HomeMy WebLinkAbout13-070Authorization Number /3 --70
(Office Use Only)
IIIARM
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
IIFirst Middle Oast
1. NameMIG✓Intl l�r4c� �oLtn50 -1
2. Mailing Address Z100 5.5, 6jx U
i
3. Telephone: Home �3 r g ) 5-1 Z - U `/N 3 Other: II
4. Prior experience in transportation of passengers: Z v a r S 7 q K ej r( ✓e T
ears C )e�;KS �ra�Sv .4— Un;-,r5jX
r
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rl O
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? Y1
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? `/ e_5
Type of offers e 11 /( Where When
Fc%r1 To 06ey 4ro-(C S.rna� Zoo 0-ck /Q 3 31 z0/U
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Y1 u
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)
Vl 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)
derkftmdrwbadg 03/2013
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
-J __7
)/I
/ y g c/ . 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 Date 3 2 3
*##4####11R*fYRRRRRR*#k**k4*******#k###*#f#1RRRfYR**4*****k*#44#**4####YH##1#RRRIRRR4*k*k***44*#k#*4*##f#*#H14f#4YYfMRRYRR*RR*k*k**W**kkk****
STATE OF IOWA )
COUNTY OF JOHNSON )
cribed Tnd sw to before me by I r `' CL -2,l _�D k On this day of
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).
Signa} re of P is 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.
Signature of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/1" (width) and 5 Yz'
(height) and prominently displayed to all passengers.
iifhff*ff***#####4####if#iiifffffhlf***********###4hifff##i#*ffffllffllftf*f********#**#*kf111f*ffflf*f*f#***f**!***##i#fi#*fifY*!H#fflfifif44f
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derMaxiddmadgwW2010. 03/2013
Il
Iowa Department of Transportation
�I , 076ce of Oliver Services {Toll Free) 8004532.112l
PO Bax 9204, Dos Moines, LA 150311&=4 515-244-8124
FM: 516.239.1931
Convictions
Citation Date
Conviction Date
Certified Abstract of Driving Record
Explanation
Inquiry Date:
3/22/2013
DL/ID #:
775YY1494 (IA)
Customer #:
2394989
Name:
Robinson, Michael Class:
D
ID Status:
None
Turner
Address:
2100 5 SCOTT
BLVD Audit #:
3160119
DL Status:
VAL
LOT 46
Issue Date:
03/27/2009
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
03/28/2014
CDL Cert Status:
None
522403017
Endorsements:
3
CDL Med Status:
None
Mailing Address:
2100 S SCOTT
BLVD Restrictions:
Corrective Lenses
Restriction
None
LOT 46
Supplement:
Date of Birth:
3/28/1976
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522403017
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
Coun
JUR
02/09/2010
03/31/2010
M 14
Fail to Obey Traffic
SI n Si nal
52
IA
Name: Robinson, Michael Turner DL/ID: 775YY1494
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 seat of the Department to be set upon this document, at Ankeny, Iowa
this date:
3/22/2013
IOWAf
D. 0. T.: -
;Vs1
X -" s
-� Office of Driver Services
1W Iowa Department of Transporation
Feb (Feb.12. 2013-2:49fMCabDjv of Criminal investigation
3193362708 No. 2893 P.N 1/1
STATE OF IOWA ^ 'r
Criminal History Record Cheep
Request Var1iu .
7b1 Iowa Division or Criminal lnvesUgetion
Support operationsliureoo, iFtoor
215 E, 7"Street ,
Darfrtarnes,rowa 5=9
(516) 725-6066
(515)725-6000 Fax
I am regM2gfi: K an.low&criminal nisi tuy Record Check oar
DCI Account Number: 9967-i�
—" (if upli;&W
From; Yellow Cab of Iowa City
P.D. Box 428
Iowa City,YA 52244
(319) 338-9777
Phone-
pax: (319) 339-7302
L29t NONe (nn.ndetary)
Mrst Name rmladelo '•
Wildle Name (t..MMdad)
DateofBirth (maaaarmy) Gender mendera
'Z
'Social Security
�/ .15 %''� PWLale OFemale
it /Numbper(�(raomtnendedl
W"ip¢r WOM06 t' WMout a Signed Waiver from the subject Of the request, a eompkte erlminal h(4lory record mayrtot
he releasable, per Cods of Iowa, Chapter -692.8. Por com ele criminat history record ig(ormatiou, as allowed bylaw, always
obtain a waiver signature from the subject orehe request.
Wa{7 PRalegse: ihctcbygive pentisslon@r lb lbQvaT,4ucwjng DiflOid 16 COnftt tniowa Cll(Otnel hh1Dryrnar&AC* Mbit thrl)msjon oCcriminal
taverti�etian (QGif. Aay erlmksg{biyfWydetaconmmfn6ma lhar L^meudainad by the [)Ctnuyba rcla+sad u nilowr4 bylaw.
�Q:V[rSfgitOPltre: ��f..�—�
a csa s� s��-aa,asaM+-ttlAfyi-Y- ZYF.i:lrl-lt'GltCt:l[ iCl%O'ITr1:�J- PM use only)
[ r,l
As of a seamh of the provided narlle and date of birth revealed: f t
No Iowa Criminal History Record found with DCI
Q Iowa Criminal History Record attached, DCI
DCT irtitials
bel -77 (Oat24f102
Received Time Feb. 2. 2013 6,22PM No. 3503