HomeMy WebLinkAbout13-028�• mil®i�Il
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319)356-5040
(319) 3S6-5497 FAX
First
1. Name
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II
2. Mailing Address 6 Q t 4a�
3. Telephone: Home 3 �� —� 3 f2 —
4. Prio experience in transportation of paste
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YJK +6(6i -for old C^
Authorization Number 15 — a
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? h 0
Type of offense Where When
6. Have you beep convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? k) U
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? U �'
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 0 U
Type oO¢ 1 ( %^Ft, s;�n,513u.f offepseI G h raHvl ,7 7TT?4V i
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9. Haveyou e/ve7 appFed to a an Iowa City taxi driver using a d1 rent name? If yes, ease provide the names)
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)
derMt idrmtadg - 09/2012
I hereby yXr�y that 1 h ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license nkmber
O12 H A 33 tib . 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) (nJ 1
Signature of Applicant I (�/ Date I/ e V K-MA'1 1 I(2 013
STATE OF IOWA )
COUNTY OF JOHNSON )
bed and sworn to before me by ��1CJt 22.E -�L On this ` l' day of
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
.2-/9-_/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.
Arc ) e . u�
Signature ity 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
::t -i9-3
Date
dart maw badWapp2f IQU 09/2012
Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Bax 9204, Des Manes, IA 50311-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/15/2013
DL/ID #:
012AA3346 (IA)
Customer #:
3632089
Name:
Wezeman, Peter Jenkins
Class:
D
ID Status:
None
Address:
1016 DIANA ST
Audit #:
3318758
DL Status:
VAL
09/20/2009
11/02/2009
Issue Date:
05/19/2009
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
05/18/2014
CDL Cert
None
522404627
Date:
Status:
Endorsements:
2L
CDL Med
None
Status:
Mailing Address:
1016 DIANA ST
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
5/18/1951
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522404627
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
]UR
04/08/2009
05/09/2009
M14
Fail to Obey Traffic Sign/Signal
52
IA
05/04/2009
06/23/2009
S92
Speed (10 mph & under in 35-55 mph zone)
52
IA
09/20/2009
11/02/2009
S92
Speed
52
IA
12/16/2009
03/03/2010
M75
Passing School Bus
52
IA
Name: Wezeman, Peter Jenkins DL/ID: 012AA3346
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:
••;,j y�
2/15/2013
1OWA :0i
a
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Office of Driver Services
\`#RIVER=
Iowa Department of Transportation
Name: Wezeman, Peter Jenkins DL/ID: 012AA3346
• • Feb. 13. 20131 4: 25 PN
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Received Timei,Feb. 4.-2013— 4:47PM—Nlo. 1873