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Home My WebLink About13-138 Authorization Number /3 - 1 1 (Office Use Only) APPLICATIF CAB DRIVER CITY OF IOWA CITY (Police Department review must be mi- e 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 fiddle Lias 1. Name Grcn II l� eye 2. Mailing Address 33 S�rawbY s�9� 1`e( i' t- 3. Telephone: Home 5/ 'g)0 -1700 Other: 4. Prior experience in transportation of passengers: rs 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When V 7. Have you been convicted of any traffic offenses in the last five years? I Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 'v o 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) cleNtaxidrivbadg 09/2010 I herebyy, certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number " 1I Le k'F (73- . 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 , /2 ��2 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Gran l— Scl-2,..,.1'2_ . On this 1 day of UK-v00L a09/-3,-----, ( 1tSONDRAE FORT Z,,, F � Commission Number 159791 4i. • My Commission Exaire Notary Public in and for the State of Iowa 3/1/4o/ 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). sli‘,z1.„,„...._________-------- -a7,k-/3 gna ure of Police Chief or designee Date . ,21 .—/3 Signatu e of City Clerk or designee Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi-cab businesses are required to provide Driver Identification cards. **.***...*....*****..*..**************....**.*****..***.************..****....*.*...**.....*....*.*******.***...***...*.****....*.*******.**..** Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgepedicabapp2010.doc 09/2010 • VS/ lit'AdV :t £IOC '6l 'un0 evilpaniaa el • rterk .pv 10C('pa�• �oenupxoaavhbourleurtaroeraox 0 Xaalga pungnioaagkoltiteurr,;rfvracy oN vir • , tpciumofjatjq os;tapptzearzwupgpjtotti'etj3 92J93vastit(I(I110ca1tLI0\ gosh .03n YJtT) : ' }Xzaga 4aa40) ?•fooaa.Vio).e Tru Wga3-Rao' 1 _ =astumagi adld/r1 ..._ _.._ ...— -- wyjAinmons aposallCogatm 4(0114pouraluMspuylmu9a1Wxu69NUSNP:UPupu)>eduy 1000oe)les)Ieoou1 • Jeu)wu.7a0llama mul%A voppoti relslJp'uJwpoutnotwtlonpuma7 tywo,e9gsaubarelagdottlayu9)n;u„odef)v/(tommtvp2j—S4,w. 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Auoi }42I }sanul 1puiwiaa Jo Aia IVvi '6 (n.OZ 'lZ 'unren eailowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 IlIr PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/28/2013 DL/ID #: 914RR9732 (IA) Customer#: 2862838 Name: Schultz,Grant Allen Class: B ID Status: None Address: 5133 STRAWBRIDGE RD NE Audit#: 7082383 DL Status: VAL Issue Date: 06/28/2013 CDL Status: VAL City/State: IOWA CIN,IA 52240 Expiration Date: 05/11/2018 CDL Cert Status: Excepted Intrastate Endorsements: P CDL Med Status: None Mailing Address: 5133 STRAWBRIDGE RD NE Restrictions: Vehicle without air brakes Restriction None Date of Birth: 5/11/1981 Supplement: Mailing City/State: IOWA CITY,IA 52240 Sex: M History Information Convictions Citation_Date Conviction Date ACD Explanation County JUR 07/26/2010 ___. 09/02/2010 S92 Speed (10 mph&under in 35-55 mph zone) 9 IA . Name: Schultz,Grant Allen DL/ID: 914RR9732 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: or '/.0%p...... .ir 4 6/28/2013 '4 IOWA :2',, 41 te SD. O.T. W' �01)..1.r''' - ,. O `�c�fOBBSEOffice of Driver Services owaDpartmetofTransportation Name: Schultz, Grant Allen DL/ID: 914RR9732 Iowa City DL Station Eastdale Mali 1700 S First Avenue Iowa City, IA 52240 Statement Receipt: 30543202 Customer Information Office Information Name: Schultz, Grant Allen Date: 6/28/2013 12:38:13 PM Address: 5133 STRAWBRIDGE RD NE IOWA CITY, IA Location: Iowa City DL Station 52240 Phone: Fax: Email: Attached Customers Name Schultz, Grant Allen Transaction Type Description Amount MISC Finance Transaction -Schultz, Grant Allen $5.50 Product Amount Sale of Records-Certified $5.50 Total Due: $5.50 Payments - -- — -- - Payment Method Payor Payor# Number Amount Tendered Cash Schultz, Grant Allen 2862838 NA $5.50 Total Tendered: $5.50 Cash Back: $0.00