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Home My WebLink About13-253 Authorization Number / 5.1 1 (Office Use Only) 141 •ot spa 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 First Middle Last 1. Name 0e ri 15 Jr 14 r �lrr e Last, v4141414 2. Mailing Address /� a�� SCEP / C „-/ Ve/v Ge ,5 2 ea41,* /*?4' / -r 3. Telephone: Home �j J / 7 9' Other: 4. Prior experience in transportation of passengers: ----1/Y� ',, S A u &/e vl 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?,,,! r np 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? 4/1/e Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ./ O 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 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) derwtaxidrivbadg 03/2013 • , I hereby certify that I have issued to by the Iowa Department of Transportation a valid Chauffeur's license number ' j-' W ,il'5 2% cx- . 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 /1!5e:'irvyc-e2-' A—Z- -,--' Date l ‘-9 -,___ ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by -o_ey11/1; 5 t,. (-,r,c ILA G„` . On this 30 t . day of e7O-rkt4 f a-o)'. 4-'"1 f WENDY S.MAYER Notary Public in nd for the Pia ate oi�owa : Cen��iea�r D ur^ba My Commission Expires ow. '1-"/3IiQ' ************************************************************************************************************************************************ 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). /7fiz _______/' /0()% -----' .•nature olChief 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,. - . e,,,,, In 1_1.c,/1 It Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derldtaxidrivbadgeapp2010.doc 03/2013 - ct. 29. 2013 1 :48PM Div of Criminal Investigation No. 3130 P. 1/2 uct. L). iui3 [:U /rill uity t,lerK — t,lty of Iowa t.tty No, gU)/ r. L :V;i u stir\ S R to Il X O IOWA A �/ISA ./ ' r 1, •. Criminal History ecord Checkz11.....e- • 1�tovrn�.)I%� ,z, a.. VA,_.' . � 4/ Request Form - z DCI Account Number: yco ^c (itappft able) To; Iowa flvfslot of Criminal Tuvestlgalion From; CITY OF IOWA CITY Support Operattons Bureau,rt Floor C,LT1t CLERt'S OFFICE 2I5 E.7thStreet 410 E WASHINGTON STREET Des Moines,Iowa 50319 (61S)725-6066 IOWA CITY IOWA-5V. (515)1256080 Fax Phone; 319-3565041 Fay; 319-356-5497 • l ain re a uostur t an Iowa Criminal histo Record Check on: ' Last Name mandotory) First Name(mandarory) MiddleName(recommended • u . ' 1-i N a—Gl e 4 e Date of Birth mandslo . Gender(mandorory) SocialJJSecuri Number(recommended) • Spf�/' id l f. Male ❑Female • '1'g�—�� _2,0a 9 . Waiver Information:Without a signed waver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:Iltcreby give potm1P2lon torte ebovo lequestlm.official to conduct on Iowa criminal history record check With the Division of Criminal Investigation(DCI).Any erindn.I history 4ota coil//umm((nng me tbetb molnWned bythe eD/DCI may be released as allotted bylaw. / WaiveSignature: AJ�,/�it zra , _ (.3 (�i altr Iowa Criminal History Record Check Results . (DCpssoon(y) As of 1 Ob-c) \l 3 , a search of the provided name and date of birth revealed; . No Iowa Criminal History Record found with DCI . 0 Iowa Criminal History Record attached,DCT# DCI initials .-- Received Timet•Oct. 23. 1r2013 2:06PM No, 2503 Iowa Department of Transportation *• Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines, IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/24/2013 DL/ID #: 330WW2302 (IA) Customer#: 3813918 Name: Gorman, Dennis Eugene Class: D ID Status: None Address: 1620 SEMINOLE AVE Audit#: 3704734 DL Status: VAL NW APT 8 Issue Date: 09/16/2009 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 09/10/2014 CDL Cert None 524052372 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1620 SEMINOLE AVE Restrictions: Corrective Lenses, Left Restriction None NW APT 8 Outside Mirror Supplement: Date of Birth: 9/10/1956 Mailing City/State: CEDAR RAPIDS, IA Sex: M 524052372 History Information CLEAR DRIVING RECORD Name: Gorman, Dennis Eugene DL/ID: 330WW2302 Pursuant to Iowa Code§321.10, I, Klm 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: e....IC....,/� 10/24/2013 . IOWA to,* l cz,),%:7 eitesicroct4 D. O. T. a / Cf `J � ice of D river ServicesRAs IowaDepartment ry Transportation Name: Gorman, Dennis Eugene DL/ID: 330WW2302