HomeMy WebLinkAbout13-074IIPUR
I
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 5 2240-1 82 6
(3 19) 356-5040 Ct'*L-., MON
(319) -5497 FAX
1. Name
2. Mailing
/ 4ecH -.5
Authorization Number t3_ 4
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
S/(a dlplo
(Office Use Only)
3. Telephone: Home 31c1 '-100 Other:
4. Prior experience in transportation of passengers: L) venr5 jyr' L CJ
r
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? U.
Type of offense
Where
When
6. Have you Peen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N.
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
When
Where When
Z-aLr.- CIL 1A o-7
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense
Where
When
9. Have you ever applied to bean 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)
cleN/IaxiMiWadg
03/2013
hereby certiry that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
I SSI 1 T li yLi . 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 4 f _ Date I Z7-1 3
HR4R#**#H###ff#**H**##H1f f *#f Hi*#H#HHIffH*##i*f**#H##HfH#ffHfH**f*#**H#HHfffff#ff##Hf#Hi**R*#**#H##f4H4HHHf#fHf*#fit4if
STATE OF IOWA )
COUNTY OF JOHNSON )
$yggcr d�and swgm to fore me by L_-rl v� On this a (Tv` day of
�� w \\ll,,ll
V<ELLIE K. TUT 221819 Notary Public in and for the State of Iowa
Mi1mbeY ,nm. issi n
I
*Rfii*#*fi***RHR44#i*****RfiRRfififi3H***fi***k*RRRfifit#fi*3**********R*RRkifiii*3#fifi***fi***R*R*RRRRRiiiifiiiifi*fifi34H****R****R*RRRRMR*33fiRRifi1*ififiR#i
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
A�_
gnature of Police Chief or designee
3�2 7Zj 3
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Sign tare of City Clerk or designee
3h7 / 3
to
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2'
(height) and prominently displayed to all passengers.
***H#1f#HH*#Hff##1f#1rt**##k##H#fffHffR#H######f##Hi#H1ff f ifff#H####HH##H#H#H11H11ffff#tf #Ht#f#*fit*##k##k*!*#H*4k#f##f f #f####f
Office Use Only
Approved application
DCI report
State certified driving record
Website update
d�de.cv2010 d. 03/2013
Mar.25. 2013 9:02AM Div of Criminal Investigation No. 7506 P. 9
near. Io. m3 1:jurM laity clerk — City of Iowa City No. 3328 P. 2
Sr7[sATM ®ice 1OW1 �6
�IWWWd,u8t ory Record cheek
0
To, To,vabtvls(OhorGrrininatlhwasNgatfon
Support OpAra([ens Puyenu, I'r$IoaC
2z8�.7MSfreet
Iies)vjofges,7o�va 5019
(s19) 720.6066
(515) M-080 k1A)I:
Check on;
l
. pCTAocountNtrm6er: `FOo
epplfca6lo)
Fromr may nu roan as9'9,
cm cum's OmOT
• 41n �_ rra�rnarr�•0�' ��
M9'A cr_ry rDAA n224Q
,phanaC . 919—gqj-.�lcf ,
.Lascrvnme imate • )hrStNAj"e r—..1TAfA-1 I MiddlelYflme Joomasmd!
-5:Kcider,
.Aa4o o£l$irth (mmdiw Gleh(TeY AnaaiA 8004flj 6eC1�'� N1)Mlior rcw,omcnde
12. Z� la.BZ ®iVlale !7>u~amaTa Z9 Z 012 S 3 3
lir�dYe/' i(favi/fpri'ayl;'ppnhoutan($nedp/q(yex']Yomihesu6jeego�:thoyegnaaP, a eompJofeph(nafnglhlp(ary reCOXc�ningnoE
i,airoloe9gbTe,per Coda oPr6m,Chapter692,2,JFor otofatacrlmfnalhiaEorgrcoord(�1forMatlvN,esaltowedbylnvirnlWgYs
III, {ACi• A WnA/eV wrAwn R•vn Ru... ♦b.. _..LL _f _O./F._ ._. _u.C_i
�lrl't/CYkBrBfP•iBf f 6crcDygiVe perN(u(Off iLrdloa6ov9regatsAopollfoldl fo mnduA! m%1YA oflm(nnl6lsmtyr[ma[dcflwX,Wr11�ADYIsfen4Pf31mfnA(
7nVnsllger/onQ]cn,{uyd(nlfnAlhfAtorydnroApnPormfnpnlArhatlAmvintAtnedlYgrhebOlmeyhaToleasedxvelroWed6y/hw
As of a swoh of the provided name and date of Wha'aveaZcdi
D%I&W-1 CWadRjOIVAecord fDwidwWthDCT
d YowaCrlmtnaIl3'tata7yRecordareaahcd,pCT� ,
' .bGZiapitials.� ,
Received.18.-2013- 1:29PNI-No, 7483 — -
Iowa Department of Transportation
CE
office of Dfiver sain ices (Toll Free) 800-532.1121
F0 Box 9204, Des Moines, IA 503D6-9204 515-244-9124
FtUC_ 515.239183i
Convictions
Citation Date
Certified Abstract of Driving Record
ACD
Inquiry Date:
3/27/2013 DL/ID #:
154TT1744(IA)
Customer #:
4537425
Name:
Skaden, Erik Wesley Class:
D
ID Status:
None
Address:
522 N Linn St Apt C Audit #:
2927089
DL Status:
VAL
Issue Date:
01/16/2009
CDL Status:
None
City/State:
Iowa City, IA 52245 Expiration Date:
12/21/2013
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Mailing Address:
522 n Linn St apt C Restrictions:
NONE
Restriction
None
Supplement:
Date of Birth:
12/21/1982
Mailing
Iowa City, IA 52245 Sex:
M
City/State:
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
]UR
05/24/2008
07/08/2008
S92
Speed (10 mph &
52
IA
under in 35-55 mph
zone
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
I Case Number
IUR
08/01/2009
522211
IA
Name: Skaden, Erik Wesley DL/ID: 154TF1744
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
��ti�c(gf l61 3/27/2013
IOWA
D. a. T.:
i dRI r Office of Driver Services
I"~""�'h� Iowa Department of Transporation
Name: Skaden, Erik Wesley DL/ID: 15471-1744