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Home My WebLink About13-003Authorization Number 15-3 r 1 (Office Use Only) -4 * .`III M It X1111®r�� APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City. Iowa 5224-1826 9) 356-5040 1 1J -fit (319) 356-5497 FAX Firstdie alk I-�ast 1. Name V 2. Mailing Address Z72- Alalfle 11(Y Q ZZ 3. Telephone: Homq(�/Q i_2i5L-16 2a r. / Other: `# 4. Prior experience in transportation of passengers: �Y'-P/ 1AlIJ / Q /✓ C /J 1995 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? /7 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 1170 Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /210 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) d.d .,d n d9 09/2012 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7 ;? . 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 /t/�rt�z� u^ u Date 1/7/13 k####HH#++i H+###+###RRFRRFRHRf 1HHH1HHHf+if 1f+FF11H11f fflf f 1f 1f f f#f11HHHff1f*#111f1ff111111Hf f 1f 11!11#f f f f11f f fffH1111H1f f f f##44 STATE OF IOWA ) COUNTY OF JOHNSON ) S bscribed and sworn to before me by On this 1 day of )--2, e fait KELLIE K TUTT� Ea19 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). Ignatur of Police Chief or designee 1-,-1-13 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�re 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 Date a. dg..a zam.m 09/2012 Jan. 4. 2013 2:03PM Div of Criminal Investigation No.0923 NV, P. 1 P. vi ,una of if JV70 L To. X01Ya MV21011 of CriminaZ XhVest(gpl(oh Support Operations aumv, P(Moov, 21gr" 974 meot Dalughiav,Iolva 50319 015)'126-6066 (516)125-6060 X+au cheak �8egrx�d•7El"pm'�aaax Cheok MY&O'X4fa� •p(Ithoutas[in adwiYer*uhttht )io Po(ea9nSle, per Co de oYYOWA, Chapter6922 7orypr�yl AGIAccounil7umBer: eppltvab co ) �'Onli OTTY ,(jR TOG7A f'T7'9' CITY CLMKTS Onlex 410 R_ WAZV QZQN 9TSLsT TOM CITY YO[dA 597 a Phone; 31g—�55 sn41 17960 319-35.VA "t GCS d�amara I ,�� 62-g�g� t of tho yequoA ), 9 romptote orbANAI h (story reaoxd uluy no t a(nalhistory rcoordlnroYmatfon, asaliewed Ey TAS', AI&ays lYIt�BW tiBrBYlJ6;TpercAygivepetmise(onfotlhoabovel'epoesllAagn(vlgl(0o07rdee[Wi%[vfletlm(ne((i�lory(eao(deh<k1YlhQeD�islongPCifm(na( YaYeslfgplron(Oeq, Ary;y(n71ne1L1arolyQb(a eonco (ngmo lheUa77w1a(elQedbyihop0(maybo [cicescd rs e( Owd byfely. Walver5Ygltat�efet. �-��G4%Gt•G.r/ �—p f . Xpwa ipn nal gto� 12ecor ghee ><�estxl(t� • O�cnrsee71y1 A.i of k ` a sear�j oJ'thekxovid'ed uameand date o� bfitlLxcvcO]cd: �' r NoXbwaG4izninalH,istoryRecoadfound with DCT ® Yom (2rlmina1141stoVPword attaohod, MU �7. •- ^' bC1'auitials �� lace ived Time"Dec. 21, 2012 12:28PM No.8311 Iowa Department of Transportation �I► Office of Driver Services (Toll Free) 80O-532-1121 PO Box 9204, Des Moines, IA 5039&9264 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/22/2012 DL/ID #: 457AF3078 (IA) Customer #: 5739165 Name: Woodberry, Kenneth Class: A ID Status: None �.finNa — Edward Address: 2722 WAYNE AVE APT 1 Audit #: 4770729 OL Status: VAL Issue Date: 10/23/2010 CDL Status: VAL City/State: IOWA CITY, IA Expiration 03/21/2015 CDL Cert None 522402534 Date: Status: Endorsements: HT CDL Med None Status: Mailing Address: 2722 WAYNE AVE APT 1 Restrictions: NONE Restriction None Date of Birth: 3/21/1958 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522402534 Sanctions History Information Effective End ACD to appear Name: Woodberry, Kenneth Edward DL/ID: 457AF3078 Occurrence 7UR IUR 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: - , 44 12/22/2012 IOWA y° .r ). 0. T. r3 r .^^" � Office of Driver Services �.finNa — Iowa Department of Transportation Name: Woodberry, Kenneth Edward DL/ID: 457AF3078