The URL can be used to link to this page

Home My WebLink About13-198 Authorization Number 3` � 1 (Office Use Only) giii11142141,111ft to "` rrrala 1Air 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 52240-1326 (319) 356-5040 (319) 356-5497 FAX Firs ,�1Middle Last 1. Name i / IZ -S� 71f-tilde, � 'tsd>7—/ 2. Mailing Address a o zJ S r C-r- S Sar �'-) :�A 5 9 2 Lt c 3. Telephone: Home Other: G C ( 3 I ► a 33 4. Prior experience in transportation of passengers: ye 11,..) L,- /C o) 5. Have you ever been convicted of any misdemeanors and/or feloni: �- - / V.) Type of offense Where n 6. Have you baqn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? (V(' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? )Y S Type of offense Where When -} f41 Q° ,!C t t_0 c . 2 / / //-2- 5 /-2- 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) clerknaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number . 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 Signature of Applicant e • � Date /v( //3 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,,f,nelab- Av"(1.,,l,_C t,Ln IrLA, . On this ti day of Notary Public i nd for the State of lo 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). Signatur: of "otic: ief o 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. Signore of City Clerk or design e Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 der 1axidrivbadgeapp2010.doc 03/2013 llpi Iowa Department of Transportation 4.liOffice of Driver Services (Coll Free)800-532-1121PO Box 9204,Des Moines,IA 50308-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/3/2013 DL/ID#: 580XX9476 (IA) Customer#: 1135116 Name: Story, Ernest Arthur Class: D ID Status: None ' Address: 203 SCOTT CT UNIT 5 Audit#: 6719158 DL Status: VAL Issue Date: 02/22/2013 CDL Status: None City/State: IOWA CITY,IA Expiration 02/27/2018 CDL Cert None 522453996 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 203 SCOTT CT UNIT 5 Restrictions: Corrective Lenses Restriction None Date of Birth: 2/27/1966 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522453996 History Information Convictions Citation Date Conviction Date ACD.__Explanation County JUR 02/19/2012 04/17/2012 _ ._._._ -M42 Improper Lane(changing lanes) u Johnson IA 05/13/2012 08/28/2012 M14 Fall to Obey Traffic Sign/Signal Johnson IA 02/22/2013 '.05/30/2013 M14 Fail to Obey Traffic Sign/Signal Johnson `IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 06/25/2013 747232 iIA Name: Story, Ernest Arthur DL/ID: 580XX9476 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: • vyt :_a.**NCIE-....r ', 9/3/2013 M. IOWA It s e 0°1•.D. O. T. ?