HomeMy WebLinkAbout13-142 Authorization Number — I`k
1 (Office Use Only)
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
c(319) 356-5040M CALL P/Z AAv/ QM
(319) 356-5497 FAX
First Middle Last
1. Name —I-OKA L.j4 rbkj CS it;alArid Dr.asdati
2. Mailing Address q J i 14. 1:O UL V iL, 'Z t7Lv✓3 G i —7y 14 c t l(y
3. Telephone: Home Other:
4. Prior experience in transportation of passengers: ►V O IAl L
•
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? (lbwt
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? Iv r
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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)
cierk/taxidrivbadg 03/2013
I tyby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4
,y k1/a- `1064 T9co . I understand that if I falsely answer any questions in this application, that this
.pplication ay be deniie . I understand thaT if I falsely answer any of the questions in this application, that this application will
•e denied. I agree thafin 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 ' ;.a fr/(4.' '1"441- Date 6/ ', ,r' 13
7/ l
STATE OF IOWA )
COUNTY OF JOHNSON ) }/
Subspribed and sworn,)o before me by c,.j Oil to 1Yk i n1►'vl i . On this J day of
\---it,CLi .()C) 1 e c (re k lLr-P-Le_,
Notary Public in and for the State of 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).
717/0/.... .le S .1ai3
Signature of Poli xChief r designee 761Date
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.
n�.r ... le • e(2-4v 7- 3 — / 3
Sign re of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81”(width)and 51/2"
(height)and prominently displayed to all passengers.
...*...****.**.......*...*...*****.*******..**.************.......******.**..*..**********************************************************.*****
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dertdtaxidrivbadgeapp2ol0.doc 03/2013
Jul. 1. 20133 4:49PM1 Div of Criminal Investigations No. 8950 P. 1/1
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Received Time Jun. 25. 2013 4: 10PNr1u'No. 7210—�--
Iowa Department of Transportation
int Office of Driver Services 515-244-9124(Toll Free)80U-532-1121
PO Box 9204,Des Moines,IA 543469284 FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 6/25/2013
DL/ID It: 706A39508 (IA) Customer#: 6110364
D ID Status: None
Name: McSkimming,John Class:
Clayton AL
Address: 1911 KEOKUK ST Audit# DL Status: V: 7069508 DLL Status: ALe
Issue Date: 06/25/2013 CDL Cert None
Expiration 02/16/2018 CDL
City/State: IOWA CITY,4IA Date:
522404443tatus:
CDL Med None
Endorsements: 2 Status:
Restriction None
Mailing Address: 1911 KEOKUK ST Restrictions: NONE Supplement:
Dateof Birth: 2/16/1961
Mailing City/State: O2 404443,IA
Sex: M
52
History Information
CLEAR DRIVING RECORD
Name: McSkimming,John Clayton DL/ID:706A]9508
Pursuant to Coe§321.10,I, or of
artment
certify that IIam the custodian of the Kim
records held rbytOffice Driver
Snook, the Office DriiiverSeryServices,that thisDispa true and accurateffi
curate 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:
vyii,
' Arabli IE p/ 6/25/2013
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f IOWA tr'w, ,r
r\D. O.T.,•:tsb ..
Sp; •5V' Office of Driver Services
y'
Ø.OgIVE6s= Iowa Department of Transportation
Name: McSkimming,John Clayton DL/ID:706AJ9508