HomeMy WebLinkAbout14-028 Authorization Number / _o?
1 1 (Office Use Only)
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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 `
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First S '"� Middle ` LAct 4- 5 Last t\ Z-A1
17--Name
2. Mailing Address ` \ 1"�' 1 Gr 4 /t ? ‘11(c
3. Telephone: Home I ) ( \ \� -�c1 t1 Other:
4. Prior experience in transportation of passengers: v(^6" C / E- 'A AAA OAst 2 t ct
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? v C
Type of offense Where When
6. Have you convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? y '—
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Jv V
Type of offense Where When
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
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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)
cierwiaxld,4bada 03/2013
I hereby, ce i t I j.(� e issued to me by the Iowa Department of Transportation a valid Chauffeur's license nurnber
`A (r, 7 . 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 recor s and documents relating to this application, and I further agree that, if a license
is granted, to comply at all times wit :II he provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant / Date a/' 1 I
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by -eci v, . P0 e�I b✓� . On this 6 Li-at day of
Notary Public in and or the State of lo I:
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�', '� CoCommtsslon My CommtssiNu•beEx ire9428�s
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-lf----------- 2 /y /SiignatuofPolice 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.
„/ „.., ),1-1
Sign ure 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
Jan: L31 L20 4 3:22PMI CDitvyof Cin iminalrInvestigatioy NNo. 8302 PP . � 1/1
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: ---a sTATE OF WA 5it,t ' %g ,:;
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:� dl Criminal! History Record Check ri?,:--:yr,; '"
r ,.;t7,..11) Reque t Form,
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OCTAccountNumber: N bb.2- "1~
(Itepplicsbit)
To: Iowa Division of Criminal Investigation b'rom: City of lain City
Support Operations Bureau,l"P'loor City Clerk's Office
215R'Ph Street . 410 B.Washington Street
Des Moines,Iowa 50319
(515)125-6066 Iowa City, IA 52340
(515)725-6080 Fax
Phones 319-3563041
, Pax: 3193564491
I ant requesting an Iowa a'Inrinal liistolyRecord Check on:
Last Name(taodeters) First Name(mandatory) Middle Nanao(rccommcndcd)
ik
5-€411
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Date of Birth(mandatory) Gender(mendemy) Social Security Number(recommended)
10 / 3 a 13 0 (m1 160 MaleOk'ewale (i 2 66' Mol-—103
Waiver ritforf laaion:Without a signed waiver from the subj ect of the request,a complete criminal history record may not
be releasable,per Code of Iowa,Chapter 692,2.Per complete,criminal history record Information,ate allowed by)aW,always
obtain a waiver signature from the subject of the request.
Waiver.Rerea5e:Ihcrebygivepccmissionteethe above I estingofficial mconduct en Iowa rill-Moat history record chedewitththe Division ofCriminal
Invesagatron(DCU. Any uim(nal history,data contenting mo l Is maintained by Ow DCtmaybo released as allowed by law.
Waiver Signature: 1 LAS G.--`
- Iowa Criminal}Blistery Record Check !aesu11t6cidtsa ay) cr,
As of I' i 1-1Y :r
a seljrah of the provided name and dale of birth revoaledl ca Ch N c2 n
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a No Iowa Criminal Hisfory Record found with DCI a DC • c`�
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El Iowa Criminal History Record attached,DCI#
DCI initials ( .
ieceived.,jime;,Jan, 28,,;,2014— 3:42PM-111o. 1639
Page 1 of 2
...911Iowa Department of Transportation
111 Office of Driver Services (Toil Free)800-532-1121
PC)Box 9204,Des Moines,IA 5031)6-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 1/28/2014 DL/ID #: 433YY0367(IA) Customer#: 980244
Name: Nealon,Sean Francis Class: D ID Status: None
Address: 2401 HIGHWAY 6 E APT Audit#: 6441766 DL Status: VAL
3416 Issue Date: 11/03/2012 CDL Status: None
City/State: IOWA CITY, IA Expiration 10/30/2017 CDL Cert None
522406788 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: Corrective Lenses Restriction None
3416 Date of Birth: 10/30/1969 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M
522406788
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
09/24/2009 T09/28/2009 M14 Fail to Obey Traffic Sign/Signal JJohnson :IA T
07/27/2010 08/12/2010 592 Speed _^ MO
05/12/2011 05/16/2011 592 ;Speed (10 mph,&under in 35-55 mph zone) Johnson 'IA
03/04/2012 ,03/12/2012 M14 Fall to Obey Traffic Sign/Signal ilohnson 11A
04/09/2013 ;04/12/2013 M14 ;Fall to Obey Traffic Sign/Signal Johnson 'IA
Name: Nealon,Sean Francis DL/ID:433YY0367
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:
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al IOWA l e cern/ is ,t
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,I�iCpf 4RNE�g owOfficeof Driver a Departme Departmeof nt
Name: Nealon,Sean Francis DL/ID:433YY0367
1/28/2014