HomeMy WebLinkAbout13-185 Authorization Number /� /g5
I r 1 (Office Use Only)
raTiTaph.gr,, 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 52240-1)326
cj31 -_3 -6-5O413
(319) 356-5497 FAX
Fir Middle Last /
1. Name ! � at,i /f �-, �olcLl -��,0v
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2. Mailing Address /6 4"2 /fief- ,4V-e- /�
3. Telephone: Home (V�)`?S�—O 1 Other: (1.7(1.7(1) (7" '"—g6
4. Prior experience in transportation of passengers:
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where v&en
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? f\10►'�-
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? At5
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)
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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)
eknaddr;vbadg 03/2013
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I herebLcertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number .i
Vs 7.2 Cv 8 3-2- . 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 /2--6/2-(--2/3
- -� /(2_ C2613
STATE OF IOWA .4-
COUNTY OF JOHNSON ) OiNe
1✓
Sl ribed andy ori to Ware me by �Srn �I 1 ►10 y���� . On this P gday of
,ter
1.)- /
KELLIE K.TUTTLE ��f � ( C // ,
to-rat s; Commission Number 221819 Nota Public in and for the State of Iowa
. 4' My C • • F Aires
Notary
'107_1___ L—
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).
1',26-i 3
Si.natur :f 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.
ign ure 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/taxidrivbadgeapp201odoc 03/2013
:. .-. Aug. 20. 2013 •12: 00PM • .,'Div of Criminal Invest igat ion , , ' No. 3135 • '. P. 1/3• '
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Received Time Aug. 15. 2013 2: 1MPII,No. 3775 0n - •