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Home My WebLink About14-240 K, Authorization Number / y- .2 0b 1 r 1 (Office Use Only) maw.:GA -tJi._ 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 Strect Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application c-13~L9L33,6_ i46 Fri icf2-'f (319) 356-5497 FAX FirstMiddle Last 1. Name (REQUIRED) /1— ie _-3—t., _y,-,.Y L _0..‹... C7— ,� 5 n yid c r� v 2. Mailing Address (REQUIRED) " L ' S C 4,)1.--, 3. Contact Information (REQUIRED) Email: C,Lx 5, wi u i,,,,, rte- ,7�Q ,-,L, , Cell Phone: S-)-5---- )-0" --9G.3 4. Prior experience in transportation of passengers: 7/1,44-, s ;"/ , CO )1— „ Lc 41_, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? rtJ c) 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? ,'J 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years'? 1v D Type of offense When ( ( i2 /ice tt ce- 4-0 /n.cte-e. '(2 eA46 9. Have you ever applied to be an Iowa Cr provide the name(s) L' :-/ pnv/e - -4 / l ( -.1 DEPARTMENT OF CRIMI 7� w _ 'E CERLIFIE@� DRIVING RECORD MUST/ brr1 Do/ 1�r CHI F1 EVIC�V - ; You must apply for an individual Departs ✓ bC�RC. ilab�'� on'IFeques✓ (OVER f CCtK iSSrt2 `J 5 Iidiaziz, /0,1/5. 4) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7 Y, Co 1 . I understand that if I falsely answer any questions in this application, that this application mayb 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 '/�� r� C��---'----r Date /16212 ) 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 wok r t 75. L . [„,,S r.WLae.r,p . On this ,;„ t tj 1 day of o c#r51.,.tr , -b14 . 77WENDY S.MAYER Notary Public in an for the State Iowa �-�re�l ! 729420 ,'.p. My Commission Expires i'_1:: .p+,� —71 *************************** ****************.**********************************************************************..********************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined th. -re is no information which would indicate that the issuance would be detrimental to the safety, health or weif. e of es': of the City of Iowa City (Title 5, Chapter 2, City Code). /0/2 y//`i Sign. ur; of P:ce 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. n �1-01e- ..L./..i 4,./14:-/,,z Signaure of City Clerk or designee Dat Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update ClerkrTAXIDRNBADGEAPPL92014amer ded.DOC 09/2014 a'r'm SMARTER I SIMPLER I CUSTOMER DRIVE www.iowadot.gov Office of Driver Services PO Box 9204 i Des Moines.IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 10/10/2014 DL/ID#: 748YY6977 (IA) Customer#: 1943560 Name: Gusomano, Robert James Class: D ID Status: None Lee Address: 1205 LAURA DR LOT 15 Audit#: 6866041 DL Status: VAL Issue Date: 04/16/2013 CDL Status: None City/State: IOWA CITY, IA 522451528 Expiration Date:' 05/09/2015 r� CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1205 LAURA DR LOT 15 Restrictions: Corrective Lenses Restriction None Date of Birth: 5/9/1956 Supplement: Mailing City/State: IOWA CITY, IA 522451528 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 12/04/2009 01/01/2010 592 Speed Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 11/19/2010 601513 IA Name:Gusomano, Robert James Lee DL/ID: 748YY6977 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,Irawa this date: o .7., IRI IOWA ..4 10/10/2014 <�"• N .....so s R: IOWA 0,,� r-, ,-- f*: tt +r �: '' 11 ....D. O. T.. f '�,1it eir * **. - Office of Driver Services It% �I xINN„„�,-- Iowa Department of Transportation - CO Name: Gusomano, Robert James Lee DL/ID: 748YY6977 • Oct. 22. 2014 2: 27PM Div of Criminal Investigation No. 2482P. 1/2 v,t. r. LV. LVI't I .U1INI t.lty t.IC(N t.tty VI, tuwa t.IL Nu, J))1 F. 1/ 1 -a a, Clriimina 1.1 is$ory ;.ecoid Chec)1� :; • v �uwnl t144,11.-117-'4 `` Requegt Form ..,r,,-._....'-` ,, � 'tl * �f ./ �, war .,....,, DCI Account Number; ltcablR), , To: Iowa Division of Criminal Investigation From: City of Iowa City - -: t o �.. Support Operations Bureau,rt Floor City Cleric's Office .,, 215 E.7rh Street 410 D.Washington Street =- Des Moines,Iowa 50319 (515)725-6066 Iowa City, TA 52240 (515)725-6050 Fax , Phone: 319-356-5041 . Fax: 319-356-5497 •• x am requesting an Iowa Criminal History Record Check on: • • • - -, Last Name(ulattdalory) First Name(mandatory) Middle Name(recommended) Date of Birth(mandator ) Gender(mandatory) Social Security Number(recommended) o 5 4, / S l 0Male DFetnale 2p,. 4 Z ^ b Wai erInformation:Without a signed waiver ftom the subject of the request,a complete crl nal history record may not be releasable,per Code of Iowa,Chapter 692,2,)+'or comntete criminal history record Information,as allowed by law,always obtain a waiver si: ature from the sub'ect of the re.ue.st. Waiver'Release:I hereby give permission for the above requesting official to conduct an lows criminal history record deck with Iho Division of Criminal investigation(DCI). Any crinlinal history data concerning me that is maintained by the DC[ y: be released as allowed by low, ;� Waiver Signature: ' / r� _____. Iowa Crimilr�a1 History Record Check Results (DCltueonly) As of /0 –).2—/! , a search of the provided name and date of birth revealed: XNo Iowa Criminal History Record found with DCT r 0 Iowa Criminal History Record attached,ACI 1 • • DCT initials4a_. .., • Received Time-75c'1 fi,•I1T014 1 :02PM No. 3397