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Home My WebLink About13-180 Authorization Number I 3 1 C r4 1 (Office Use Only) Tri. ::VIII t. 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 Cj' ,-lower /52240-I82 19) 356-504 /11/1161161 /c� (319) 356-5497 FAX Firs) M c1 le List 1. Name )<- „+ CSA n } ��u I �—v e 150 2. Mailing Address i c� �So�i 11 iRi4e Dr. ,e Cor.-i�. ;//P LA sa.yl 3. Telephone: Home 1" Ic,qc, Other: ( 6-3) 9yo'SSSS Cell :c P17"e 4. Prior experience in transportation of passengers: usr� --t, eer. v e '-e..1ry r✓ �n f ;lYIG< I� CCkJ/ fc,c; M 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? N Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? r PS Type of offense Where When C(�e cf. +rC uwy ' \-/ 4; �eiN�rLA �I 2I Dot 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ e) 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) ,Vo DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C-- HREVtEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) cierk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 6 i 7 3 Y'Y 3 3 kl7 . 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 � c- LDate D -D' ~ I ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) G ubscribed and s orn t�before me by vl�Cil} �v-e cso-r On this 2.3r day of r _ _ . 0 l-. , r _ -- 1,.1-"L o.1-"L KELLIE K.TUTTLE '`� L`t-e K 1 k c Commission Number 221819 Notary Public in and for the State of Iowa pin co ************************************************************************************************************************************************ 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). ..710,-...:W Signa e of Polio"- ief 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 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 derkttaxidrivbadgeapp2010.doc 03/2013 4 IIowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50385-9204 515-244-9124 41.00 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/10/2013 DL/ID#: 773YY3387 (IA) Customer#: 4141596 Name: Iverson, David Paul Class: D ID Status: None Address: 1969 S RIDGE DR Audit#: 7228453 DL Status: VAL Issue Date: 08/10/2013 CDL Status: None City/State: CORALVILLE,IA Expiration 02/03/2016 CDL Cert None 522411058 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1969 S RIDGE DR Restrictions: Corrective Lenses Restriction None Date of Birth: 2/3/1972 Supplement: Mailing City/State: CORALVILLE, IA Sex: II 522411058 . History Information Convictions Citation Date Conviction Date ACD Explanation County 3DR 11/21/2011 112/16/2011 S92 Speed (10 mph&under In 35-55 mph zone) Washington ;IA Name: Iverson, David Paul DL/ID: 773YY3387 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: o�474p'o Q,.........!4%\ 8/10/2013 '�: IOWA .0. lo*1 ho':D. O. T. C,e•. eitrestajk e • of Driver ces '1jf� owaeDepartme teof iTransportation Name: Iverson, David Paul DL/ID:773YY3387 Wn'6IV`pNdEl 610 zi ''.fel awl oan'iaa4 - • #fxq.ct`pagob�ltapxo)0 Ao01,4-I naJ IPOW0X i ! • 33atrot pang p 000-g fsoa0lrlettltailDZWUCON I , ;popaonoryJarq,�+ro op pts otueu pa,pJAoxu etPip x192020 n s Q'I 1.0-, i t n .go nVil .-. 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