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Home My WebLink About14-040 Authorization Number ^ t-4b r 1 (Office Use Only) ��.ca.ter APPLICATION FOR TAXI 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 First Middle Last _ 1. Name ��— /14, // i 2. Mailing Address � c D✓', ,�owc� �/ ) 3. Telephone: Home —S �, '✓7? Other: 4. Prior experience in transportation of passengers: . z� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? !14 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? "4-4; Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? " Type of offense Where When I 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,t'' 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) clerMaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number __ !,-' ,.Z/>/ Z..2„?— . 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 • -r- Date ,2—„,2_ �. i7 STATE OF IOWA ) COUNTY OF JOHNSON ) , I Stcribed and sworn to before me by t�n �� r\ ��1 u . On this `---- day of (OYu 0 ( )1- C ( / V-. `Z C 1- LQ - `d'! KELLIE K.TUTTL Tary Public in and for the State of Iowa r!,.,,,',,., 2210101 aminissi i FUpires -S LIr ************************************************* **�/* ************************************************************************************* 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). j. / ` 1 Signatur= of Polk. ief or designee Date c 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. ?e�z—. -moi Al . )�2 2 . `.i -/ S gna 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 1/2" (height) and prominently displayed to all passengers. *******************************************************************************************************"",,,*********************************** Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp201 o.doc 03/2013 Feb. 20. 2014 9:55AM1 Div of Criminal Investigation No. 3427 P. 14/15 • . ��. v. �vl I . 1'.I. r• ., o141n u. •, a .vn. VI \y uv. TJul I . • Lai' STATE OF IOWA �v `rail 'L'. tt r ..., aA.' _� iN iii.e- .:- \ Creinainal libistory Record (Chock ';: {+j; .e. t.- :7�I e; IegWIeot Form as .'„ :+ > ' ,`' DaAccountN'umber: L3c,c -P (itepplicablc) To: Iowa Division of Criminal Investigation Fromm City of Iowa City Support Operation Ttureau,I" ioor City Clerk's Office 215 F.714 Street 410 B.Washington Street . Des Moines,/own 80319 (515)725-6066 Iowa City, IA 52240 (915)725-6080 Fax Phone: 319356.5041 • bax; 319356.5497 • I am requesting an Iowa Criminal RistoryRtecord Check on: Last Name(mandatory) First Name(mandatory) Middle Name(recommended) 519L--t_ 44412 44- Date of Birth(mandatary) Gentler(mandatory" Sodal Security Number(recommended) 0f-0,-1 -c1.9XX raWile D 'emaie ,19-` 0 6,2,tO1. Waiver Information:Without n signed waiver from the subject of the request,o complete orlminaI history record may not be releasable,per Code of Iowa,Chapter 692,2.Ppr complete criminal his tory record information)as allowed by law,always obtain a waiver signature from the subject of the request. Waiver Release:Ihereby give permission for rho above requesting official to conduct an Iowa criminal htstoiy rccord check with the Division of criminal lwesugaslon(ACI). Any criminal bistoiydelecoaandngntoihaltematnlalned1 I a my ba refrascd as&io\ycd by low. Waiver Signature: _�C .61v „ .. - - . / • Iowa Criminal fi Wiott Recor°ai Cheek Resuli6 (Dataonly) . As of /---\12-b\V , a search of the provided name and date of bath revealed; _- • :: W No Iowa Criminal History Record found with DCI c', —. c'1 '9 -IC a Eu 7 El Iowa.Criminal History Record attached,DCT# _ _ •• .0 r' iNj • — 1'— DCI Tallith 1 • Received Time—Feb. 18.-2014— 1 :41PMr-No. 3199 eIuwAooT ':: www:lowadOta SMARTER GSIMPLER I CUSTDMEWDRIVEN _Office of Driver Services RC)Box 921341 Des Moines,IA 50306-9204 Phone;515-244-9124!.806-532-1121 I Fax 515-239-7837 ww&iowadotgoi Certified Abstract of Driving Record Inquiry Date: 2/26/2014 DL/ID S: 662YY1237(IA) Customer I: 1895748 Name: Nguyen,Son Minh Class: D ID Status: None : Address: 2557 INDIGO DR Audit iT: 6884444 DL Status: VAL Issue Date: 04/23/2013 CDL Status: None City/State: IOWA CITY,IA 522406824 Expiration Date: 08/01/2016 Col Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2557 INDIGO DR Restrictions: NONE Restriction None . Date of Birth: 8/1/1966 Supplement Mailing City/State:IOWA CITY,IA 522406824 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 07/03/2009 --107/27/2009 592 Speed(10 mph&under in 35-55 mph zone) JohnsonIA _I 08/02/2009 166/25/2009 592 Speed Johnson JA I 09/25/2010 _10/25/2010 _ :593 kneedJohnsonIIA 01/302012 02/20/2012 .592 {Speed :'Johnson ':IA__ 01/30/2012 102/20/2012 (Miscellaneous Johnson iIA _ 11/26/2013 {01/06/2014 :592 {Speed 'Scott ;IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/25/2010 '592868 _—_— —�-_ SIA _ __I 02/19/2012 _._-_.�__.__.__ .___ _-1675679 -----_..—__._..— ,iIA. Name:Nguyen,Son Minh DL/ID:662YY1237 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 art 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: o,0�+ ^ `(per 2/26/2014 Q:'IOWA ,a clip O.TI i ffiSeres M1YH-gyp IowaOce DepartmentofOriveer of rviTransportation Name:Nguyen,Son Minh DL/ID:662YY1237