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Home My WebLink About13-122 Authorization Number /3-- ca (Office Use Only) Ar.611r4rwitattt uniggir 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 Middle Last Q7_ 1. Name 0,R 6Q ._ P 7 v T': i �:' (, ' / 2. Mailing Address / 9'9 5 E - 4 F r 5 t 3. Telephone: Home 3 v S— 3 I P 6 6 8 S Other: 4. Prior experience in transportation of passengers: f 2er e_ . ( 'v /Cf.-41 ,-7 r 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Y S Type of offense i ,.r Wherez, ,4„cc When1 ��- -� Af.s.) Lot �'i�G -20o S Pc)S5 Bf /�AFiCores' Ce xpc.v1"J) G:crL.Ir �' , N / 9 F 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A) 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 'Y Type of offense Where When ro .S t01,. S.y. fcz(CJA Cr. , a 1. Z o.3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i't- C 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) 4 -10 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) clerkftaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nu,riber „k t-f ? S er 3 . 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 relting 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 ,Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) _ , Signature of Applicant / Date C� � v 6/l_3 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) r �J� S ibed and worn before me by N1 0 )1‘. c- iVCrS ��GC I (e . On this ' " day of KELLIE K.TUTTLE L ( ((` Commission Number 221819 Notary Public in and for the State of Iowa k yY�y. N:�Gui,i,n �!U AFJtI **************************************************** ******************************************************************************************* 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). /\ ' / 7 / Sig ur-of/ 'e 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. • Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/z" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp201 o.doc 03/2013 Iowa Department of Transportation .14/1.1111)p Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/30/2013 DL/ID It: 638AH7593 (IA) Customer#: 6027518 Name: Rivas Valle,Jorge Aldo Class: D ID Status: None Address: 319 1/2 W 4TH ST Audit#: 6855031 DL Status: VAL Issue Date: 04/11/2013 CDL Status: None City/State: MUSCATINE,IA Expiration 08/15/2017 CDL Cert None 527613121 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 319 1/2 W 4TH ST Restrictions: Corrective Lenses Restriction None Date of Birth: 8/15/1952 Supplement: Mailing City/State: MUSCATINE,IA Sex: M 527613121 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 01/03/2013 04/03/2013 M14 Fail to Obey Traffic Sign/SIgnal 52 IA Name: Rivas Valle,Jorge Aldo DL/ID: 638AH7593 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: _,' ttUCIf/" •45302013 (WI 4 eigszna ' ' f Iowa Department of Driver rtmr Services iceansportation Name: Rivas Valle,Jorge Aldo DL/ID: 638A117593 Apr.-2.5. 20133 2:57PM, Div of Criminal Investigation No. 1414 P. 1/1 in ..1/.. Li. 1.111 I . vi1. Vn itt' ViViI vitt' VI !VIM ulty ;nL4 I IYV. JY IJ I 1 L pr. LV13vJ 7...11111Inv UI L.1111L.1111111141ut 1a1 ave) agatlull IW. 1.113.1 I. I/2 ' rApt 16. 2013 1 : 15PN. 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IoWg Cr:ithL1w! topji{ea(izd, c o *110fildtg, , Ad utak) A.Yof' L aaalir0.ho t<�opro'vldedtfa>laanrtdatao�'blithaovepted; ' . t�', • ` JFK Nb Nita csainicadgistotyizecordreihua 0200)011 • + 0 .Yawescbrdnal '1siOVRecordWalked,bOfff '1 - .._ I I a Received Time Apr, 25. 2013 10:11Ak14.19;,,1313 ki17—) •