HomeMy WebLinkAbout13-257 Authorization Number 13.— d 7
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APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.)
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
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1. Name �� Ghurl.e5 Lr e54-
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2. MailingAddress ) �� BJUV ]vOrf L,rp�v +�� ,`T4 5�?
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3. Telephone: Home 6:1-(0) S Other:
4. Prior experience in transportation of passengers:/ I1'ta6v't (LA J C jt f,Mt n r)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A
Type of offense Where When
6. Have yobee,convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
®
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? Q
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?V
Type of offense Where When
9. Have ou 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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
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derknaxidrivbadg 03/2013
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Ier y i�C I that J have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
f 0 y . 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) c.-- —
Signature of Applicant _ _de- Date AM/ /(-2011
/ j;
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 0\4Q.(t C , Lev\--res-ti . On this LQ 1.•-\._ day of
),..l--, -e hW
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A.,al4l WENDY S.MAYER Tr ary Public i 1:nd for the Stat- .f Iowa`
zCunmdaalu+r Numlrai 729420
My Commission Expires
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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).
/
Signai re of Police -f 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.
2 .
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Signa e of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 51/2"
(height)and prominently displayed to all passengers.
************..**************************.*******************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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clerkdtaxidrivbadgeapp2010.doc 03/2013
g Oct, 16. 2013 12: 30Pt Di,iv of Criminal Investigation No. 1544 P. 1
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STATE OF IOWA al
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k' ^�I;\4 .Criminal History Record Check " . I,
.k—.. 'ATI Request Form
DCI Account Number: -1400 --P
(if applicable)
To; Iowa Division of Criminal Investigation prom; CITY OF IOWA CITY
Support Operations Bureau,1I Floor CLTY CJ.&Hlt'S OFFICE
215 B.7th Street 410 E WASHINGTON STREET
Des Moines,Iowa 50319
(515)725-6066 _Irnrn CITY IOWA 52 24 0
(515)725-6080 Fax
Phone: 319-3565041
Fut 319--356--5497
1 ain requesting an Iowa Criminal Histo _Record Cheok on: .
YJast Name (mandatory) First Name(mandatory) Middle Name(recommended)
k‘AV&SW Rob e+- Ortottis
Date of Birth 'mandatory) Gender(menditory) Social Security Number (recommended) .
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J
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DG'S l Ci i 19 (6s ,Male OFemale 8-3 3--1 l�j-°`+`I o
WaiverIn/Ormalion:Without a signed weivor f1om th_0$11-Jeet o.1'the request,a complete criminal history record may not
' ho releasable,per Code of Iowa,Chapter 692.2.For eomgleta criminal history record information,as allowed by law,always
obtain a waiver signature from the sub(eet of the request,
Waiver Release:Thereby glee permission for the Above requesting ofilalnl to conduct en Towa erimtnal history record checkwith the Division of C7iminal
Investigation(DCO. Any criminal history data concerning mo tint Io Me Interned by rite DClmay be released as allowed by low.
Waiivef'Signal: ,. •
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((��Iowa Criminal,History Record Check Results • (Daus*only)
As of I V'l lQ I i ' , a search of the provided name and date of birth revealed;
SLI No Iowa Criminal History Record found with DCI
❑ Iowa Criminal History Record attached,DCI#
DCI initials 05
Received Time7'Oct. 14, [(2013 3;20PM No, 1248
Page 1of1
y J
cj Iowa Department of Transportation
Office of Driver Services {Toll Free)800-532-1121
'*41IP PO Box 9204,Des Moines, IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 11/6/2013 DL/ID#: 382AE4804 (IA) Customer#: 5530147
Name: Lenfesty, Robert Class: D ID Status: None
Charles
Address: 1710 N JONES BLVD Audit#: 7504533 DL Status: VAL
UNIT 2 Issue Date: 11/06/2013 CDL Status: None
City/State: NORTH LIBERTY, IA Expiration 10/14/2014 CDL Cert None
523178828 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 1710 N JONES BLVD Restrictions: NONE Restriction None
UNIT 2 Date of Birth: 10/14/1985 Supplement:
Mailing City/State: NORTH LIBERTY, IA Sex: M
523178828
History Information
CLEAR DRIVING RECORD
Name: Lenfesty, Robert Charles DL/ID: 382AE4804
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:
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1IOWA
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� Office of Driver Services
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11''�h.®RT..r- Iowa Department of Transportation
Name: Lenfesty, Robert Charles DL/ID: 382AE4804
11/6/2013