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Home My WebLink About14-154 -• - Authorization Number / i / 5-1 , �' 1 (Office Use 0 y) ova AS�t �III � APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 4 1 0 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 Fir t Middle La t 1. Name f1oc�5;ht e CAz Ps78 2. Mailing Address U 7/3 .8i- , S' 3. Telephone: Home si5 Sts 9t 72 Other: 4. Prior experience in transportation of passengers: 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? 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? /20-- 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 names) r. 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) clerk/taxidrivbadg 03/2014 - y I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `;'6Z-AA-1-.: .i'`/' . 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 4e._ C .- ;;Ji-,.,,1 Date 7/7/2o// 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. .********..* *...***************** .,,.....***********..*.*.«*F***,,,,,, ;........t, *„****..*******,.**„*,t* ...E,t,F,t„.*f* .,tit** .*�,.******* STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by --"D1 c,.S C., r.,, , i--„,,,-., . On this 3C {-L day of ,, -i 2019- . 1 b`�¢i�ir WENDY S.MAYER 0,Li -c �` �,,,,,,,;,-ion Nbirrbar,7aaHa �4Notary Public in nd for the State Iowa ? My Commission expires 7x3-11 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::'o!fy:•n of rcE:donts of the CV,.of low:-..; City(Title. 5, Ch,tepter 2, City Code). If ,..------ 6/5//i Signat o `”• i iChief 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 cn the city website at icgov.org. � j J - 414.2 /5 ii.z Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identifcation 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/taxldrivbadgeapp2014.doc 03/2014 , r - - SMARTER I SIMPLER I CUSTOMER DRIVEN WWVh44.44, di3G.0 OV Office of Driver Services PO Box 9204 i Des Moines,LA 50306-9204 Phone:'515-244-9124 1800•-532-1121 I Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 6/20/2014 DL/ID#: 406AF5294 (IA) Customer#: 5563003 Name: Fulton, Douglas Chester JR Class: C ID Status: None Address: 713 BROWN ST Audit#: 4065294 DL Status: VAL Issue Date: 02/02/2010 CDL Status: None City/State: IOWA CITY, IA 522455901 Expiration Date: 03/31/2015 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 713 BROWN ST Restrictions: Corrective Lenses Restriction None Date of Birth: 3/31/1987 Supplement: Mailing City/State: IOWA CITY, IA 522455901 Sex: M History Information CLEAR DRIVING RECORD Name: Fulton, Douglas Chester JR DL/ID:406AF5294 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: *19lClf 4 - • %pA 6/20/2014 CiW;) �n�-L--- rvices owaeDepartme Dof Driver epartment Transportation Name: Fulton, Douglas Chester JR DL/ID:406AF5294 r r. • t OF Po State of Iowa P,e abio�Q-A, Q�� k ��,? Division of Criminal Investigation y` + * , 1-'- W i► �. 215E7tsSt . * a '*' 4S r IOWA Des Moines IA 50319 -c ' .. ,ts a c Pb.515-725-6066 Fax 515-725-6080 s"°"* �� APO 1 �Q / ap`toixt'7"�\ '4770n\- Iowa Criminal History Record Check 7 IT Walk-In Request Your name rcc 74 , (24,—,4,____ y Address /a/Pion< g , -G City/State/Zip Z2-,,,, G L/, , iP,%,i 4.2 514/4" Fill in all shaded areas. / , Phone#4/S S.J 9,,e)9., � Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) Date of Birth Fecha Nacimiento(mandatory) Gentler Genera(mandatory) Social Security Number(recommended) Male ❑Female t /6,-r/. .3/ /(197 ter / /pit ;/ Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) .. /t-r„./ 6. ” A— v c Results 7 DCI USE ONLY As of r ZHy , a name and date of birth check revealed: • No record found VV❑Record attached, DCI# - DCI initials LbW Receipt Number of requests I IP x $15.00 per last name=Total amount$ 15 Method of payment: U�lcash ❑money order ❑check# ❑MasterCard or Visa Cardholder's name / ' Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date