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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
(319) 356-5497 FAX
�First . l Middle 1 ` `�// Last
1. Name —37) S'k L U 1 5 �/EF c,q 3
2. Mailing Address 31 0 6 s S N.,c, o c'J Cr6w jp t.,.-,d %y , 2--> 5-2 :2 9 C
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3. Telephone: Home 7, 9 i ( ` 9 S 6-e Other: .r 7/' c / "7--`z3 7�`
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? st/�
Type of offense Where When
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6. Have you be 9 cpnvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? JJ11�1__�_1 C'
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? tAl J
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N
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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)
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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)
derwtaxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license-number
me
// c C CT'? Q? . I understand that if I falsely answer any questions in this application, that Nis
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 o C- /o - 2 o 13
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by Uus U I, i7 p g ct . On this /0 day of
5+✓tn..e /D� c20, (7 .
SONDRAE FORT
C• ommi`nmmNunn mber FSI"791 Notary Public in and for the State of Iowa
71/.;717it5
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).
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Sign
at a of Pol.,:- hie 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.
ASignat f City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z"(width)and 5'/Z"
(height) and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkltaxidrivbadgeapp2010.doc 03/2013
r, 1. 2013 8:51AM Div of Criminal Investigation • No. 4981 P. 4/11
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. Feb. 25. 2013 9:23AM City Clerk - City of Iowa City No. 3264 P. 2
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ve rem Cilmtnal X1'istoxylte*ord attached,1)01# co 1411 I, _..
`4!ar. 1. 2013 8:51AM Div of Criminal Investigation No, 4981 P. 5/11
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IOWA CRIMINAL HISTORY DCX 00511471
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OP 1
DATE PRINTED-
2013/03/01
DCI:00511471 •
NAME: . VBNEGAS,JOSE LUIS
DOB SEX RAC HGT WGT EYE HAIR SKN POE
19641114 M U 505 120 BRO ELK MED GT
ADDITIONAL IDENTIFIERS
CCH RECORD x°'
01 ARRESTED 19951116
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA321-210A
DRIVING UNDER SUSP NO PAYMENT OF FINE
TRK#: 022558601
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA321-218
DRIVE U/SUSP
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#; 022558601
SENTENCE DISP EFF DAT
FINE $250 19960208
PAY SURCHG
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OP CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN TEE ABSENCE OF FINGERPRXNTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
Iowa Department of Transportation
Office of Driver Services (Tali Free)800-532-1121
PO Box 9204,Des Moines,IA 50398-9204
515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 6/11/2013 DL/ID#: 211CC9907(IA) Customer#: 265506
Name: Venegas,Jose Luis Class: A ID Status: None
Address: 810 BASSWOOD LN Audit#: 6220118 DL Status: VAL
Issue Date: 08/16/2012 CDL Status: VAL
City/State: IOWA CITY, IA Expiration 11/14/2014 CDL Cert None
522465889 Date: Status:
Endorsements: HP CDL Med None
Status:
Mailing Address: 810 BASSWOOD LN Restrictions: Except Class A Bus Restriction None
Date of Birth: 11/14/1964 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M
522465889
History Information
CLEAR DRIVING RECORD
Name:Venegas,Jose Luis DL/ID: 211CC9907
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:
a Q1I�Cff O w,
p'o.�0e• /`/p�0�� 6/11/2013
Mi IOWA *y ,,
s. D. O.T.; y tfree
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BhOffice
of Driver BBNtl1 owaDepartme teoflTansportation
Name: Venegas,Jose Luis DL/ID: 211CC9907