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Home My WebLink About13-239 Authorization Number /3 _ ca3 A r 1 (Office Use Only) 4:7:5710; 4 II I �� AO®Ig,1 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 1'i,,{�:� ids: �h (L1.;VIS 2. Mailing Address 412. N L,„ Si .5-0, 1 60- 1 , 7-4 522q5 i 3. Telephone: Home 30 - 759 -3521 Other: 4. Prior experience in transportation of passengers: I"OlC 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? J•s Type of offense Where When 1F 4 f1 Drpy.e ( fry De( 201 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /Jo Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? No Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i'vo 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) uU 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) clerkltaxidrivbadg 03/2013 75-5-Yr q'G' s I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, /55 YY9055 . 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) /��I�I'1�,� /25/ 13 Signature of Applicant "YDate 9 /0/4//5 STATE OF IOWA COUNTY OF JOHNSON ) SuJicecribed pnd sworn to'gqefore me by A/c f/Li�ow;C r1 i1_s . On this day of ,C Ec i / cc 0 KE�E K.Terri F Notary Public in and for the State of Iowa 1 r „� Lommission Number 221819 • My C missi n E Aires 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). ��— / ?? S ature 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. . - //- Signa re /-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 clerk)axidrivbadgeapp2010.doc 03/2013 (Oct. 1. 2013 110:46AM CDiv of •Criminal Investigation 02:7194PP. 1 r STATE OF IOWA m tun..• `/. m;,No`. Criminal fl(istorry Record Cheek • /i; ��.= Request Form • Ora • • DCI Account Number: (.1ry1n,i •• Fr (1fippplroable) Tel Iowa DIVISlon of Crlminnl Investigation From: CIfl OF IOWA CITY . Support Operations Ehreau,1'Floor 41TY CLEWS LE WASHINGTON OFFICTREET 215 ,7 Street Des Moines,Iowa 50319 (515)725-6066 TnY.re= rmv nor-5-22,40 (515)725-6080 Fax Phone: 319-3565041 • Fox: 319-356-5497 I am requesting an Iowa Criminal Ilistory Record Check on: Last Name (mandatory) First Name(mandatory) Middle Nanto(rccommcndcO Cbl I,i1 s Nth oin Ise,In . Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) OC/04 / 1997 EiMale ❑]Female 13 - I9 `S32 Waiver In/orma/lon:Without a signed waiver-from the subject of the request,a complete criminal history record may hot be releasable,per Code of Towa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from Oto subject of the request. WaiveI Relense;I hereby glad permission(Or ale above requeslIng official to condoot an lows criminal history record cheek with the Division of Ceiminol Invesligation(DC1). Any criminal history data concerning me thatismaintained by lha DCI may be Iacono as allowed by law, Waiver Signature; ISN 4 (.. Iowa Criminal History Record Cheek:Resullts (Must only) As of AO — /—/3 , a search of the provided name and date of birth revealed; • • • % No Iowa Criminal History Record found with DCI 0 Iowa Criminal IlistofyRecord attached,DCI# i DCI initials ED .• DCI-77(08/25/10) Received Time Sep. 26. 2013 11 : 55AM No. 9187 rp Iowa Department of Transportation 0t Dt Onvec Services (Toll Free)800-532-1121 PO Bac 9204,Des L! nes,IA 50306-9204 515-244.9124 FAX 515-239-1x37 Certified Abstr:1-7. of Driving Record Inquiry Date: 8/20/2013 DL/ID #: 755YY9055(IA) Customer#: 3909045 Name: Collins, Nathan Class: C ID Status: None Joseph Address: 4866 E COURT ST Audit#: 4643735 DL Status: VAL Issue Date: 09/01/2010 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 05/04/2015 CDL Cert Status: None 522459400 Endorsements: NONE CDL Med Status: None Mailing Address: 4866 E COURT ST Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 5/4/1987 Mailing IOWA CITY,IA Sex: M City/State: 522459400 History Information CLEAR DRIVIVG RECORD Name: Collins, Nathan Joseph DL/ID: 755W9055 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 AnIz'ny, Iowa this date: „ETA, Q�`� 8/20/2W 3 l IOWA %. ��pyy� 'Sot ntyi' rO � . fi {■ e ot- 6jN'think%�= Office of Driver Services "aA`""a. Iowa Department of Transporation Name: Collins, Nathan Joseph DL/ID: 755W9055