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Home My WebLink About14-043 Authorization Number 1 q - 3 1 (Office Use Only) LEGA St 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 S2240-1826 (319) 356-5040 (319) 356-5497 FAX -,'MF)rs M dle st 1. Name 1 i�(��to z �� 2. Mailing Address I".� G ( 1�r 1,(V61 / -77 ( C 2 2 S 3. Telephone: Home Other: ( -P 1( - - 1 - 1L/ 7 L 4. Prior experience in transportation of passengers: 6,1 b 01 y tLe✓ 'Z Ai -Puff S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? U 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? (V- Type VType of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �� 7 Type offense Where When �^ u .Pf u� N() � N c h: 411(q- a -3 / 4 / 2Q 11 (UI v.P �p y�ti r Ir, I (ih - /2G 13 ,, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1lU!, 5 Type of offense Where When hOY ila1,11^ 4 6 � �� /_ .: J, G / 20 / 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) .1 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number . 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) /CO7//11 Signature of Applicant Date ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by fV1 . On this 2-l-- day of r. la 54- 201 �{ 11 � Y \rye Notary Public in for the State of wa 47,t, 1MENDY 3.MAYER ° Commission Number 729428 1. •yy • My Commissjpn E piles 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). -ate 1 l Sign.. ure of Pr'i.' Chie or designee Date 1 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. Signat re of City Clerk or designee Date 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 clerWtaxidrivbadgeapp2010.doc 03/2013 _ ...e C310W1 DOT vuww.itiwadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN At IIIA s..r Office of Driver Services PO Box 9204(Des Moines,IA 50306-9204 Phone:515 244-91241800-532-1121 I Fax:515-239-1837 vAvw.iowadat.gov . Certified Abstract of Driving Record Inquiry Date: 2/21/2014 DL/ID#: 156AC8945(IA) Customer#: 5283367 ID Status: None Name: Ludy,205 MarR Andrew Class:uditD DL Status: VAL Address: 1205 LAURA DR TRLR 103 AIssue 6440266 COL Status: None Issue Date: 11/02/2012 City/State: IOWA CITY,IA 522451535 Expiration Date: 10/04/2017 CDL Cert Status: NoneCDL Med'Status: None Endorsements: 3 Restriction None Mailing Address: 1205 LAURA DR TRLR 103 Restrictions: NONE Supplement: Datee of of Birth: 10/4/1976 Mailing City/State:IOWA CITY,IA 522451535 Sex: M History Information • • Convictions Citation Date Conviction DateACD Explanation County 3UR ._._..... ....___._ Johnson IA 'N50 :Improper Turn 02/04/2011 03/16/2011 . . 03/17/208/09/2013 M81 Careless Driving Johnson IA : 013 Accidents-Accident involvement indicated does NOT mean the Individual was at fault or given a citation. Accident Date Number JUR 783844 12/16/2013 • IIA • Sanctions • 1TypeEffective End ACD Explanation Occurrence JUR JUR 1..._.. ... 0. ._..... IA Suspended 10/04/2011 X10/OS/2011 :D53 Nan-Payment of Iowa Fine Name:Ludy,Mark Andrew DL/ID:156AC8945 • of eby certify cPursuant o Iowa Coe§321.10,1,Kim Snook,ustodiantof the r corrds held by the Office of DrivDer Services,tthhat this its as true and accurate Dcopy of antofficial Transportation, that irector of 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: OW c ithli istp0. **•ri• 2/21/2014% 'y� IOWA 1 a "_ 4a �r Nefi•••gt.". Office of Driver Services "`n tl .p�,•-� Iowa Department of Transportation Name:Ludy,Mark Andrew DL/ID:156AC8945 Feb. 19; 2014. 2:36PM1 Div of Criminal Investigations iNo: 3353 P. `1/1 • % STATE OP IOWA —Itch, ' Criminal History Record Check r ..:Ato ..on Nicomriir 411-0 I I i, DM Account Ntrmber: 1`UCD,- • (irapplitabia) To; Iowa Division of CriminalInvestigation &Yom: City of Iowa City Support Op oration sBureau,l'rFloor City Clerlt°s Office 215E.7h Street 410 E,Washington Street Des Moines,Xowa 50319 (519)77.5.6066 Iowa City, IA 52240 (515)725.6080 Pax — Rhone; 319-356-5041 Bam 319-3565492 • I am requesting an Iowa f:lminalliisto Record Check on: Last Name(mandatory) ,First Name(mandatory) Middle Name(recommended) Lu dv, n M ow is 4eife Ill Date ofBirth(mandatory) / Gender(manaerorv) Social Security Number(recommended) / r l V I I ((q7 I!/ D\6aIe DFemale i frac•- s-5-2277 Waiver.lrtformallou:Without a signed waiver from the-subject of the request,a complete criminal histoty record may nof be releasable,par Coda of Town,Chapter 692,2.For complete criminal history record information,as allowed bylaw,always obtain a waiver slgnaturo from the subject of the request. WatverRelease:Thereby give permission for the 40ove requesting official to conduct an Iowa criminal history record chock with the Division of criminal Investigntias(DCl). Any cciminai history dole concendng nig dial(emalnh,bed 6y rhe 1QCI may be released ea allowed 6y law, Waiver Signal's '; a . :. v,, t. . it • • • ][o 1 a Criminal]H[istory Record Check ResuitS (,Lct,j1$p szy) As of IA 0 L} , a search of the provided name and date of birth revealed; -_•, a? • _.{c) `l ;.Iy IVEr No Iowa Crianinal History Record found with DCI G.,?Y n op .c ® Iowa Criminal History Record attacked,DCI# f_r — DCIinitIalsf) eceived Time-Feb. 14. -2014- 3:40PM-No, 2967 rl/.r-In en alien A%