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Home My WebLink About13-110 Authorization Number //Q _ 1 (Office Use Only) - 4 7III "it AO ISE i Agir 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 JA E S p A L l{ of / 2. Mailing Address P. /� O X 1 9 0 4 f l p, Rp/k'S �lt 5^� y Qli 3. Telephone: Home S6 3 - -2 0 3 — / / 7 t Other: 4. Prior experience in transportation of passengers: /V 0 A/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /11."---5 Type of offense Where When Pu 3Li e 1-/\J 'lc :� �L /Y a ,9/2 /,,AI°1t9f S17MME moo/ 6. Have you be n 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? /V 0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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) f\J 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) clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I t y /3 i3 y S6 2 . 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,- Ate. `"1:aci//,, Date 5 — / G — / s' STATE OF IOWA ) COUNTY OF JOHNSON ) scribed and sworn to before me by v 0. S t ( S . On this _ )Lc%F4'\---- day of )�e C_C ;-� l/ / c i4 C ___, :,,iii, KELLIE K.TUTTLE Notary Public in and for the State of Iowa , GUnmJaaiv„Nu !c1 221810 z My ComrJpissio/P Expiresxp L__194, _ y!j r'—/ *****.**********************.,tie*********.***. * *** *****************.*********.***********************.***.************************************ 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). dr )r.� 3------/4--/,Signatu of Poli - ( hief 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. / _ .� it) - ---7 -A--1/ $ — /3 Signat re 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 derkftaxidrivbadgeapp2010.doc 03/2013 r "Uf pd State of Iowa .t£OF to ; • /%8�'t \ Division of Criminal Investigation � 0�i * `- (' I .qt.f.‘ 215ETn St =1 ' ' IOWA r. Des Moines IA 50319 "i' a Ph.515-725-6066 Fax 515-725-6080 'JJJF ,r,"°.^°"". '/o., • 47708 P�� Iowa Criminal History Record Check ar"�� Walk-In Request Your name TAAi ,s5 ALAN WCLLS Address a.Sr^ i A Ave- • tie # City/State/Zip CpnA-p RAPIDS .1 e • S v2 4o 2 Fill in all shaded areas. Phone# 5703 -a u -3 - 117 Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) I First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) /JCLLS T _S ALAN Date of Birth fFecha Nacinvienlo(mandatory) Gender Genera(mandatory) Social Security Number(recommended) pa-G , / / I qJ�j i ®Male ❑Female 3/0 -148 y' / % Waiver Si nature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) Results DCI USE ONLY As of S 1 C 13 , a name and date of birth check revealed: Io record found rl _ ❑Record attached, DCI# DCI initials Receipt 00 Number of requests x $15.00 per last name=Total amount$ Method of payment: IEVash ❑money order CI check# ❑MasterCard or Visa Cardholder's name _ Last 4 digits of MC or Visa _ DCI initials Credit Card Number# Exp. Date Iowa Department of Transportation IIIII 1133 Office of Driver Services (Toll Free)800-532-1121 U PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/14/2013 DL/ID it: 194BB4562 (IA) Customer#: 4135127 Name: Wells,James Alan Class: A ID Status: None Address: 2805 A AVE NE APT 1 Audit#: 4845966 DL Status: VAL Issue Date: 11/29/2010 CDL Status: VAL City/State: CEDAR RAPIDS, IA Expiration Date: 12/13/2015 CDL Cert Status: None 524024827 Endorsements: LNT CDL Med Status: None Mailing Address: PO BOX 1905 Restrictions: NONE Restriction None Date of Birth: 12/13/1951 Supplement: Mailing City/State: CEDAR RAPIDS, IA Sex: M 524061905 History Information CLEAR DRIVING RECORD Name: Wells,James Alan DL/ID: 194BB4562 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: =--.1.1 IE . i 5/14/2013 A <9 ill DO, '/jIi 4;,:.D. 0. T..;t: 21 II,tORNE4So`- lowaeof Drtmrr Servliceas nsportation Name: Wells,James Alan DL/ID: 194BB4562