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Home My WebLink About14-248 a:' " Authorization Number 1 tf— 1 r 1 (Office Use Only) �i•:�Kr tII, r ill 'III Hal MO 1 gnir APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday.) 410 East Washington Street lo a - ' o- . 52240-1826 Failure to complete the "rec,uired"information will result in denial of the application (319) 356-5040 ( 356-5497 FAX First Middle Last 1. Name (REQUIRED) z M i) I b 2. Mailing Address (REQUIRED) II .S .Si , C I r t. 4//c\/ 3. Contact Information (REQUIRED) Email: S-r {-er r 4n e 5 r..y; r-K Cell Phone: 3 1'3 33 6 t2 4. Prior experience in transportation of passengers: ,,- ,- l 7 q 5. Have you ever been convicted of any misdemeanors andlcr felonies in this State or elsewhere? (Y.0 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? ✓) o Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? y t S Type of offense Where When Ob`c7t n l T eff IZ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? I'7 0 Type of offense Where When 11 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provierthe name(s). : i< 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09!2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number •6 YY `I 06 c . 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 an, •ocuments relating to this application, and I further agree that, if a license is granted, to comply at all times with all of •moo of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant f,�,�,r/ Date ti/t72- it 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. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by L_e- 14. t.), It .be . On this 14J day of �4- �a� i vvFrvov S.MAY ER Notary Publi n and for the Ste of Iowa io commission Numoer 72'4M I• „�' • My Co mis on Expires 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). ►_ II PA/ /y Signature • 'o e chief or designee Date YOU A- 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. ))t -4,911-1 - . - -i (( /�� Signa of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2” (width) and 5 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Cleri TAXIDRIVBADGEAPPL92014amended DOC 09/2014 . . . .. . .. 4 I i i i'' WA DOT , .. lam iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 I 800-532-1121 I Fax:515-239-1837 www_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 11/4/2014 DL/ID#: 760YY4065(IA) Customer#: 1827411 Name: Willberg, Lee Marinus Class: D ID Status: VAL Address: 1115 SAINT CLEMENTS ST Audit#: 8284854 DL Status: VAL Issue Date: 07/23/2014 CDL Status: None City/State: IOWA CITY, IA 522456111 Expiration Date: 07/17/2022 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1115 SAINT CLEMENTS ST Restrictions: NONE Restriction None Date of Birth: 7/17/1980 Supplement: Mailing City/State: IOWA CITY, IA 522456111 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JIJR 05/31/2010 08/09/2010 S15 Speed IL 10/29/2010 11/02/2010 S92 Speed Linn IA 04/07/2011 04/07/2011 S92 Speed Johnson IA 07/14/2012 07/25/2012 S92 Speed Johnson IA 08/04/2012 09/05/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 02/12/2014 03/12/2014 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Willberg, Lee Marinus DL/ID: 760YY4065 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: ilICLE IN ®�:'•....••:.$0, 11/4/2014 N 4.:' IOWA•=y%; ;a: icy + :D. O. T./6,1 o El s tl''hh 11110.owaOffice Departme tServices Trransportation f-, Cn 0,1111•=1* —^� 77 Name: Willberg, Lee Marinus DL/ID: 760YY4065 �'� C3 ` QCi•. TD. 2014 .11,:43AM Div of Criminal Investigation No. 2211 P. 2/6 • ' vti. l4. LUi'f 3:4orIi t,tty Lien ( - l,lly 0T 10Wa l.1ly No. 71Uy F. L � orruE� STATE OF DIVA - ) 073LI``, CnirifikiiraaX History Re olid Check ;, ,,`' x • r�„ 1U19A � ui C")';‘. I r •?• 'f '1 r bequest FOIl'M .N ' �,,Y • c.., DCI Account Number: cf OQ.. - -' (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1"Moor City Clerk's Office 215 E.7th Street 410 E.Washington Street Des Moires,Towa S0319 (515)125-6066 Iowa Citi, TA 52240 (515)725-6080 Fax Phone: 319-356-5041 Fax: 319-3g6-g497 Y am a'e f nesting an.Iowa Criminal History Record Cheok ou: • Last Name mandatory) First Name mandato j MicldleNalia®(tecontntended) i\ r ` I, /6 r C_ - M 141(, n K f Date of Birth(mandato Gender(mandatory) Social Saud Number teeommeeded 4-Male OFemale LIP/— Q'—3 $ v Waiver information:Without a signed waiver from the subject of'the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,2.For Complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request, • Waiver Release:I hereby give permission for the above'guesting official lo conduct tut Towa criminal history record check with the Division of Cantina) rims ligation(DCI). Any criminal lus(ory data concerning mc that is maintained by I t CI may be rot-. s bk law. • Waiver Signature: ' "'i W 1 Q ou V lOVVcriminal i or ecordl Check Results :.(Dcltete onI • As of ,O��1 1 1 , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI . r•) 0 Iowa Caiminal History Record attached,DCI# ACI initials Received Time7Oct, 14. '12014 3:42PM No, 2852