HomeMy WebLinkAbout14-036 • r Authorization Number it/ —3 t o
_ i (Office Use Only)
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 Cit Iowa 52240-182(?
9) 356-5040 1 urs
(319) 356-549-7-FAX
First Middle Last 'TSS 1<
1. Name I��er - ( e'-- /
2. Mailing Address b I �1/UQ/S{>N V" S 1) -
3. Telephone: Home 3 1 3b 27‘9 Other:
4. Prior experience in transportation of passengers: NIA
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A'/A
Type of offense Where When
6. Have you bee�convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? AJ/ 4
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A-//4
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)
clerkltaxidrivbadg 03/2013
-
I hereby �rt r
that I _have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
Lf I I '3 I ) . 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 /--/'e -- 7-K 7sc : Date :J 4- Z("�
. ,
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by H c,,,,`1 1 • T Q, . On this c `-r<J'. day of
ran fa�� ad)q- .
Notary Public in and fo ale State of Iowa
4,,,„,m VV NUY S MAYE R I
i.. Commission Number 729428
• My Commission Expires
*******,a +************************** *****************************************************************************************************
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�
Signa a of Po>e,'hief 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.
2 i
Signatur 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
clerWtaxidrivbadgeapp2010.doc 03/2013
• Feb. 17. 2014 1 : 00PM1 Div of Criminal Investigation No: 3070 P. 1
`
,
,s � STATE OF IOWA ..0.h.. °,
o IA Crfimuinall History Record Ciiecs . ` r- rf.4
t: v „ 1 .i'' ,.:.
Ar
/ Request Form , ;, /
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DCIAecountNumber: 'o2" F
(itapplicable)
To: Iowa Division of Criminal Investigation From; City of Iowa City
Support Operations Bureau,la Moor City Clerk's Office
215 E,7th Street 410 E.Washington Street
Des Mo Ines,Iowa 50319
(515)725.6066 Iowa City, TA 52240
(515)725.6080 Fax
Phone: 319-356-5041
• 319-156-5497
. Fax:
I am requestingien Iowa Criminal Ilisto _Record Check on: .
Last NAM (mandatory) FirstName(mandatory) Middle Name(rccomucoded)
—Ret' Pen* — (ser •
•
Date of)iirtb;(mandatory) Gender(mandatory) SocialSecurityNumber(recommended)
/C//0�l�gs 2/Male (Male ° emale 1 — ( 7." o 83- I •
WaiverInjbrmaPlon:Without n signed waiver fro iu tilesubject of the request,a complete criminal history record may not
be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record Intbnnatlott,as allowed bylaw,always
obtain a waiver signature from the subject of the request.
Waiver Release:ihere6yalvopumbsronforlinobovotequestingo®ciaitoconductmIowacriminalIdstotptccotdchuckwiththoDivisionof riminal
Investlgation(DCo. Anyalminelhistoryddeconcendngme;hntlsmalnlornaby11w101may6orokasedasallowedbyiew.
Waiver Signature; 1(6 — 25', . 75.4;
- Iowa Criminal History Record Check Resulti (Dalin ealy)
As of it.in \ALI , a searoh of the provided name and date of birth revealed: r;c.. m <-
rn C7 cit —
urn --- =7 I.
mac) IV :CYC::
No Iowa Criminal History Record found with DCIg •
me _)
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.6-74:1 1` +r
El Iowa Criminal Iiiatory Record attached,DCT# 2.3- N v
DCI initials Vt,
f eceived Time—Feb, 12. -2014— 3: I6PM—No, 2790 •
Iowa Department of Transportation
. ill Office of Driver Services (Toll Free)800-532-1121
\impPO Box 9204,Des Manes,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 2/12/2014 DL/ID#: 416AF3153 (IA) Customer#: 5601353
Name: Tsai, Heng Tser Class: C ID Status: None
Address: 461 WESTWINDS DR Audit#: 4176732 DL Status: VAL
Issue Date: 03/12/2010 CDL Status: None
City/State: IOWA CITY,IA Expiration 10/10/2015 CDL Cert None
522462749 Date: Status:
Endorsements: NONE CDL Med None
Status:
Mailing Address: 461 WESTWINDS DR Restrictions: NONE Restriction None
Date of Birth: 10/10/1985 Supplement:
•
Mailing City/State: IOWA CITY,IA Sex: M
522462749
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
10/09/2010 10/29/2010 X515 Speed IL
Name:Tsal, Heng Tser DL/ID:416AF3153
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:
t>'''CI .-*1"a 2/12/2014
VD. 0. T.
-tes:;" astrocuirk
kr..
� of Driver
j1% RRM%S IowaOeDepartme tervices of Transportation
Name:Tsai, Heng Tser DL/ID:416AF3153