The URL can be used to link to this page

Home My WebLink About14-060 Authorization Number / `-r_l c rj j - 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (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 1. NameIYA AF , I 1 Al ddle L�st 1/ 17//1-70 2. Mailing Address —a7 �� c S . 4A--) 3. Telephone: Home 31 cr-, pj"' ?/96 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? v 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? A fl Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? S Ped 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 /,_;3 q/b ' 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) AJ 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) e!erkltaxidrivbadg 03/2013 I hereby certify that I h v issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4 55 . 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 / / a Date -3h2-) 1 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribe and sworn to before me by AA��'`)i,r L. 1�;L\ C . On this /c2 t_k_ day of . e7. * s VVENDYmission N S.MA.YER NotaryPublic in and r the State of low. o: Com 'y ommission Expires p 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). 1/ �z//r Signature of oli�ef 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. .1//,, ,„/ Sig atu of City Clerk or designee Date 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/taxidrivbadgeapp2010 doc 03/2013 i WNW IowadCJ's.go) SMARTER I SIMPLER I CUSTOMER DRf �N – —_ - --a Office of Driver: PO Box 9204 ¢ Des Moines. IA 50: Phone:515-244-91241800-532-1121 1 Fax:515 WVAy.1or. Certified Abstract of Driving Record Inquiry Date: 3/11/2014 DL/ID #: 813ZZ4955 (IA) Customer#: 2937222 Name: Hillsman, Marvin Russell Class: D ID Status: None Address: 291 27TH AVE SW Audit#: 6751385 DL Status: VAL Issue Date: 03/07/2013 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 03/30/2015 CDL Cert Status: None 524044162 Date: Endorsements: 3 CDL Med Status: None Mailing Address: 291 27TH AVE SW Restrictions: NONE Restriction None Date of Birth: 3/30/1942 Supplement: Mailing City/State: CEDAR RAPIDS,IA Sex: M 524044162 History Information Convictions Citation Date Conviction Date ACD Explanation County 05/29/2009 06/03/2009 S92 Speed (10 mph&under in 35-55 mph zone) Johnson Name: Hlllsman, Marvin Russell DL/ID: 813ZZ4955 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 thl: ..e '�VE+IICLF a COQ: 44, 3/11/2014 1$' IOWA �'', .e : ;O ar %5:D. O. T..l / 0,e DavOcs- IowaOfficeof Driver Departme ternices Transportation Name: Hlllsman, Marvin Russell DL/ID: 813ZZ4955 - • :.. OFPUBO[„ tpt orr prr Qj ,o,, s� STATE OF IOWA e, n _IOWA,, Criminal History Record Check 2::11 .sa '- y. pP�r nor p Request Form "vto,,NP A� ' 5 DCI Account Number: 9861-F (if applicable) To: Iowa Division of Criminal Investigation From: .City Clerk's Office Support Operations Bureau,1 Floor 215 E.7th 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: Last Name lm�aaamry) Frr&rthe mandatory) = anaatory) - 7 - in:=-. , a — _ Lisp _ gyate otBirraaa .:_ r e der4(manaetoxy)a d oc al+_ecuri-f;NVumbe�manaazory i — -' - _ �- - `� ; 1 ®Fein la ee sWa_,rve—r info m---- out a sl end waiver from ZLe s b e of the request oca mple pct nmmyalhlstory ie�cord maynot :w-Taut e�Codeo oma, kap erect or comnle a cmm�atLlsfo I'�T C �f y ry eco7rd mformat�on a�a owedbylaw,a�waya s , = T zotitam awaiver slgna st-froom h ublec' `of tke request£ - �� - WaNer` eleaSe IhaLarra ss�d eabovereques gofficialto dud au Iowacnw storyiec d-checkwitl�theDrvisoraC } 97nvesh (DCI) .4aycnmineChsstor}�dataconcemm the, is=mamtatia thelaii8 eI eased asaliaatt§law - _ _ arSlgnat re 3f, 17 ; Dal Arra- t- T 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 Hillsman Marin 1942-March-30 409686671 Criteria Results Not found in Database Background Check Complete As Of 3/11/2014 3:09:20 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$1559.00 Generate PDF _Sears irAgain https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 3/11/2014