZ
,7E9A-1
Date of Birth Fecha Naciniento (mandatory)
Gendreer Genero (mandatory)
Social Security Number (recommended)
Ion- cP;— / 9&7
Male ❑Female
Waiver Signature Fit ana (N/A.)f the request is on yourself, please sign. If the request is on someone else, write N/A
e;7,� G%i^
-n
OCT USE ONLY
Results
As of \ a name and date of birth check revealed:
o record found
❑Record attached, DCI #
C-0
en
DCI initials_i�b
Receipt
Number of requests x $15.00 per last name = Total amount $ 5. 0 0
Method of payment: Xcash ❑money order ❑check # El MasterCard or Visa
Cardholder's name Last 4 digits of MC or Visa
DCI initials
Credit Card Number # Exp. Date
ARTS
Page 1 of 1
Iowa Department of Transportation
ILA Office of Dmrer Services (Toil Free) 8043-532-1121
PO Sox 9294, Deas Moines, lA 59306-92G4 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
11/7/2012
DL/ID #:
082CC2468 (IA)
Customer #:
2931188
Name:
Lathrop, Kenneth Dean
Class:
A
ID Status:
None
Address:
301 Maple Drive
Audit #:
4033375
DL Status:
VAL
Issue Date:
01/21/2010
CDL Status:
VAL
City/State:
Lone Tree, IA 52755
Expiration
12/22/2014
CDL Cert
None
Date:
Status:
Endorsements:
T
CDL Med
None
Status:
Mailing Address:
Po Box 183
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
12/22/1967
Supplement:
Mailing City/State:
Lone Tree, IA 52755
Sex:
M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County allR
08/09/2008 ;09/08/2008 592..
.Speed SMO
05/08/2012 .06/06/2012 _ ,592 -Speed [77 IA
Name: Lathrop, Kenneth Dean DL/ID: 082CC2468
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:
11/7/2012
Mft,
U
Office of Driver Services
Iowa Department of Transportation
Name: Lathrop, Kenneth Dean DL/ID: 082CC2468
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 11/7/2012