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Home My WebLink About13-120 Authorization Number I-3 -- r 1 (Office Use Only) ——- gra, 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 1. Name 2. Mailing Address c� 3. Telephone: Home (7./ . _3 3 902 / Other: 4. Prior experience in transportation of passengers: 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 been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 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) 03/2013 I hereo certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number .,-4-r--, 7 > S' 3 . I understand that if I falsely answer any questions in this application, that this app ication 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 _...01111111er • 41101.... .::„.....1._;....--_,,--- Date ..5 '? -�j ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) fu crbed and .) I sworn, before me by )) rylo.nL___,,sr-) .OS On this 31�� day of Il L\ 0 ! J TatAi KELLIE K.TUTLE /�.e (' (l e /1 /I ( 7 ,�. '; Commission Number 221819 :� C t�, c•�r�.y' Notary Public in and for the State of Iowa iow1` ************************************************************************************************************************************************ 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). /2i s - 5. 3 ignaturof Police 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. 71(. x --r...--1--- • s. 3 - /3 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 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 J. - Page 1 of 2 Iowa Department of Transportation r Office of Driver Services (Tall Free)80(1-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX.515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/25/2013 DL/ID #: 960ZZ5662 (IA) Customer#: 669423 Name: Lyons, Damon Alshah Class: B ID Status: None Address: 2780 TRIPLE CROWN Audit#: 5447619 DL Status: VAL LN UNIT 1 Issue Date: 08/16/2011 CDL Status: VAL City/State: IOWA CITY, IA Expiration 07/06/2014 CDL Cert None 522407246 Date: Status: Endorsements: PS CDL Med None Status: Mailing Address: 2780 TRIPLE CROWN Restrictions: Corrective Lenses Restriction None LN UNIT 1Date of Birth: 7/6/1974 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522407246 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/22/2003 ,02/06/2004 - A20 Deferred Judgment OWI 16 IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 11/22/2003 'A98 ;OWI Test Failure 'IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 12/03/2003 06/01/2004 'A98 OWI Test Failure SIA ,IA Name: Lyons, Damon Aishah DL/ID: 960ZZ5662 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: '' IOWA ?° D. 0. T. .tr S 4/25/2013 4/25/2013 ��S OF PUB--� State of Iowa ,E�F Io�Q , it .`..:'-fa' s Division of Criminal Investigation 4:11,41# " `1 fd� -- �� 215E7thSt m Fc ' IOWA ` Des Moines IA 50319u ,�.,. ,Q,1:,�\., - 1Ph.515-725-6066 Fax 515-725-6080 jA ._�`� S% 90\ "-••p i cer d. 4660 M. Iowa Criminal History Record Check M�p Walk-In Request Your name �is9/nnsr/ ..,P,- s//.aL/ -s i —✓S Address c 7 R-0 -->-7-7 Ai-G er c----i7o W�c/ 1.-A. "E/ City/State/Zip, 7—„e-_,,e c' , y j . .2-741 . S 02..P .0 Fill in all shaded areas. Phone# (-- i/a 3e s' - ? ? / Requesting an Iowa criminal history record check on: Last Name Ape/lido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) ..,...}1:-.0-'-S 717,q..,09 .,9,-s .7 f� Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) Wale ❑Female /// 5‘ O 2- a6” - y22/ g 6 _s-i) Waiver Signature Firrmmaa(If the request is on yourself,please sign. If the request is on someone else,write WA.) Results DCI USE ONLY As of Se 2 9- 13 , a name and date of birth check revealed: ❑No record found r . Record attached,DCI# 3-1 A5 ?' 3 DCI initials 14 c.. • . Receipt Number of requests 1 x $15.00 per last name=Total amountS. /t$ �. .•; 0 v Method of payment: 111,cash ❑money order ❑check# ❑MasterCard or Visa Cardholder's na e Last 4 digits of MC or Visa DCI initials $JO Credit Card Number# Exp. 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