The URL can be used to link to this page

Home My WebLink About14-112 Authorization Number / r 1 (Office Use Only) ftg gia II OW 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 C/�n, kA.�r� 2. Mailing Address 6 3c 5 6re ibe .1.4)- L),i y-c3 - +`ed4 Rp ;cLs- Z 4 3. Telephone: Home 31 ! - 3 G 5 - q 5/ Other: 4. Prior experience in transportation of passengers: / , y,r-'S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ /1: 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? l; Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /tic"--) Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) clerI taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 1 1-1 A Q - . 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 0,,,„.14,„,7 .� . 1�� Date -) -/.i - 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 `To +M-e S 12-,. K___(-4,1A . On this I ,-1---1,.._ day of l , -L.) j ,L1v Notary Public in aid for the State of I a ************************************************************************************************************************************************ 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). lidg / /(' 3/ZY Signature if Pol .1 hief or designee Date YOU AR' ► .T 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. // (Q-r �. �iL. -s ,s // Signaturebf City Clerk or designee /Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (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/Iaxid,vLadgeapp20?4.doc 03/2014 A . � �4F PUB!/ pcs os luy s! c.\‘1, STATE OF IOWA 5<Pr•;fr \;* 10 it Criminal History Record Check pP�`c7lON 0.` P, Request Form ""g�R s d11NP1 t 10'4 ® DCI Account Number: 9861-F (if applicable) To: Iowa Division of Criminal Investigation From: .City Clerk's Office Support Operations Bureau, 1't Floor 215 E.76 Street City of Cedar Rapids 101 First Street SE Des Moines,Iowa 50319 Cedar Rapids,IA 52401 (515)725-6066 (515)725-6080 Fax Phone: 319-286-5060 Fax: 888-966-0171 I am requesting an Iowa Criminal History Record Check on: I ast Namit anaa f = =a illijalariattn*a 1Middle leteanaatotyJ 4 taaaari Date of Bu t (maoa tory)- s= Gender r aiaazory) Social SecuritySinaamry) a _[Male OFemale FrallerinftWatl011R'lthifi aelgnedwalveLfromahe subaec £tho r641. ,acomplete.crtmuialhlstoryrecordmay not be i'eleasable,_per_Code lit_or ,Cha er 22,For complete criminal history record�nformahon,as allowed bylaw,always rbtaln a waiver signature:Ecom the snblect.of ttierequest= _ = a -I'17a1Ve/keleaSe ItZfebygigiemusvou_feleaboveregniftmg'�aaltoconductan-Wacnmmaltastoryle acre eckwiththoaof l aDrolslCnmmaL Inge hien(DCI)r.e ny cii ifillaory aata eiadinmg mei1D s mamtain3by tlisDe fnaybria ries u allowenyiaw — Waiver Signature Iowa Criminal History Record Check Results (DCI use only) As of , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached,DCI# DCI initials DCI-77(08/25/10) - � � PLEASE MAKE ADDITIONAL COPIES AS NEEDED. SING - Page 1 of 1 Single Contact License & Background Check \ Results Criminal Histo Background Check Last Name Other Last First Name DOB SSN Name Selection Kane James 1935-December-09 480342261 Criteria Results Not found in Database Background Check Complete As Of 3125/201412:04:23 PM NOTE: The first and last names, date of birth, and SSN displayed in the abuse registry and • criminal history results are just as they were entered on the screen. Billing Account 9861-F Cash Deposit Currently at$1334.00 Generate PDF „-_,Search.Again- httns•//www inwannline state is ns/S1NC:/CTNGSClT.Prnrress_acnx 9/25/7014 V SMARTER ISHAMIR1CUSTOIv1E1jDRiVD? vvvarttiovvadot.gov Office of Driver Services PO Box 9204 i Des Moines,La,50306-9204 Phone:515-244-9124 1800-5532-1121 I Fax:5 t 5-239-1837 wvAvIow:doot.g0v Certified Abstract of Driving Record Inquiry Date: 5/9/2014 DL/ID#: 117AA9482 (IA) Customer#: 1933866 Name: Kane,James Randolph Class: D ID Status: None Address: 6305 GREENBRIAR LN Audit#: 7517921 DL Status: VAL SW UNIT B Issue Date: 11/12/2013 CDL Status: None City/State: CEDAR RAPIDS,IA Expiration 12/09/2015 CDL Cert None 524046217 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 6305 GREENBRIAR LN Restrictions: NONE Restriction None SW UNIT B Date of Birth: 12/9/1935 Supplement: Mailing City/State: CEDAR RAPIDS, IA Sex: M 524046217 History Information CLEAR DRIVING RECORD Name: Kane,James Randolph DL/ID: 117AA9482 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: �ENICLf��,, %-ot0�. A y 5/9/2014 IOWA ` ; :.D. O. T. j °'= „, II'1j��F ORNEASS Iowce of Driver rtmr Serf lies Transportation Name: Kane,James Randolph DL/ID: 117AA9482