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HomeMy WebLinkAbout13-0139. 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 Pol;ce Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derWYaxitlrivbadg 09/2012 Authorization Number J) J 1 _ r t (Office Use Only) • Mlw®r�,l CITY IOWA CITY APPLICATION FOR TAXI DRIVER OF (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.) Iowa 52240-182 f 3S6-SO40 --fk 1 17 (319) 356-5497 FAX First Middle Last 1. Name � " � a« 4 10 �" '�� 2. Mailing Address 1-V ,) L2 i�- v ( IIf/ le e; / �} 3. Telephone: Home. 1�_ �U ' O � 'I— Other: 4. Prior experience in transportation of passengers: 7,41�k 7 Li o % Lr S. GL �' � =/•off /awe 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 ben convicted of operatin; a motor vehicle while under the influence of alcohol or drugs in the last five years? tiPG Type of Offers; a Where When 7. Have you been convicted of any traffic offenses in the last five years? ;ey �/ Type of offense Where When 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? /1/ 6 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 Pol;ce Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derWYaxitlrivbadg 09/2012 I here7by certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 0 Y� / 7 S 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 /NJr�rrL , Date o /— / 7 - Z 01l STATE OF IOWA ) COUNTY OF JOHNSON ) Sd and sworn to before me by / CL 2�, 3 k— MaWf"% . On this /d 74' day of 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). r , ghafurel6fPolice Chief 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. Sig atur f 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 Date der / dnvbadgea,2010.dm 09/2012 1 -ARTS Page 1 of 1 3 1.0wa D.epaftment of Transp©rtEtioFn (lfficBaiDrivsrSeivices iroli Freel.md-5321121 00 p=9^ [les Moines; IA 5030&92U4 515 2449#24 FAX: 515 2391837 History Information CLEAR DRMNG RECORD Name: Madden, Patrick George DL/ID: 701YY1753 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: ..W � IOWA s 1/10/2013 � Certified Abstract of Driving Record ef.• /f••• � Inquiry Date: 1/10/2013 DL/ID #: 701YY1753 (IA) Customer #: 2857327 Name: Madden, Patrick George Class: D ID status: None Address: 223 W WILBUR ST Audit Jl: 6590415 DL Status: VAL Issue Date: 01/04/2013 CDL Status: None City/state: HAWKEYE, IA Expiration 11/22/2017 Col. Csert statu None 521479128 Date: Endorsements: 3 CDL Med None status: Mailing Address: 223 W WILBUR ST Restrictions: Corrective Lenses Rest ictii on ent: None Date of Birth: 11/22/1950 Mailing City/State: HAWKEYE, IA Sex: M 521479128 ' History Information CLEAR DRMNG RECORD Name: Madden, Patrick George DL/ID: 701YY1753 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: ..W � IOWA s 1/10/2013 � ef.• /f••• � Office of Driver Services __' bra = Iowa Department of Transportation Name: Madden, Patrick George DL/ID: 701YY1753 http://172.29.254.55/drivers/reports/customerNstorylcertifieddrivingrecorcLaspx 1/10/2013 Jan. 17. 2013 4:26PM Div of Criminal Investigation No. 0289 P. 5/9 t Jan, 11, 2013 10:28AM City Clerk City of Iowa City' No.3131 P. 2 n H (ir aaraatnstory Reeolra chepR ' pCX�aoounE2lamher: ��' eopprreab o) To: Xo1YA br'47slen Of Cn5'm11atYrcvavega P(eh y oh11 017T OW ToWA OTTY Support OpergflmHurmur,VPoor CITY O%MV61 o9.NICE 216E,7110rcet 41n -RXiM11WW= ,9MXj! besMgfnor,Tolva dOs19 (915)726-wd IOTTA CYTY xpG1A 52240 (sts) 72s-6aeo r3arc , ' Phonal 3i4asrs—Fnu�i • - - ttaxl a1,q=R56-51197 ,. �„ L2mre uestln an Ioyv�CriminatHi 0 RecordCheakan; - • ]Lasbld'rime Pna,ro First�l'ame(m�aerory) lhliddloMame recomuenGeo) ' Ilia/,l.�4 ��� � ��e o v 9 Q— J-7(o 'L Z ' / % ✓r G IAAaTe �omaTe / ���D — J -7C / t91V8F rr{foPftraftard: Without a s($nsd wAYvel from thasubjeot oitha Yegl7rah, a comp)a!e ,Ptrainpl history record may 11a t hol'ologsabieypor Code oExaU)ChapterO2.27porcotn (eta'dria»nalhlstoryreeoraTlnroimatfott,e38llowedDylhvialwpys Mohyapi iay'VOR Pon Aeof _ I3.aaeare�ofthopro�idednameanddateofbilt}liayea�ed; �1'ox6WaG4')l�irlai�iatox�/12acord�o�undwlhhUGT ® 16v7a C�rhfns' MistosyReco�d attsn cd, �S GT , I�CZirsifials Mr til M917.10m