HomeMy WebLinkAbout13-018� r 1
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
- First
1. Name -'MM
2. Mailing Address
3. Telephone: Hor
Authorization Number / 3 — 19
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday – Friday.)
vuuul"
I(knd (
160 CU_YhYv Other:
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? h v
Tvpe 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? V)(9
Tvpe of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? no
Tvpe of offense Where When
8. Has your drivel's license or chauffeurs license been suspended or revoked in the last five years? OD
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)
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)
derkAmidrikadg 09/2012
hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
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 a Date -1-30-/3
+++*++++++++RRRRRa+R+Ra++++++++R++++#a+++#+##*+##*+#**##R#*###***##**##*#*##*###R++++++++++#*+###**##**+#*+R+++++++++++#+a+##+++#a*+a++++++++***
STATE OF IOWA )
COUNTYOFJOHNSON )
I and sworn to before me by ei ,,A 001L_nL � On this 30 day of
�a°�t� SONDRAE FORT
12!
i Commission Number 159791
My�ommissionEx , 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).
SigKature of olice Chief or designee
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.
Signatur�rk 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
Date
denw dnvbadaea pP o. 09/2012
ARTS
Page 1 of 1
Iowa Department of Transportation
CCE Na Office of DriverEielvices {71681 Freei'811i1ra32-1121
PCO 6px 9204, Des Manes, IA 5=16-92M515-2449124
FAX; 511-5-239-1837
Certified Abstract of Driving Record
Inquiry Date:
1/16/2013
DL/ID #:
302BB2858 (IA)
Customer #:
1808601
Name:
Calloway, James
Class:
B
ID Status:
None
Michael
Address:
1527.ABER AVE APT 6
Audit #:
4986660
OL Status:
VAL
Issue Date:
02/03/2011
CDL Status:
VAL
City/State:
IOWA CITY, IA
Expiration
01/20/2016
CDL Cert
None
522464704
Date:
Status:
Endorsements: NONE
CDL Med
None
Status:
Mailing Address:
1527 ABER AVE APT 6
Restrictions:
NONE
Restriction
None
Date of Birth:
1/20/1968
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522464704
History Information
CLEAR DRIVING RECORD
Name: Calloway, James Michael DL/ID: 302882858
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: ...
.......... 11', 1/16/2013 .� .
IOWA �*
,
aBIls Office of Driver rvices
IowaDepartment eofTransportation
Name: Calloway, James Michael DL/ID: 302882858
htlp://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 1/16/2013
Jan. 30. 2013 10:04AM
�OS/L1/LU1J 1l.ue FA
Div of Criminal Investigation
No.1400 P. 1/2
4 DCI MIA'wvVM
1
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STATE OF IOWA
Crimingl History Record Cbeck
Request Form
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As of d e search of the provided name and date of birth revealed:
No Iowa Criminal History Retold found with DCI {
Iowa Criminal Malwy Record attached, iJCI tl
l]CI wtials-
1(OBO/10)
Received Time Jan. 21. 2013 10:59AM No. 2414 4