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HomeMy WebLinkAbout13-055CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Address Authorization Number )3 -SS APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 3. Telephone: Home �� - ^� -C' s Other: (Office Use Only) 4. Prior experience in transportation of passengers: ©w -1f.P /1 #-r {z 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? //Ur" Tyne 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 C Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? wo 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) /Co 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) GeNWidrivbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number« SSS yY 75 7 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- 7-!3 STATE OF IOWA ) COUNTY OF JOHNSON ) cribedn and rn to before me by �(JY1 �k LJ� O� K L�C�1 On this _74v ` day of r V X13. .�:.. xewe K_ Turne Notary Public in and for the State of Iowa 'A1 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). ignature of Police Chief or designee &/ 5 ate 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. �CgiKa ad _" k . 7VLZA� Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update .1- 7-/3 Date e rkftdddwadgaapp2010.d 09/2012 oi,leb. 6. 20134 9:43AM Div of Criminal InvestigationDCI I01..No' v�2086 P. 1/l, � .�v� STATE OF IOWA Criminal History Record Check Request Form 70i JAWS Dlr6kautcrlmlealtnrertt;alka Support DpenOau Burda, to Piller 116 L IO Street Doe btalzim lows, A319 (616)716.66r6 ' (616)7254010 MAX rm,yyaa� DCI pccouillNwabor. 4383 -FC. Prom: {MAYUS TAx1 Phan; Fut lam muesting meow <trmmtu ntaw Flret Name ) ilattt Name Mid 11 Name ren lt,w (roL7. Date of Dirth Gerd r Spew u ft Number 67.0 / -/? G-7 OfKate p>Remale q 1 �'- W — V - Q Watper,rgftrAdatitde: Wphoat a shoed wall's trwm the eabpd of the ragaeat, a complete crta>mal lottery naeord may pot code otlowl, CLapter 6914. For pailuilick etteel.al Wary record tatoimetka, v A%Wed by law, atwaya M reldre►DIA per otde waWer et atu m rhe eoe r:+ o IDO .G Itl dayllM�ft � e mdnne,eeb/'t ioa� releueaiu Ylvaed�abm. WR1 d�ebmamofC,lnlad Aar to fWvalvet lam• n1vi1�Y�alaMrx Walner ftnmord: Iowa Cri fugal�o r-Reeord Check Result locta��r2 As of L 1 �,Q a much of the provided name and data of birth reveoled: No Iown Criminal Hlrtory Record found with DCI fO ❑ Iowa Criminal History Record attached, DCI N DCI Initials, DO -77(0W5110) Received Time Jan. 29. 2013 3.34PM No. 3149 I ELIIvvva Ulupilr irnent oT 1 ransportativn Office of Driver Services (roll Free) B90-532-192 t PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 1*0 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/5/2013 Name: Nunley, Donald Legene Sr Address: 955 BOSTON WAY APT 2 City/State: CORALVILLE, IA 522413180 DL/ID #: 555YY7573 (IA) Class: D Audit #: 3628863 Issue Date: 08/21/2009 Expiration 07/01/2014 Date: Endorsements: 3L Mailing Address: 955 BOSTON WAY APT Restrictions: Corrective Lenses 2 Date of Birth: 7/1/1967 Mailing City/State: CORALVILLE, IA Sex: M 522413180 History Information Customer #: 1591551 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3DR 06/22/2012 1692476 IA f Name: Nunley, Donald Legene Sr DL/ID: SSSYY7573 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, 2/5/2013 IOWA :?'8 D. 0. T. U..... S` r' Office of Driver Services .�.� Iowa Department of Transportation Name: Nunley, Donald Legene Sr DL/ID: SSSYY7573 2/5/2013