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Home My WebLink About13-045s► IIIIry ya CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle I � -+'S (Office Use Only) 2. Mailing Address l�03 t-4VQyc,rood '13(UcA (,w_ 3. Telephone: Home 3 I C1 q` 6 R O i Other: 4. Prior experience in transportation of passengers: 'z e. �(ht� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Alkb 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? N'9 Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When Type of offense Where When t se to dbQ'C' l bue, C't _hi aoV/ Ovt 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? t Gto P� e Type of offense Where When 1101 orm J J ■ r Jigijpiii I ■ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) U0 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) ." .m,me�g 09/2012 M I herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number,. %[e �I V Y �4 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 ######+YY##f##Y#H++#++##+#++++**RR**f*lfff#*#iffRffiflf#f!f#fifllRf*!f#lfffHf11t1ffff#ffflfffflff*ftlflf111flf1fYf11f1fft*H*1**HftfltflftRRf STATE OF IOWA COUNTY OF JOHNSON Bribed and sworn to before me by ZaOL c7 ✓lPIS,6titi On this L day of KFwE K. TUTrLE Notary Public in and for the State of Iowa 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). 142�- Signature of Police hief 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. -AIaA-" 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 2-8-13 Date deNJl dnWadgeap 2010.tl 09/2012 o2; eb._21__—01.3,a11;25AM Div of Criminal Investigation DCI IobN,:4066 P. 4/10 a-IH3 STATE OF IOWA Criminal History Record Check Request Form 4 r . 1 •1..911? 7o: Iowa Dlvhlm of Crlalnd lavmdpdoo Sappm Operallom Hurray la Fleer 715IL 7° St,wt Del MoMa, Iowa M319 (515)7j"= Faa DCIAreountNuvabor. 4315-pe- (Kyylip0ie) iib 5}evcs �r. Pboae: ,1919 Faay. 0 Laat Noma rcawnnA Fint Name Lmwgaz) Middle Name Date ofBlrth Galidelr (warwfimw Social Secaritir Number twwaLoM e) I j ei M183 dMate OFemak 40 5 a� 1. Wc(Wr,rgrvnudOn: WHhoutadjordwolvertreat meeabjeatofthengvay.eowpleleedmindlheeryr000rdngnot be mkaabk, per Cede of loves, r2iopter 021, For ftp ertaelml Wary nerd lotormada. ru 4owed by hw, atweye bl WejWerXjjpAtVN,the nbeotof[he r wr. 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No Iowa Criminal History Record found with DCI © Iowa Criminal History Record attached, Do q DCI Initial$ 99 Received Time Feb. 8, 2013 8:07PM No.4110 (caro mly) ro CIowa Department of Transportation �/ ► Office of Driver Services (Tall Free) BOU-632-1121 PO Bax 9204, Des Moines,lA 503D6-9204 515-249-9124 FAX: 5i5 239-1837 Inquiry Date: 2/28/2013 Name: Johnston, Zachary William Address: 1103 HOLLYWOOD BLVD _ City/State: IOWA CITY, IA 522407047 Mailing Address: 1103 HOLLYWOOD BLVD Mailing City/State: IOWA CITY, IA 522407047 Convictions Certified Abstract of Driving Record DL/ID #: 769YY8452(IA) Class: D Audit #: 4942186 Issue Date: 01/11/2011 Expiration Date: 08/19/2013 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 8/19/1983 Sex: M History Information Customer #: 3605007 ID Status: VAL OL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date' Conviction Date ACD Explanation__ _ County JUR 02/27/2011 ;04/08/2011 -`M 34 Fail to Obey Traffic Sign/Signal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/06/2012..___._._�.w._._...�.._.�......W.__.�.._......�—I668178 __._......_._.._.._.._....._._.....,IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 09/09/2009 .02/16/2010_ D53 Non Payment of Iowa Fine 'IA IA Suspended .07/03/2010 .10/11/2010 'D53 .Non -Payment of Iowa Fine ;IA JA Name: Johnston, Zachary William DL/ID: 769YY8452 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: •""••:;�'%'p 2/28/2013 .10WA10 D. 0. pf PRO $�J� Office of Driver Services n�� = Iowa Department of Transportation