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Home My WebLink About13-248 Authorization Number a r 1 (Office Use Only) =.1 .:..®lir 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 Jo, Last 1. Name U./n ti-dam l\ frim' ,A JAP; 2. Mailing Address q 1� 1 M �f' r 1�V Q �_ -4-oia c '4 y 3. Telephone: Home Other: 3 i 9 d rA Z / 31 -33 I -$$o 4 4. Prior experience in transportation of passengers: cl f of c. 5)1 .)-j-1 Q ✓c n -(n `) \i r s. c }- r 1 hsL �a�-1- 5 v1 I-R...s ( ,\6' ( e hod-e�. R3YAM `10143w t uN npt snmo.� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or els Minoio:tav Type of offense Where —WRIT 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? J O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? (\J 0 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) hi 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) clerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number "1 �1 A . 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 Applicanav\t\f\ksy\& )(A ,IA.,u,,-- Date I C)/) STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by f{vv�L�c-u-t,. �i iQvt.U� . On this 1 � .(_ day of Dc '&� rc) )-1\ . cJ�(_ 6,1-p141 1NENDY S.MAYER Notary Public i nd for the State off wa • MyCommission .�"t Expires 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). 7// Signature o 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. ((e?tu� Signatbreof City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation eYe Office of Driver Services (Toil Free)800-532-1121 • PO Box 9204,Des Manes,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/10/2013 DL/ID it: 742A]3353 (IA) Customer#: 6071638 Name: Manuel,Anthony Class: D ID Status: None Wendell Address: 961 MILLER AVE APT 1 Audit#: 7423353 DL Status: VAL Issue Date: 10/10/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 08/04/2018 CDL Cert None 522465314 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 961 MILLER AVE APT 1 Restrictions: NONE Restriction None Date of Birth: 8/4/1980 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522465314 History Information CLEAR DRIVING RECORD Name: Manuel, Anthony Wendell DL/ID: 742A73353 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: 1-4F.• $.-. lClf-. 4 10/10/2013 14• IOWA 10, ,,., ° D. O. T. r�s' ry,'„eOf gab S Office of Driver Services Iowa Department of Transportation Name: Manuel, Anthony Wendell DL/ID: 742A73353 Oct. 16. 2013110:.5,0/1 Div of Criminal Investigation No. 1502 P. 1/1 V l 1. I I• L V I D LV I lyo V I G I a au l t r V 1 t V 116 V I \y hu. J 7 7 V I . L • STATE OF IOWA. `e •Pr l\''= Criminal History Record Check "1'- Io • wa qa, 'AY i' Request Form • '� ' •; ; DC!Account Number: LIDOA- —) . Cr applicable) To: Iowa Division of criminal Investigation From: t. i kt l CA4 res mei ,'1Z 4- CR: Support Operations Bureau,laFloor Ci Ey Celt VA 3 4. F.Ci Ce 215 E.7i1'Street 141/4. Des Moines,Iowa 50319 (515)725.6066 ttl tea 74- 5 as VD (515)725-6080 Fax Phone: 31 °l -boil, COSI Fax, 3t9 6dig -t19.-7 I am requesting an Iowa Criminal llisto:y Record Check on: Last Name(rltandatonq First Name(mandatory) Middle Name(recommended) MlanlAt\ An-Aony W4.nd.e.l Date of Birth(mandatory) Gender(mandatory) Social 2 SecurityNumberCnl ecomendcd) O' 7° u � WMale 19 Male °Female JS l' ~ l9/3— SS 31 Waiver In ormation:Without a sighed waiver from the subject of the request,a complete criminal history record may not be releasable,per Coda of Iowa,Chapter 692,2.For mach criminal history record information,ns allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:Thereby giro permission for the above requesting oWloial to conduct an loom criminal history record chock with the Division ofCriminal Itwesagaslon(DCI). Any criminal history data concerning mo that Isrnalniolned by rho DCI may he released as eliowed by law. Waiver Signature: to . 1. i,.._ sa Li . a. . .i .. 1_•!./ .1. 1� Iowa` nCriminal History Record Check Results . (DCins°only) As of lb\l yP 1\. , 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,DCI# DCI initials G ` l DCl/77(08/25/10) Received Time Oct, 11. 2013 2:20PM No. 1087