HomeMy WebLinkAbout13-099 Authorization Number 13-99
1 (Office Use Only)
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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 Middle Last .1.
1. Name /(,�q2.,
/,
2. Mailing Address y 26/ S• 7v r•,on, �' 7 f_ (J
3. Telephone: Home (31 9'� C��� �' 4179 Other: (7/40 9 3k " l S t-
4. Prior experience in transportation of passengers: /lo✓''-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A.0
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? A U
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? A.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? A0
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)
(\-0
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)
clerkttaxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
431, 133 2 t 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) eT..,.149/5
„Signature of Applicant � Date 7 - - 3
03..-----
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STATE OF IOWA )
COUNTY OF JOHNSON )
id—
cribed and sworn tt] before me by .�t�r�C�-t 1J L(_i�-L' . On this 3 day of
� 2-- > I •J ,-e J
(DJ k_ k L_ (0
KELLIE K.TUTT�E A79 Notary Public in and for the State of Iowa
ea t Ov,nmio Licn i;,m
tJ'y C itsio �cp�res
ow !� �`—�
*********************************************** **** *******************************************************************************************
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.;,,,, e'/,,,c /, 1;41i,j,,`_
s3/3
gnatu e of 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.
ax-t-a,,e4'_ ie - zc.,/ 5-- .3 -- /3
Signatare of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81”(width)and 5'/z"
(height)and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derkttaxidrivbadgeapp20l0.doc - 03/2013
Or
Iowa Department of Transportation
Otficeo1 or r�^ervices (Toll Free)800-532-1121
PU Box 9204,Dos Moines,IA 503069204 515-244-9124
FAX:515.239.1837
Certified Abstract of Driving Record
Inquiry Date: 4/22/2013 DL/ID#: 436882128(IA) Customer#: 4719219
Name: Nunley,Donald Class: C , ID Status: None
Legene Jr
Address: 929 S SUMMIT ST Audit#: 6278619 DL Status: VAL
Issue Date: 09/06/2012 CDL Status: None
City/State: IOWA CITY,IA Expiration Date: 09/03/2013 CDL Cert Status: None
522403339
Endorsements: NONE CDL Med Status: None
Mailing Address: 929 S SUMMIT ST Restrictions: NONE Restriction None
Supplement:
Date of Birth: 9/3/1989
Mailing IOWA CITY,IA Sex: M
City/State: 522403339
History Information
CLEAR DRIVING RECORD
Name: Nunley,Donald Legene Jr DL/ID:436882128
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:
;���i�f ,Ni 4/22/2013
MI IOWA \AI
%.:D. 0. T.; s
f
s
l-hr
-hitt, Office of Driver Services
Iowa Department of Transporation
Name: Nunley, Donald Legene Jr DL/ID:436882128
Apr. 30. 2013 2: 50PM Div of Criminal Investigation No. 1684 P. 3
Apr. 23. 2013 12: 16PM City Clerk ; City of Iowa City r No. 3409 P. 4
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