HomeMy WebLinkAbout14-143 Authorization Number / `I - 9
1 (Office Use Only)
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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
First Middle
1. Name .� ; e I I�r v,
2. Mailing Address 9 I 1 c�vi c NueA--A_ co ro.1 v i 1 l,-
3. Telephone: Home 3/9 G/DC) 7, S �` lir Other: r _
4. Prior experience in transportation of passengers: h e J v r / C Gu r cvre..4a
vvl0 1 �5 0;0 /U
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 be,n 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? Al0)
Type of offense Where When
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /13
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)
/V (/
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)
clerkitaxidrivbadg 03/2014
I h reby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
h L/`/ Y X Ct Cit (-1 . 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 �- ^V Date -d, ( � I
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 —1,, 11,,,L,tY e L , &-. t�,A_A- . On this .y2.? s-- day of
-til, \ aat -) .
4,9.1Ar Notary Public intnd for the State of lo!.
WCMDY 5 MAT CK
i•;+': : Commisswn Number 729428
:,; y Corn 'fission Expires
******* . -!,. ****40-* *4.*x ,r*tvr**** *****************************************************************************************************
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).
-----2/ 7////V
Signature o-Reitc - or designee Date
1
YOU ARE 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.
7 ‘,\:\.,\.•,:-)\ -\,.._C.._ 7 \- _,,\ “__\,
Sign tur of City Clerk or designee Date
Taxi cab businesses are req 'red to provide Driver Identification cards. Cards must be 8'/2" (width)and 5 '/z"
(height) and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derk/laxidrivbadgeapp2014.doc 03/2014
(1111,P,
OF PUB(j - State of Iowa-72�cs Division of Criminal Investigationa! tr. orkr., 215E7'"StIOWA Des Moines IA 50319 ,.... o—,Ph.515-725-6066 Fax515-725-6080 9`t4v� • lMINO: \
CNN FNS Iowa Criminal History Record Check iroc
Walk-In Request
Your name f; IMS �.� , Y- „�-4-
Address C 1 ( a �t!eY < 1- 7
City/State/Zip C --. )/;(�a° L.e. 5a `I Fill in all shaded areas.
Phone# '3 i el —41 — s$a 6
Requesting an Iowa criminal history record check on:
Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) I Middle Name Segundo Nombre(recommended)
-e._ Lee
Date of Birth Fecha Nacimiento(mandatory) Gender Genera(mandatory) Social Security Number(recommended)
9 Q$Iale OFemale 33 -7-7 Lk 4 L-1
Waiver Signature.Firma(If the request is on yourself.please sign. If the request is on someone else,write N/A.)
/R/esults ✓/ DCI USE ONLY
As of - a ( 1 , a name and date of birth check revealed:
/1\To record found
❑Record attached, DCI#
DCI initials f� r
Receipt C10
Number of requests I x $15.00 per last name=Total amount$
Method of payment: Pcash ❑money order Ocheck# ❑MasterCard or Visa
Cardholder's name Last 4 digits of MC or Visa
DCI initials
Credit Card Number# Exp. Date
.,_
C iti WA '
4
CIT
SMARTER I SIMPLER I CUSTOMER DRIVEN
www,iowadot.gov
Office or Driver Services
PO Box 9204 I Des Moines,IA 50206-9204
Phone:515-244-9124 1800-532-1121)Fait:515-239-1837
wMv_iawadoLgav
Certified Abstract of Driving Record
Inquiry Date: 7/19/2014 DL/ID#: 644XX2994 (IA) Customer#: 1025027
Name: Bryant,Jimmie Lee Class: D 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: M
522411531
History Information
CLEAR DRIVING RECORD
•
Name: Bryant,Jimmie Lee DL/ID: 644XX2994
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:
a1IUCZE,n,,
;100. !�i�a 7/19/2014
5trIOWA et
Llk D. O. T. :
''1j�hf omat$ owaOfficeof Driver Departme Deparces
tmentTransportation
Name: Bryant,Jimmie Lee DL/ID:644XX2994