HomeMy WebLinkAbout13-108 Authorization Number 13 - a$
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FOR PEDICAB DRIVER
CITY OF IOWA CITY (Police Departmentt Fevi
410 East Washington Street between 8 a.m. to 3 p.m., Monday—Friday.)
Iowa Cit Iowa 52240-1826
3 1 9) 356-5040 eA2.1.oelLI trial 5
(319) 356-5497 FAX
Frs Middle Last
1. Name Tb PrV( J AMIE-5
2. Mailing Address 72-S 011 Alte-N-
3. Telephone: Home 31 5�( 5897 Other. -3i191 -337
4. Prior experience in transportation of passengers: ( —
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rJ
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?
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? f--Q--9)
Type of offense Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 3
Type of offense Where When
9. Have you ever lied 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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
09/2010
I hereby ce)ofily, that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
c55 . 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 — .. �a�1 Date
AIN
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STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by v >w ; � vY•• eS �>o Y r CAt. On this day of
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Notar Public in and for the S te of Iowa
!31 1')-
************************************************************************************************************************************************
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).
—1
Sign- ure of P%is • Chief or designee Date
A • '._ --
Signat e of City Clerk or designee Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi-cab businesses are required to provide Driver Identification cards.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerk/taxidrivbadgepedicabapp2010.doc 09/2010
Mays 6. 2013 2: 29PM Div of Criminal Investigation Jo. P• L 1
P . 2/7
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iIowadriver Department of Transportation
Ja Office of Services (Toll Free)> -532-1121
PO Box 9204,Des Manes,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 5/9/2013 DL/ID#: 075883892 (IA) Customer#: 4505206
Name: Parrott, David James Class: C ID Status: None
Address: 728 13TH AVE Audit#: 6568081 DL Status: VAL
Issue Date: 12/27/2012 CDL Status: None
City/State: CORALVILLE, IA 522411737 Expiration Date: 07/20/2017 CDL Cert Status: None
Endorsements: NONE CDL Med Status: None
Mailing Address: 728 13TH AVE Restrictions: NONE Restriction None
Date of Birth: 7/20/1989 Supplement:
Mailing City/State: CORALVILLE,IA 522411737 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
12/27/2012 01/01/2013 B51 Expired Driver's License 52 _ IA
12/27/2012 _�. 01/01/2013 M14 Fail to Obey Traffic Sign/Signal _ 52 IA
Name: Parrott, David James DL/ID: 075653892
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:
/ 4..........pf%ird�y 5/9/2013
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Name: Parrott, David James DL/ID: 075883892