HomeMy WebLinkAbout13-031�III� i
CITY OF IOWA CITY
410 East Washington Street
Io�114
Cit I 52240-1826
(356-5040(356-5497 FAX
First
1. Name
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
�.a/ •
2. Mailing Address 2357 io0 A
3. Telephone: Home _34? Other:
4. Prior experience in transportation of passengers: =E c
Last
13-3(
(Office Use Only)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 4/
Type of offense Where When
6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? o
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years??,,� Oy�B—C��9�5�0�1�0—S(hol
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ZVO
TVDe 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) 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)
de .drew dg 09/2012
I herehy certif II have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
or /f . 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
Hff11f#*H#HHFHF#HH4FF#4#FHHFHHH44f44f4H4#*ffffHH#Hfff1#f14Hfff ll`HHHf*f iff#f!H*HHfHff *-fHH1*ffHflf 1*!H*HNH*!##HH#
STATE OF IOWA )
COUNTY OF JOHNSON )
MMed and sworn tQ, befg[e me by �SD n On this day of
) f_ c (w KKK_
i_'jsm� KELLIE K. TUTTLE Notary Public in and for the State of Iowa
Gmmi<einn nlumne, v��nm
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).
Igna ure Police Chief or designee
2-�7/-/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.
Sign&kwe 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
.Q -'y- /-/�7
Date
Ge'Wlaxltlnvbatlgeapp201o.tloc 09/2012
4"
Iowa Department of Transportation
OO Office of Driver Services (Tall Free) SOD -532-1121
PO Box 9204, Des Maines, IA 503015-9204 515-244-9124
4"
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/21/2013
DL/ID ft:
662YY1237(IA)
Customer #:
1895748
Name:
Nguyen, Son Minh
Class:
D
ID Status:
None
Address:
2557 INDIGO DR
Audit 7i:
5413758
DL Status:
VAL
09/25/2010
10/25/2010
Issue Date:
08/03/2011
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
08/01/2016
CDL Cert
None
01/30/2012
522406824
Date:
Miscellaneous
Status:
IA
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
2557 INDIGO DR
Restrictions:
NONE
Restriction
None
Date of Birth:
8/1/1966
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522406824
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
3UR
07/03/2009
07/27/2009
S92
Speed (10 mph & under in 35-55 mph zone)
52
IA
08/02/2009
08/25/2009
S92
.Speed
52
IA
09/25/2010
10/25/2010
S93
Speed
52
]A
01/30/2012
.02/20/2012
S92
.Speed
52
IA
01/30/2012
02/20/2012
Miscellaneous
52
IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 3UR
09/25/2010 592868.._ _.. IA
02/19/2012 675679 IA
Name: Nguyen, Son Minh DL/ID: 662YY1237
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:
�' `AcIWFai
'3~ 2/21/2013
Feb.15.
2013
4:39PM
Div of Criminal Investigation
No.3360
P.
1/17
Feb. 6,
2013
12:56PM
City Clerk - City of Iowa City
N0.3200
P.
3
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