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Home My WebLink About13-172 Authorization Number \/ � l 1 (Office Use Only) erSiawillia. 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 First Middle Last 1. Name K61)ect ctiw.Ci ,ttS C h(4}coe< 2. Mailing Address 3 d SS Hc,_ctl ni' 3. Telephone: Home 3,r, 4- -76 o9 Other: 4. Prior experience in transportation of passengers: k5 years ct f 76 ns th Ti I y e_-t c cis -t 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? h 0 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? n Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? kl 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? f1 a 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) n0 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 herebyr ify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number c 0 1.55 . 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 8 - 13 13 STATE OF IOWA COUNTY OF JOHNSON ) C\--\ \ \ h Sul� cribed and Sworn to before me by \\o o-g-- MSS 1-t x v.K.y_Ovn this 1 3 day of 1` 7 =tare ,clic in and for the State o Iowa ************************************************************************************************************************************************ 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). Signa . e of Folic' .'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. -7e /..3 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 der dtaxidrivbadgeapp2010 doc 03/2013 Page l of 1 Iowa Department of Transportation Ilir IIIOffice of Driver Services (Toll Free)800-532-1121 FO Box 9204,Des Moines,IA 503Dff 5204 515-244-9124 110 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/8/2013 DL/ID #: 126AC0155 (IA) Customer#: 2108144 Name: Lllttschwager, Robert Class: C ID Status: None James Address: 3255 HASTINGS AVE Audit#: 6108316 DL Status: VAL Issue Date: 07/10/2012 CDL Status: VAL City/State: IOWA CITY, IA Expiration 07/08/2017 CDL Cert Non-Excepted 522454022 Date: Status: Intrastate Endorsements: P CDL Med None Status: Mailing Address: 3255 HASTINGS AVE Restrictions: Corrective Lenses, Restriction None Vehicle without air Supplement: brakes Date of Birth: 7/8/1962 Mailing City/State: IOWA CITY, IA Sex: M 522454022 History Information CLEAR DRIVING RECORD Name: Liittschwager, Robert James DL/ID: 126AC0155 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: .ER '.?. 8/8/20132013 / IOWA S fo: 10, y; D. O. T. il41 4,:•• ;I'I''Crvices �f D $5@, Iowa Department eof Driver eofTransportation Name: Liittschwager, Robert James DL/ID: 126AC0155 8/8/2013 08/07/2013 12:03 FAX y DCI IOWA 10003 STATE OF IOWA Criminal History Record Check • maf,' Request Form • DCI Account Number: 11 v) —�^ (if applicable) To: Iowa Division of Criminal Investigation From: �a 't 5 1 4X1 Support Operations Bureau,1°Floor 215 E.741 street 104 5 4-tutiA s Dr. Des Moines,Iowa 50319 [Wit st C t t s�yi O (515)725-6066 (515)725-6080 Fax Phone: ,Cala 33F- "Li • Fax: 31a) 5514'14 l am requestinuan Iowa Criminal History Record Check on: Last Name(maaaetory) First Name(mandatory) Middle Name(recomn,andod) Date of Birth(mmabaaury) Gender mandatory) Social Security Number(recommended) 1 g to 2- 11111aie OFemale LI s LI --7a- 73 W Waiver Information:Without a signed waiver from the subject of the request,•complete criminal history record may not be releasable,per Code of lows,Chapter 692.2.For copmlete criminal history record information,as allowed by law,always obtain a waiver Armature from the subject of the request. _ Waiver Release:I hereby give permission ter the above requesting official to conduct an rows criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature: `-kze ' Iowa Criminal Itistory Record Check_Results (DCI use only) \-1 As of C4 1 13 ,a search of the provided name and date of birth revealed: Fr No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached,DCI# _ DCI initials . DCI-77(08/25/10) Received Time Aug. 7. 2013 12: 01PM No. 1821