HomeMy WebLinkAbout12-286III
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CITY OF IOWA CITY
410 East Washington Street
Iowa 1 52240-1826
3 356-504
(319) 356-5497 FAX
Authorization Number / L�_ — (P-P�G
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
First Middle Last
1. Name I r1'S taoher -/ob,H &fl'ovY o
2. Mailing Address Z Z-7 Z f4y Ii do 2J 4-&61 rel-4lui/ J�e ; Z A
3. Telephone: Home 519- Nob - 6:2,-7 7 Other:
4. Prior experience in transportation of passengers: Y4 k eci PS ,&Yi drittloji h
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? tj3
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? Jlo
Tvoe of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? Me 5
Type of offense Where When
f,6 in5, otied TCIy__ocJI:St. zoo$
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ e5
Type of offenseffVIP �Where When
Noe M+ Meht VIP Z C LDof(
Io
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
00
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)
clerknarvdriwadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
SS6 Y y dN S N . 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) „ 7 ,
Signature of Applicant (; U Date 1L—/8 --/Z
a+++++a+++aa++aa++++++++++a++a+a++aa++eae+++++++aa+aaa+++a+++++++aw+++++a+++a+r+++++++++++++aa++++aaa+++a++a++++++a+aa++aaa+aa+aa+aa++++++++»++
STATE OF IOWA )
COUNTY OF JOHNSON )
scribed and sworn to before me by CA r- C,(-+kDrKF-. On this day of
, a " 1„e .-
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).
V
Signatufe 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.
Sigrtature of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
/2- /9 - l '�;2-
Date
++a+++a++++aaxaxx+axx+xxxxxxxaa+a++aaa+++a++aa+++axxxxxxxxxxaxxxaxxaxxaaa+aaaaaaa+aaaa+a+a++a+a+aa++aa+++a+++xx+a+++++xa+axx+x++a++aaa+aaa+++xxx
Office Use Only
Approved application
DCI report
State certified driving record
Website update
d imm g.pooloa 09/2012
Iowa department of Transportation
Office of Driver Services (Tall Free) 8010-532-1121
PO Bolt 9204, Des Maines, IA 503D&9244 595-244-9124
140 �*) FAX: 515239-1837
140
Certified Abstract of Driving Record
Inquiry Date:
12/18/2012
DL/ID #: 556YY0454 (IA)
Customer #:
4040780
Name:
Cutkomp, Christopher
Class: D
ID Status:
None
John
Address:
2272 HOLIDAY RD APT
Audit #: 5901351
DL Status:
VAL
601
Issue Date: 04/04/2012
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration 06/28/2017
CDL Cert
None
522413277
Date:
Status:
Endorsements: 3
CDL Med
None
Status:
Mailing Address:
2272 HOLIDAY RD APT
Restrictions: NONE
Restriction
None
601
Date of Birth: 6/28/1979
Supplement:
Mailing City/State: CORALVILLE, IA
Sex: M
522413277
History Information
Convictions
Citation hate
Conviction Date
ACD Explanation
County JUR
07/21/2008
09/03/2008
B64 No Insurance Card
52 IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
Case Number
JUR
04/16/2010
r568015
IA
Name: Cutkomp, Christopher John DL/ID: 556YY0454
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:
i:•""••�`[�'y 12/18/2012
IOWA O
D. O. Tj C41V a4elli:=A
Op' _- Office of Driver Services
Iowa Department of Transportation
Dec.14. 2012 2:32PM
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Received' T•ime'SDec: 10. 2012 3:23PM No, 1618 W
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