HomeMy WebLinkAbout13-171 Authorization Number ( - 17(
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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 52240-1826
(319) 356-5040 AU_ i s. $I13
(319) 356-5497 FAX `
First , Middle -- Last
1. Name /fl .r4 1.t k �- 01 errc(
.
2. Mailing Address o` _ _(r7' ,( 4 r I2...2.4_:\,
3. Telephone: Home 3) �f U 7/ 4o OOther:
4. Prior experience in transportation of passengers: � /D
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 4/(
Type of offense Where When
6. Have you e 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? Al()
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Na
Type of offense Where When
9. Haveou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
N/fr
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)
clerWtaxidrivbadg 03/2013
I heeby certify. tOt I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
_")0 2, (=1 511'2 . . 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)
1 Signature of Applicant �/ Date r / 4
' 1-/27 ' s g// ,3) 15
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by N\QrQret' S; -er►^� . On this 13 day of
AUL J -S -j �
,oht_ s�, SONDRAE FORT
z Commission Number 159791 Notary Public in and for the State of Iowa
Aly Cnmmiscinn Frpiram
ow si7/ar.).‹
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).
/ -i3-/3
Sig ture of Police 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.
Signatof City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (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
clerkdtaxidrivbadgeapp2010.doc 03/2013
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Iowa Department of Transportation
Office of Driver Services (Toll Free)800-532-1121
PO Box 9204,Des Moines, IA 50305-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 8/6/2013 OL/ID#: 502AG5772 (IA) Customer#: 5802487
Name: Sierra, Margaret Louise Class: C ID Status: VAL
Address: 2401 HIGHWAY 6 E APT Audit#: 6624663 DL Status: VAL
3414 Issue Date: 01/17/2013 CDL Status: None
City/State: IOWA CITY,IA 522406788 Expiration Date: 05/17/2017 CDL Cert Status: None
Endorsements: NONE CDL Med Status: None
Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE Restriction None
3414 Date of Birth: 5/17/1961 Supplement:
Mailing City/State: IOWA CITY,IA 522406788 Sex: F
History Information
CLEAR DRIVING RECORD
Name: Sierra, Margaret Louise DL/ID: 502AG5772
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:
oQQ''' ''''.:7�� 8/6/2013
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�Ch,rf Big%S��s
Iowa Department of Driver
rtmr terviceansportation
Name: Sierra, Margaret Louise DL/ID: 502AG5772
Aug. 12. 2013 10: 03AM Div of Criminal Investigation No. 3174 P. 1/1
Aug. /. 2013 9:25AM City Clerk - City of Iowa City No. 3/3/ P. 2
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Received Time Aug. 7. 2013 9: 23AMi14,,.1780 Yf--)