� ,,li�11113/4%f/es-SJ OfficeDepartmentfDerv(iceansportation Cedar Rapids DL Station K-Mart Plaza 152 Collins Road NE Cedar Rapids, IA 52404 Statement Receipt: 31251290 Customer Information Office Information Name: Story, Ernest Arthur Date: 9/3/2013 3:10:22 PM Address: 203 SCOTT CT UNIT 5 IOWA CITY, IA Location: Cedar Rapids DL Station 522453996 Phone: Fax: Email: Attached Customers Name Story, Ernest Arthur Transaction Type Description Amount MISC Finance Transaction-Story, Ernest Arthur $5.50 Product Amount Sale of Records-Certified $5.50 Total Due: $5.50 Payments Payment Method Payor Payor# Number Amount Tendered Cash Story, Ernest Arthur 1135116 NA $6.00 Total Tendered: $6.00 Cash Back: ($0.50) • • • • STATE OF IOWA Criminal History Record Check Inn • Request Form DCIAcrountNumber tf fl-F- (If Spptkable) Tot :Iona Division of Criminal Iavetdr/tloa From: r.\4 Vtrs TAX I &Ippon°paratloes Bursa 1"Floor 215E.is Witt I54-eaes i Or. eDeaMoira, rt. 5031V QOIL C.v6, I A Se39 (5(5)n540so Fat • Fboae: bila) 338 v)H- • Far. - (3i,) 551-8,-99 1 am requesting an Iowa Criminal History,Rererd Check gni beatNamesmrmwy) Pint Name oSaw'y) Middle Name Irereearaaed) Story Sr rerm• - Date of Birth(,rYam:yr Gender ferry) Social Security Number ansae emo I3/ llg6 e °Female 47h— gab ad33 Waiver Infeemeden:Without taped waiver from the aebled attbe request,a compote erlmiaall Watery mord may not be rekiaabie,per Coda of lova,Chapter 697.2.For pubajdo erlmlaal MNory record Ioforea&n,as avowed by law,always obtain a waiver SWIM floe the to Jed of the music. Waiver Release:i hoes eve nuke Por an aeern,e4aklsoekw to ooMmits mr..cdmial Army moot theck with St Miss oferiftim rnrneparta(130).AyaimMJ bbioty can=caning ay that Is maWaHad le'ifo DCI ary be Messed nalooed by 4r. WalverSlgnafare: • • )(or C iminal History Record Check Results (al,useonly) c:6 �`Aa of 1k1) ,a search of the provided name and date of birth revealed: • • • w1 No Iowa Criminal ll(story Record found with DCI • IF Iowa Criminal History Record attached,DCI M (O003(O( • • DCl initiate • DCI-77(08/25110) . Received Time Aug. 22. 2013 4:28PM No. 3496 L/9 'dOZE6 •11N uoile8ilsanul [Elite! 10 to n!0 WdSE Z t;106 '6Z11V Aug. 29. 2013 2:36PM Div of Criminal Investigation No. 4320 P. 7/7 • • MOIYVDIYSaANI TVMIWIN3 80 NOISIAIa • 'xumnONI HnOX 80 &JafQOS 3HY SHaAOJ aj0DaU SHY YVHY mat HO W9IdNO0 YOMNVJ HM 'Q3HSINHnd NOIYVWHOBMZ MO aaSYH SI auOJau SIHY NOIYVOI6IYN3aI SAIYISOd HOA SYNIHaHZOMId 40 3DNSSITY SHY NI 'IDG SHY AH SaIJNBOv.sNaWaounom MVR-NON OY aSSVH' TH 3H ARNO MVD Ins UHOJSH DIROOd V SI NOI AIYNSQI ao nv3Hna 'NOIYVDIYSSANI RVNIWIHD 30 NOISIAIQ VMOI HH.L AS. aNIVYNIVW QHOJBH SIHY 'rano 40 NOIYVJIQNI NV SON SI NOIYISOdSIQ YOOHYIM YSHUHV NV 6Z60666t sasoJ mom 6Z606661 05$ HNId • 6Z606661 AMINO avagd YVa 3d3 dSIC SONSYN1S ZOt60t005 :#3011 NOI/DIANOO HONV2WSQSIW :SSVRJ SOHVHJ YRnvssv g1aWI6 (60Z-soLVI 3YnLVLS VI ZO -ON SNOOD YHnOJ YSIa OJ NNIR fStOLSOVI ;AONSOV NOILxSoaSla muno= ZOL65EOOS +#HHS YRnYoSY HUN'S ' (6)e-0oLvr 9YnLVYS VI ZO -ON aelVHD as Saldvi HV09J ootOL50VI :x3NfOV SZ906661 081S2HHV LD m.* 0300311 HOD NHV un mu • WHY RC YVY WHY dH YVY rIVJ H YVY WHY XI YVY 3x3 H DS SHSI4IYNSUI RVMOIYIaav NW caw HRH OUR, OLZ Ot5 M W LZZ09961 • god NHS HIVH axa mon YOH DVH NHS sea HOHYHY SSSNHB'AHOYS 29NVN 19E00900'IDa 6Z/SO/ELOZ • -a3YNIHd atva 1 40 I HDVd ARNO SNOIYDIAMOD HONV2WHQSIq 19E00900 IDU AHOSSIN RVNIWIHJ VMO/ 1