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Home My WebLink About13-226 Authorization Number A 1 (Office Use Only) ,�► :::11141;41111)ftt ciqr CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (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 FirstAI/0 Wst, 1. Name f`'�t?�Ncl� �•I�' 2. Mailing Address 4,2063' iti n-'A Si 3. Telephone: Home 3 / 447( Other: 4. Prior experience in transportation of passengers: T A X / D,i v t - n- o2 / 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or itsvqx Type of offense Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /U Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?�O 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) N'2 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) derk/taxidrivbadg 03/2013 • . . I h reby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Ti-/e✓ 'ciZ, . 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 Date 120/3 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by J , esr , • _ �. . On this c.St'� day of WENDY S.MAYER Notary Public and for he State of I pa Oa,..,i.it u Pan '721r+ie ! —11Q� 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). ignatur�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. "eZ/R--/ r/a t r/t3 Signat fe of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2"(width)and 5'/z" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 Sep. 20. 2013 4: 26PM Div of Criminal Investigation No, 8574 P. 4/4 ....r. 1 /. LV IJ T.JJ1IU vI L, vIcI a vI L7 aI Lu!a yr Ll' lin. 70, 0 P. L ,LL t'`y, IOWA �?iatit4 STATE OF , • w� )?•!11 ) Criminal History Record Check ti Request Form (....ae:::: •`. DCT Account Number: 4' (Iblt To; Town Division of Criminal Investigation From: City of Town City Support Operations tureen;1"Floor City Cleric's Office 215 Tt,rStreef 410 E.Washington Street - Des Moines,Iowa 50319 (515)725-6066 Iowa City, TA 52240 • (515)725-6080 Fax Rhone; 319-356-5041 Fax: 319-356-5497 I am requesting an Iowa Criminal Elisio Recordy� Check on: Last Name (mandatary) First Name(mandatory) Middle Name(recommended) f yeas ti«-rr H&W 5 mil Date of Birt)hp(mandato,y) Gender (mandatory) Social Security Number(recommended) O/ /L7 ( D 3 nMa1e Oiromale Q7 -994' waiver informal=Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6922.For complete criminal history record information,ss allowed bylaw,always obtain a waiver signature from the subject of the request. Waiver Release:I herebygtse',emission for Iho above re I nesting official Lo conduct an Iowa criminal historyrecord chock with thepitdsion of Criminal InvesligaiIon(Del). Any cthnlnal history data con twin nmme i is r..- tamed by the Del may be released a4 allowed by law. Waiver Signature: ( . u3-'44151°-'---- . Iowa Criminal History Record Check Results (DClaae only) As of 9 bts [13 , a search of the provided name and date of birth revealed; . No Iowa Criminal History Record found with 1CI • ® Iowa Criminal history Record attached, DCI if : - DCI initials ir.. - Received Timer,Sey,,17;_02013 4:54PM No, 8038 Il Iowa Department of Transportation (I 3 iOf ice of Driver Sernux (Toil Free)800-532-1121 PO Bax 9204,Des Moines,IA 50306-9204 515-244-9124 FAX 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/25/2013 DL/ID#: 960ZZ3361 (IA) Customer#: 4120683 Name: Ayers, Matthew Class: D ID Status: None Sean Address: 1206 DIANA ST Audit#: 7162419 DL Status: VAL Issue Date: 07/23/2013 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 06/27/2018 CDL Cell Status: None 522404629 Endorsements: 3 CDL Med Status: None Mailing Address: 1206 DIANA ST Restrictions: NONE Restriction None Supplement: Date of Birth: 6/27/1983 Mailing IOWA CITY, IA Sex: M City/State: 522404629 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/29/2012 717195 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 10/13/2011 03/04/2012 WOO Unpaid College IA IA Loans Name:Ayers, Matthew Sean DL/ID: 960ZZ3361 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: if 4`h' 9/25/2013 : IOWA�•'s�$ pit tr def. a caLorestA %�j. D. 0. T. :s hi,J T Office of Driver Services Iowa Department of Transporation Name:Ayers,Matthew Sean DL/ID:96OZZ3361