HomeMy WebLinkAbout14-053 Authorization Number / — `7 3
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"II AS 11411:71r
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 Last
1. Name //ceS•-!cvv 1 1=1 kyC s 72=.1-)-0/voL,
2. Mailing Address 1/U $4 e/2rc/c,i-✓
3. Telephone: Home Other: P/9- Y7,72.
4. Prior experience in transportation of passengers: ' 4/0/1/e
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ��>✓L
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? /i/c/vt
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? NO 0 1"✓6:
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)
clerk/taxidrivbadg 03/2013
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�y AT (0 9 7h . 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 ���i �f.L�, Date 34/7 y
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STATE OF IOWA )
COUNTY OF JOHNSON ) F
Subscribed and svyQrn to before me by •
YDS V1 `)��I tl Ure. On this (-i--I-e - day of
11 V,,i 10 to J L. 1.1-1 i
` k_-- l l !`c J. ( 1 ; -I t
IF K TI ITTI F Notary Public in and for the State of Iowa
- ri Number 221819
missi n Wires
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).
E
.... i i
4r%dip
Sign ur- of '4li. Chior 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.
.7) ,e . - - /V
Sin ure of CityClerk or designee Date
9 9
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5'/z"
(height) and prominently displayed to all passengers.
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerk/taxidrivbadgeapp2010.doc 03/2013
'_)tht,
/t effete State of Iowa ii .SE OF r°
/ti'<"�/ ,r Division of Criminal Investigation '�Vy`i • •
'
i /�t .. 215E 7`h St j°//r v:
IOWA �'` Des Moines IA 50319
/ Ph.515-725-6066 Fax 515-725-6080 2t"* r< 'jy
A9 . :moi iy moo„ , « 4
\AoN A�� Iowa Criminal History Record Check
Walk-In Request
Your name `Kgyinyxl S
Address /1 Q r ciG),tn)
City/State/Zip {' S 74,( Fill in all shaded areas.
Phone# 5-4 ,7- ,..)5F- y7,. (p
Requesting an Iowa criminal history record check on:
Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended)
Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended)
3/01 s/ Iniale ['Female 33°
Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.)
' I
Results
2.15 DCI USE ONLY
As of \ \L\ , a name and date of birth check revealed:
•
o record found
❑Record attached, DCI#
•
•
DCI initials
Receipt
Number of requests x $15.00 per last name=Total amount$
Method of payment: ❑cash ❑money order Ocheck# ❑MasterCard or Visa
Cardholder's name Last 4 digits of MC or Visa
DCI initials
Credit Card Number# Exp. Date
Page 1 of 1
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7174 •
C;,'; r . •
\--+.•.••••••• ww,iowadot.gov
SMARTER 1 SIMPLEI I CUSTOM:1 f i:;11 EU • -- -_ _-Office of Driver Services
PO Box 9204 Des Moines, IA 50306-9204
• Phore: 515-244-91241800-532-11211 Fax:515-239-1837
ww w.iowadot.gov
Certified Abstract of Driving Record
Inquiry Date: 2/26/2014 DL/ID #: 699AJ6970 (IA) Customer#: 6090530
Name: Stelnhour, Preston Lane Class: C ID Status: None
Address: 110 SHERIDAN ST Audit#: 6996970 DL Status: VAL
Issue Date: 06/01/2013 CDL Status: None
City/State: MUSCATINE,IA 527615543 Expiration Date: 03/25/2018 CDL Cert Status: None
Endorsements: NONE CDL Med Status: None
Mailing Address: 110 SHERIDAN ST Restrictions: Corrective Lenses Restriction None
Date of Birth: 3/25/1981 Supplement:
Mailing City/State: MUSCATINE,IA 527615543 Sex: M _
History Information
• CLEAR DRIVING RECORD
Name: Steinhour, Preston Lane DL/ID: 699,436970
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 custpdian 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:
•
>�OQ••' 07'/ �4 2/26/2014
tr
; • IOWA ',
%o; D. O. T. sW? e�
,,'I'4�f ORNER evi, ' office
of Driver
Transportation
Iowa
Name: Steinhour, Preston Lane DL/ID: 699A36970
2/26/2014