HomeMy WebLinkAbout13-035� r
III
AVI
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa $_224_0-.1826
319156-5040 �I
(3 19) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
I3 -315�
(Office Use Only)
1. Name P l+ A
Gv. L u
2. Mailing Address 1 Zv�j uyQ rl°o — I U /
3. Telephone: HomeII II Other: Ci -7
4. Prior experience in transportation of passengers: V .1+ rom i ( A0 v SPr u< C P S
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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? 11U
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? PS
,T a of offense Where / Wen
tyn� fv�Cr vn �u inn+0�vlN 2
ut u�
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense COYfjq Where When
%� SAM mcg} �✓ I i 4M %U Zu I
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) 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)
aed dnw dg 09/2012
I here certify certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
` a 'F1 y5 . 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 /
f4lfffffHf#4##*H********tf**+if1f##f#HH###*Hf4tt***H*HH*fff#ffH#fHH4Hf####*#*#Hf**#f#f**tt*H**HffHfff#f#!H###*#*#*Mif#fHH#H
STATE OF IOWA )
COUNTY OF JOHNSON )
$ubsgribed and swor to before me by C� � % On this day of
lafKELLIE K. TUTfLE �/��:.( u
nmisslon Number2".$ otary 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).
Signe ure of �Or Chief or designee
�12 - ( /?
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.
;; 1) 4 e�- , :? t/ . L
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
-C;:?2-3
Date
clerlNaxidnWadgeapp2 10tl 09/2012
Page 1 of 2
t
Iowa Department of Transportation
Office of Driver Services (Toil Free) OM -532-1121
PO Box 9204, Des Moines, IA 5031)(1-92134 515-244-9124
l
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
1/24/2013
Name:
Ludy, Mark Andrew
Address:
1205 LAURA DR UNIT
D.0.T.%
103
City/State:
IOWA CITY, IA
�.;
522451528
DL/ID #: 156AC8945 (IA)
Class: D
Audit #: 6440266
Issue Date: 11/02/2012
Expiration 10/04/2017
Date:
Endorsements: 3
Mailing Address: 1205 LAURA DR UNIT Restrictions: NONE
103 Date of Birth: 10/4/1976
Mailing City/State: IOWA CITY, IA Sex: M
522451528
History Information
Convictions
Customer #: 5283367
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Citation Date Conviction Date ACD Explanation County 3UR
02/04/2011 03/16/2011 _ N50 ,Improper Turn 52 IA
Sanctions
Type Effective End ACD Explanation Occurrence 3UR 3UR
Suspended 10/04/2011 10/05/2011 D53 Non -Payment of Iowa Fine IA IA
Name: Ludy, Mark Andrew DL/ID: 156ACS945
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:
...... r!R °
11
1/24/2013h
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D.0.T.%
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Office of Driver Services
�.;
Iowa,Department of Transportation
1/24/2013
Name: Ludy, Mark Andrew DL/ID: 156AC8945
Page 2 of 2
1/24/2013
Feb. 4. 2013 11:16AM Div of Criminal Investigation No.1810 P. 4/5
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Received Time;SJan; 25. 2013 2:03PW-No, 2874