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HomeMy WebLinkAbout13-145 Authorization Number_ 1 J , `_5 r i (Office Use Only) • ---...fmio®Ar 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 13 _ 19) 356-5040 City /SPS ``7 (319) 356-5497 FAX First;I_ Middle V I�L In ^� Last E�K5 1. Name cel Zl 2. Mailing Address p?0 iJ l-tq02 I, 3. Telephone: Home .9)ig 4 - qq Other: (� 4. Prior experience in transportation of passengers: J d r G'� +-A11-.‘ \- (t j fS .A y f 1\.) N0:L01ritCT , - — J �J 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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 d Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? t\14 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ni 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) 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) deddtaxiddvbadg 03/2013 f6•0 X1.1" 7(1C1" I herby��ce��t Iave issued to me by the Iowa f-Jepartment of Transportation a valid Chauffeur's license nurrit-er esu . I understand that if I falsely answer any questions in this application, that this appiication may be denie . 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 docun.ents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions cr Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 6t_trSignature of Applicant g Date 1 01 iS STATE OF IOWA ) COUNTY OF JOHNSON ) Subseribed and sworn,to before me by Sha roil- 0 rook-S . On this 2Ot k' day of / I /9.1 ,r KELLIE K.TUTTLE /� , �/ / ,- i Commission Number 221819 l,....., f < < �! `C/ M o mis on E>fpires Notary Public in and for the State of Iowa *f.*************************************************ick.****************************************************************************************** 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). gnatur 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. % 2 �/lu 71 k - kllit-1-- 7` /' /3 Signature of City Clerk or designee Date Taxi cab businesses are required to providc Driver Identification cards. Cards must be 8 1/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cleddtaxidrivbadgeapp2010.doc 03/2013 i • S`. h'!!6 .°�VTty,v.U1 t UU6 '6 Ind• avil VdA! d de • . f lO q tpegtrop©pxoya2ilxo�aF.FSTt3naa;.V•wFtor u • yy • ' JpOXsanotina ;o Qv ptta eider]papplo,e otjJ jq 110,m 9s m jo s'y • • (cJ°o?,nOa) i I iixn"a Votv pxa°9UA1.1° 6M tgmpj V1a13,1r ,pt/nffirWa ,ragta,,i atxlxgpoAtopyAHpo 'Nog datirJOgeyibypovlwu7cutsrtur0ot • •u{pelapAels)IJiuJWp°,IW'{tomvopaapcPAU,J JPJETDaouoll MM301)VeVQ 13700gYrnolsO 10110110bAMItalgatirIS 071/161170 WPfiralltrOXPAag Iy°QJcslwdadcAngviggl:.59.5)18p32T.t2q11 .15V MO.41.So,oo/gpeaglcdoka,tn]au5is.e,ftt1).tgIvurngo C' )dtb`49Jfg p2Mvlielaruom}utu7oJUJpxooax810p trramtupao.6nSjf o3 taitfa.to_s 7tlMoxgouponau(7tncrustleloltig_ q otottna jArom koppiltayao ejo;dwoaa; • sIowa Department of Transportation .r.tOffice of Driver Services (Tall.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: 7/3/2013 DL/ID#: 680A37904(IA) Customer#: 6077198 Name: Brooks, Sharone'Chuntia Class: C ID Status: None Address: 2104 TAYLOR DR Audit#: 6807904 DL Status: VAL Issue Date: 03/26/2013 CDL Status: None City/State: IOWA CITY, IA 522407042 Expiration Date: 09/22/2018 CDL Cort Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 1121 GILBERT CT Restrictions: Corrective Lenses Restriction None Date of Birth: 9/22/1971 Supplement: Mailing City/State: IOWA CITY, IA 522404528 Sex: F History Information CLEAR DRIVING RECORD 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: uuy VEwCIf p�l% irt 7/3/2013 ',49 itocak ' Office of Driver Services 4y�`DRNER, Iowa Department of Transportation