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Home My WebLink About13-067� VIII CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX n . First 1. Name Authorization Number \3- �o—1 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Last W,6,(- 2. Mailing Address i 3. Telephone: Home y I - q 30 `% 1 i (. Other: 4. Prior experience in transportation of passengers: 5 t, o o ( (' C 1 �� L 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? No 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? 4_ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? c Where ss) SS T -P. When When 8. Has your driver's license or chauffeurs 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) 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) rJerk/laxitlrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number T, q AA X92'1 . I understand that if I falsely answer any questions in this application, that this applica ion 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 VILIX Date 3 3 RH##F+####F#+##f##+4#f411ffRflflRfff*fRR#f*R##FR##F##M#4f##f1ff11f1ff41fffi4lRfflRflRRR*f*RR+R#ffR+tR###F#*#####Ff#1ff14#fflffflfflfflf#ffifff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _eob.c.4' We b It On this /.f d� day of AIA or, H ae/.3 r tis I SONDRAEFORT and for the State of Iowa ***Ft*********k*R#f**RR#fM#f#f+#fiii#ff**tits******t****k*****kR#*#llfffif#tiiffkiifkFf****fit***Rt****tk*R******#*#R#kkf*fift#ff*if+kiffii#iff 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). ignatur of Police Chief or designee '711,11-3 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. Signature of City Clerk or designee 3// 9 //.3 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 51/2' (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update denme, Wn dgmpp O.m 03/2013 Iowa Department of Transportation Office of Driver Services (Toll Free) BOU-532-1121 PO Box 9204, Des Molnes,IA 50395-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 3/19/2013 Name: Weber, Robert Lee Address: 720 FRONT ST City/State: GENEVA, IA 506338901 Mailing Address: 720 FRONT ST Mailing City/State: GENEVA, IA 506338901 Convictions Certified Abstract of Driving Record DL/ID #: 954AA1927 (IA) Class: D Audit #: 6757513 Issue Date: 03/08/2013 Expiration Date: 05/29/2014 Endorsements: 3 Restrictions: NONE Date of Birth: 5/29/1961 Sex: M History Information Customer #: 1231406 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation D_aCounty IUR _te Conviction Date ACD Explanation _ _ 07/08/20ll592 Speed (10 mph &under In 35-55 mph zone) 4 85 IA Name: Weber, Robert Lee DL/ID: 954AA1927 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'4 3/19/2013 IOWA'*,, 10. T. r'"••••''$� Office of Driver Services aA = Iowa Department of Transportation Name: Weber, Robert Lee DL/ID: 954AA1927 State of Iowa Division of Criminal Investigation 21SE7'"St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal history Record Check Walk -In Request Your name Ko6itr r_ �r Address 7_0 rank- )+rc - City/State/Ziem-va_ M:X S043 Phone# I ' 3 d —16 Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) Lj,� t f 1 K. , I,e-e .,- Date of Birth Fecha Nacimienlo (mandatory) Gender Genero (mandatory) Social Security Number (recommended) 5 2qI q I Male ❑Female $ s 8 a y/3 Waiver Signature`Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.) Del USC ONLY Results As of 3 - l�C 13 a name and date of birth check revealed: No record found El Record qttached, DCI # DCI initialsi Receipt Number of requests x $15.00 per last name = Total amount $ Method of payment: ❑cash ❑money order check # -7 $ `6 El MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number # Exp. Date