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Home My WebLink About14-184 * - Authorization Number / cf , 4 j r 1 (Office Use Only) Cii;g �:.=.®grim. APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name ,;i 0,1,0"; ef2-- j3 r 2. Mailing Address i I t a c:� A✓e � � 7 `J 3. Telephone: Home 31-6? `iOD - $ 53 Other: 4. Prior experience in transportation of passengers: / K,00+11 c-e cep ��y ��U w1t�JG( cckb 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have youpe� onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Al Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ai Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N 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) /./CD 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) clerWtaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 6`1£ k)( 't L/ . 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 yytivG� �—w / Date 1' (, ; Y i `J 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 —rt ,,Lt ,u L L . T „t On this �l �� dayof _201 4. `t d?)_ y t-z Mor Notary Public(and for the Stat of Iowa sa.ndx3 uoissiwwo3 AA 8Z176ZL J2gwnN uoissiwwo3 ************* , *¢ ; a.a. 1Yl *****,*********,******,***************************************************************************** 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). leA t/Z6'./1 Signa . - ..Ji'e Chief or designee Date YOU •RE 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. /'C . ? f£Li V-7'2 Signature of CityClerk or desi nee e 9 ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (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 clerk/taxidrivbadgeapp2o14.doc 03/2014 • _ _ . Jr e _• cr, as nrA, Ltd r 1v-4, ra 1, . `r . SMARTER l SIMPLER l CUSTOMER DRIVEN wuvvw.iowadot goy Office of Driver Services RO Box 9204 i Des Moines,IA 5033469204 Phone:515-244-91241809-532-1121 [Pak:515-239.1837 ww,v_io^.radotgov Certified Abstract of Driving Record Inquiry Date: 7/19/2014 DL/ID#: 644XX2994 (IA) Customer#: 1025027 Name: Bryant,Jimmie Lee Class: 0 ID Status: None Address: 911 22ND AVE APT 7 Audit#: 8162164 DL Status: VAL Issue Date: 06/13/2014 CDL Status: None City/State: CORALVILLE, IA Expiration 04/02/2019 CDL Cert None 522411531 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 911 22ND AVE APT 7 Restrictions: NONE Restriction None Date of Birth: 4/2/1984 Supplement: Mailing City/State: CORALVILLE,IA Sex: 14 522411531 History Information CLEAR DRIVING RECORD Name: Bryant,Jimmie Lee DL/ID: 644XX2994 Pursuant to Iowa Code §321.10, I, Klm 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: .*** vyY� *tE.4 ig 7/19/2014 E(VX2) ir bh4r ORia%'.= s Iowiceof Driver a Department ervicesnsportation Name: Bryant,Jimmie Lee DL/ID: 644XX2994 8 State of Iowa `' Division of Criminal Investigation "sP,� *'d-a9 al c Q ' 215E7n'St � " b . Des Moines IA 50319 m, Ph.515-725-6066 Fax 515-725-6080 tGC' ., s of 4} ft ri . b11_ Iowa Criminal History Record Check j.4 1,S- Walk-In Request Your name •.� i r•.•�n.�_ � . t`::"-�•,--. ,.. Address `r, I I "1 -1 ,IA 1i 4, :4? ..U- j r- 7 City/State/Zip Cr,. —. ( i;;(1.r _%6E. S) ,H C Fill in all shaded areas. Phone# 31 5 — ilior% -- G 7 6 Requesting an Iowa criminal history record check on: • Last Name Ape/lido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) 1 `— J D ) v VI lCrl i Yom_ Date of ,,irth Fecha Nacimie,to(mandatory) Gender Genero(mandatory) Social Security Number(recommended) r• t J t_ 1 (-v/ ?` _ I l i ® tale ®Female 7:z, _?Li _C2i,l4 (...A 'Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) f F]3/�c�n A}� t �- _ DCI USE ONLY As of I U.7 I- t t M , a name and date of birth check revealed: -12-No record found •Record attached,DCI# DCI initials'fy ---- Receipt _ r w Number of requests € x $15.00 per last name=Total amount$ ��----- Method of payment: ,`" cash ®money order ®check# ®MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials ; Credit Card Number# Exp. Date