HomeMy WebLinkAbout13-137 Authorization Number 1 1
! r 1 (Office Use Only)
Ca
gel CiO
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.T-1 52240-1826
((319) '�55
(319) 356-5497 FAX
RirAtMiddle Last
1. Name Ile 1t i e `rc f
2. Mailing Address a �C�S �►� 5S �. C. j A ) S-1-2--
3. Telephone: Home l d—3 V " 2 52,5" Other:
4. Prior experience in transportation ofo/ passengers: 7 e�S �� G..-: t I T 1 e---f`3 LLA0
L._r � 2 ''e 1it1 L c 2 A , S -r{`..o r✓� c-sox,�S (0,013
Z/61-, •
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? n U
Type of offense Where When
6. Have you een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 0
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? tj CS
Type of offense Where When
l
1 /
g Y
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? In t,
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)
P )1„k-lovaS Biu 00 N) te-r
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)
cl=rL:Raxid-ivbadg
03/20*,
I herebycertify that I hav s d to me by the Iowa Department of Transportation a valid Chauffeur's license'number
�-, I D,deaf . I understand that if I falsely answer anyquestions in this application, that this
e s PP
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)
O 7
Signature of Applicant _ `� Date_ 6-11 -/3
STATE OF IOWA )
COUNTY OF JOHNSON ) --
Sub cribed and sworn to before me byL.;S 1�C r . On this a. day of
i -E, ( . . L'1Z__,
-4i;-7— KELLIE K.TUTTLE Ke. ( 6 C t -7,-;-:171-(0
.1 Commissio Number 221819
.�y r� sio Ex•i es tary 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).
., /,(//,i6 ,77- /3
Signature of Police of 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.
Signat - of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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
clerWtaxidrivbadgeapp2010.doc 03/2013
11111111
Iowa Department of Transportation
Office of Driver Services (Toll Free)80x-532-1121
4
4FO Box 9204,Des Moines,IA 50396-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 6/25/2013 DL/ID#: 153682737 (IA) Customer#: 4101693
Name: Doderer, Dennis Woods Class: D ID Status: None
Address: 3212 HASTINGS AVE Audit It: 4420862 DL Status: VAL
Issue Date: 06/09/2010 CDL Status: None
City/State: IOWA CITY, IA 522454021 Expiration Date: 12/01/2015 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 3212 HASTINGS AVE Restrictions: NONE Restriction None
Date of Birth: 12/1/1948 Supplement:
Mailing City/State: IOWA CITY,IA 522454021 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD ExplanationCounty JUR
12/09/2008_ _ _ _ _01/15/2009 _ _ 592 ,Speed 52 IA
09/05/2011 10/18/2011 .M14 Fail to Obey Traffic Sign/Signal 52 IA
-.— _
01/17/2012 02/02/2012 ,E34 Defective Lights 52 IA
05/23/2012 09/06/2012 S92 Speed 52 IA
Name: Doderer, Dennis Woods DL/ID: 153882737
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:
"`..x
Gelb
_-* •itgl . 6/25/2013
0�' IOWA '71
a
ycaCocak
' ti
% things_. Iowa Department Office of Driver ervices
nspo talion
Name: Doderer, Dennis Woods DL/ID: 1536B2737
• Jun. 24. 2013 1 : 10PM ; Div of Criminal Investigations . , • IN0. 7979 IP. 5/5. ••
• 4 . . . . , . .
•
• , r . • , '
.
, •
•
.,r `ti . 8 TATM CJK'IOWA 4. P „
(. V.11-1 • b$jaulllAaL J5 6P(y $eeb Cheek °
• •p /hen Terre ,,, • %I` •Act , • Re est? nu ittif,�, ahrisiunt
a•;
•
DCIAOcounEr�r3mBer;
P- _�
. atcpif(e•bt, , •
rot Xnuets.b.M1s(on oiteminalinvontrotiou I Front cm o'm TOtJ4 on • •
Sapp°rtaileratlOnsRuralu,Yai:Flooe - can examcvs o rez
2XE,riaireog - 410 i VAS13't' X06 STREg!
n shOrnc9,r'owa $OgID ,
015)725400 IOYTA CITY 'TWA 52240
(515)725-6080 ac ,
.
rrinnoi T,9-.3sti- -
WQXi 919-3 Dt$/ig7 _
I Ant re•uostln: entlooa,flt lna(Hf otw •ccord Cbaok on; . , . , '
Last Maitre, inJat•• ' .%Yretilieue&dram°°. Mil ciao NAMES68comraeaded)
WbOaP— Dodeea.f' t'eiii n-tS - - - - - - - .-
Dan oof: G9rth,(mwtderon) Gfdhclor(mandatary) Soeta18eomrItwmsAnithar(romn,ncndea)
17— (/Y f are dSemaTe 4nz^ 6o- /a3
Wailsa "itl7J'awnadoil;Without a alinednlsol'itontthe,rubfeatotinorersges4aromp/alecrIrmthglhls(aryrecordntpynot
------- .13s-koronubTorDestriunanwarehgstang&-z.2.k.oktohlpTota'orintitmfilial ly-vefroa-hiibkhtatfon;yi.�nutomdli3`rlrF'r'ykf5`1Rp--- —_.-.
• ohiail; atvorsl:nmiural?omthasuhoat ofttta1,9.Wett. ,
•
Wiver Se Igasig'rheray$trapermisttort yeyequesudgokra(ocondudriirowaortmnml nuroryetrosemittiavionislanaccdnirmg •
Ynytsttgal(am(Da1)rrinytrlmtaatldsrorydat4 wmingn at1smatn� ye4oDgtmeyhate(cw4 gal(oWdbytily.
if'aiver&:m lane: , C
- arm Catee6
•
Iowa &xzrnfai}Bator'.11e,Cord Cheek Rea tritO . • (DOnraconly)
Ag of G- ati- 13 yasearohOftheprovldettname anddeo ot'bMlazeveaIed: ' '
a- NoIowa GiitnhtaIB;ictolykocordnovndwithDCl
•
n AMA C4fml'na1 'iatoryRo ord attached,.1D Cz# - . - . •..
•
rim iptft,40 l�1
Rece-ivee Tune Jun. 19. 2013 4:45PM No, /641 - -
•r/'Y.te./n A/n a!Y nl