HomeMy WebLinkAbout14-073 Authorization Number /2/ 7.
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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
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1. Name 41-e/M- 0�121 (/2 llic
2. Mailing Address c 36 �t,, / Tit !C e- ,s--id L�';�` J p/} %JO,j' 471-
3. Telephone: Home j 1 / 0-3 — 70 ) ) Other: �f S-ZI—S-0& S---2Vel
4. Prior experience in transportation of passengers: yes m alp O" ( _31(1—d7:5-- O l61
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? th,
Type of offense Where When
6. Have you b9en 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? �/L--
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A) 0
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)
clerkitaxidrivbadg 03/2014
I herb certify thatI have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number"
7/1141i05 8 . 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)
/ /A20/ V
of Applicant i (/Signature . t 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.
STATE OF IOWA
COUNTY OF JOHNSON )
Subscribed and sworn to before me by -; . Cirt-11;c 1� . On this a t — day of
u,t � 1 c t Ll
yiapv g uevFR Notary Public in and for ie State of Iowa
"i Commission Number 729428
• M Commission Expires
*****,*., *,**** :!1. .L.n__... *******************************************************************************************************
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).
ignaturezOf Police 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.
Signature of City Clerk or designee 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.
**********************It*************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cled taxidrivbadgeapp2014.doc 03/2014
` ► DCCT
SMARTER I SIMPLER I CUSTOMER DRIVEN WWWdOVI/ad{ t.gt3t
Office of Driver
PO Box 9204 Des Moines, IA 50;
Phone:515-244-91241 800-532-1121 f Fax:515-.
www.iaw
Certified Abstract of Driving Record
Inquiry Date: 3/21/2014 DL/ID#: 997AA6058 (IA) Customer#: 956525
Name: Mccormick, Patrick Henry Class: D ID Status: None
Address: 3636 STONEVIEW CIR SW Audit#: 4441241 DL Status: VAL
Issue Date: 06/17/2010 CDL Status: None
City/State: CEDAR RAPIDS, IA Expiration 09/29/2014 CDL Cert Status: None
524047923 Date:
Endorsements: 3L CDL Med Status: None
Mailing Address: 3636 STONEVIEW CIR SW Restrictions: NONE Restriction None
Date of Birth: 9/29/1952 Supplement:
Mailing City/State: CEDAR RAPIDS, IA Sex: M
524047923
History Information
CLEAR DRIVING RECORD
Name: Mccormick, Patrick Henry DL/ID: 997AA6058
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do here
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 offic
currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportal
certify.
In witness whereof,I have caused my signature and the seal of the Department to be set upon this document, at Ankeny,Iowa thi:
o`�ENCLF 4`y,
e.... ./411, 3/21/2014
trI IOWA II 1=
D. O. T. W%
eon- ate,04.
It.; Office of Driver� � Iowa DepartmentSeof lces
Transportation
Name: Mccormick, Patrick Henry DL/ID: 997AA6058
Mar. 10. 2014 3:30PM Div of Criminal Investigation No, 4767 P. 1/2
2014 uo, uo ea:u0 HIKYURT $11UIILL JCKv , .515,6621094 » 51, (eg 608u r 2/3
'�.\S\1t or p(ip,
F. . - „'v STATE OF ilk,,,,,,07;k,.
IOWA
(� �r° Criminal History Record Check • -5 •(,.>" w`-1
4)10a Ref;gest Form re`n:'^„\`amu
DCI Account Number: qSQL —r
•
(if applicable)
To: Iowa MAW anofCriminal Wes ngalion From: A;rpey44c }r,
Support Operations Bureau,1"Floor
_,215E.7hStreet air I Ar s i •
Der Moines,Iowa 50319
(515)72S-6066 (]j... •e IL • 5 _ +s`
015)172S-608D Fox • .
-- Yhonc: 3l9_3�,1�5 L
Fax: etci coo tor
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i am requesting an Iowa Criminal histo Record Check on:
Last Name(mweuay) First Name ootndtwry) ' Middle Name(rcwmmendcd) •
//.fie , Rai .
t' .
Date ofBirth(mtndeIory) ender(mandtlory) Social Seen ty Number(retonuncndod)
O 9/a 0 95a XMele °Female 1,93 49 ,5o? 7 P-...
ff)aivrr worn/aeon: Without a signed waiver front the subject of flee request,a complete criminal history record may not
be releasable,per Code of Iowa,Chapter 692.2,Forcomnletq criminal historyroaord information,as•alfowed by law,ahvays•
obtain a walYor*astute from the aubieet of the request."
T9a(verRekasedthereby give permission for die alma requeninga loltitocondpertofowlcriminalhinoryrnotdcheatwiththeDlvittenofCominal
tmwstletdon(DCI). Any edmhul hhlandeli concemtnamo!heti i... , ..nrd by theta mW be rd •.. ,.. .td bylaw. '
r Waiver Signature! /rev .4y x .
Iowa Criminal 1.'istory Record Check Results (DC1 uu only)
csof .3-16-Ly )a search of the provided name and date of birth revealed: `-`' c
— ' .....
No Iowa Criminal History Record found with DCI cn '_
i GY.'J –0 05 '
.t`'
). ❑ Iowa criminal history Record attached,DCT ii _- r
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x' N •
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f DCI initials' t.SJv" _ t~
•vci-77(08/25/10)
..
Received Time Mar. 7. 2014 1 :52PM No. 1323
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