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Home My WebLink About14-059 Authorization Number 4Y-54# A P 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 First % �� Middle L -z) Last /pv�-66� 1. Name 2. Mailing Address 3 S C7-'/AI?L-6S G(� /V F 2 w' ( A ,501.Q-iii- 3. Telephone: Home 3/`.7 �,_3/ — S,5-- , -- 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? t,s Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 1 ) -� 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) {N U 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) clerkltaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number l0 7 YX D ? . 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) IrcSignature of Applicant 'cl-- &`}-C /C) / L/ ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by—i L`r,,,.i.o S L . 52-4,,s(.. ...Ca_C . On this /f) A_, day of Moo r: -Q- _ -nl aw WENDY S.MAYER 9. 4 5 ��- u l AI..°i ('nmmission Number 729428 Notary ublic in d for the State Iowa M commission Expires ' "l Irl ************************************************************************************************************************************************ 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). s/10-------------— ,.1//p//, ignature of 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. -L,,,,..2 ki . k-;,..„-) _V, 7ign of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width) and 5 '/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkRaxidrivbadgeapp2010.doc 03/2013 "24 .. DOT \......a...- SMARTER I SIMPLER I CUSTOMER DRIVEN WWW,IOW�dOt.gOV Office of Driver Services PO Box 9204 I Des Moines.IA 50306-9204 Phone:515-244-91241800-532-1121 I Fax:515-239-1837 www.Iowa dot.gov Certified Abstract of Driving Record Inquiry Date: 2/20/2014 DL/ID 1: 467XX0889(IA) Customer a: 2779602 Name: Roeder,Thomas Leo Class: D ID Status: None Address: 85 CHARLES DR Audit is 7286006 DL Status: VAL Issue Date: 08/27/2013 CDL Status: None City/State: IOWA CITY,IA 522459237 Expiration 07/04/2018 CDL Cell Status: None Date: Endorsements: 2 CDL Med Status: None Mailing Address: 85 CHARLES DR Restrictions: NONE Restriction None Date of Birth: 7/4/1962 Supplement Mailing City/State:IOWA CITY,IA 522459237 Sex: N History Information CLEAR DRIVING RECORD Name: Roeder,Thomas Leo DL/ID:467XX0889 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: Trirircrel 4:4 /Qg IOWA••.,001 220/201` �,� /� r ,. Office of Driver Services Iowa Department of Transportation Name: Roeder,Thomas Leo DL/ID:467XX0889 ��5 OF pU8l� State of Iowa �PtE OF,ok .c, ' Division of Criminal Investigation ' . H aa. r 215E7 St " o IOWA -4 Des Moines IA 50319 Ph.515-725-6066 Fax 515-725-6080 °'C'CriON ak. Iowa Criminal History Record Check rR`"'��` Walk-In Request Your name The'`A/►S- L.6/ A =dccic Address 3-3- c/ix Ru=-r ,biz,.. City/State/Zip .t)c_JA e .1 Sa d yl Fill in all shaded areas. Phone# 3/7- G3/ Y". Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) POCC)Cf( �f7/0 7z°--b Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) Q7/o/6 2._ /El Male ❑Femalec/7 ) L (5:216Waiver Signature Firma(If the quest is on yourself,please sign. If the request is on someone else,`write N/A.) reTh/I.- / Results DCI USE ONLY As of 3-10-N , a name and date of birth check revealed: No record found - ❑Record attached, DCI# DCI initials t/Av tn Receipt Number of requests I x $15.00 per last name=Total amount $ 1 5.C)0 Method of payment: cash ❑money order Ocheck# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials rot Credit Card Number# Exp. Date