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Home My WebLink About14-005 r Authorization Number !61 — 43 *...III ,.` _ 1 (Office Use Only) �1:11P�.®� ."6"t.ii16_ 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 — Y`lAir. ‘y --- /CrVe—: 2. Mailing Address \ 5 to c'c\S\ a c- j c- - 3. Telephone: Home( .`` `-\.O 0 ` 3 0 kir Other: i 4. Prior experience in transportation of passengers:-�; •. .L. -U c, �' �/ i�i 1 <a(,J \ rte."21--\ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ,ti 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? 1J c Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When \x_.) \,-4-.60--....„ t ca .�.�c�ev \� 3 a - SS 'Lti,r-,� L AV t V\43 C � \2 ( Q�,Zc�ti 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? tai 7- 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) c!er Utaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license ne.rnber 5-r) / fL 51 --j . I understand that if I falsely answer any questions in this application, that this application may be denie . 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 ,....0‘ `l \ - c.^-(\ Date 1I.-10I C l STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by S i c P , LiontA ALA-- . On this /0- 1,\._ day of C41.4.) u14 c9C1 t''1 1 , II i .../-9'141se fl mmLavnr Numt�er 72942$NDY S.MAYER ro—tary Public f and for the Stat:1sf Iowa . „. • .,,,,I • My Commission Expires iowik. -1-17i-1 UA 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). xf/ i_„—/, ignature of Police 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,z/ H' . -� 1 - 10 `1`"A Sign ture 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 cicrkltaxrdrivbaddcapp2010.doc 03/2013 ' Ja:n, '7. 2014 4: 13PM Div of Criminal Investigation No. 0010 P. 1/1 u L. eui4 J: tirdl vity wen( - Lit); of town telly iu. 4147 r. Z • • STATE OF IOWA Jy`' tt�s/ mirl ` Criminal History Record Check ; ;<:..� i1..`, Request Form ' �v: !t . J/ ' 4j Fi i;i:, ; DCI Account Number: WCX7F.,- (Itapplleable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,111 Floor City Clerks Office 215 D.7'h Street 410 R.Was)dngton street Des Moines,Iowa 50319 (515)125-6066 Iowa City, IA 52240 (515)725-6080 Fax Phone: 319-3564041 Fax: 319-356-5497 I am requesting an Iowa Criminal History Record Check on: • Last Name (mandatory) _ First Name(mandatory) Middle Name(teconm,ended) �� rr � WAMArly-NI Date JofBirth(mmdetory) Gender(mandatary) Social Security Number(recommended) 7/ 2 �^I1 5 Cs 1 Ei. de OFemale 0° ` y 23 — 02_ O Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa, Chapter 692.2.For complete criminalhistory record information,as'slimed by law,always obtain a waiver signature from the subject of the request. Waiver Release:I hereby gin permission for the above requesting official to conduct an Iowa elminal blew record cheek with the Division of Criminal invaelgellon(DO4, Any criminal history data concerning me Met Is maintained by Ilm DCI hew bo mimed as allowed by law. f� ,t Waiver Signature: `\ k, ),l erC vvJ-- W w92j.. Ak ens -- Iowa Criminal History Record Check Results ___ UUU (DCiuonly))y) r As of a search of the provided name and date of birth revealed; r m m n &FM I Om O� No Iowa Criminal History Record found with DCI �;n IN) :ti p -D co"'l art ' Sr.0 Iowa Criminal History Record attached,DCI# U I3 3 DCI initials �/ 'f!'--� Receivednfime7Jan..`2.q)2014 3:20PM No, 9750 0iiIowa, DepartmentServices of Transportation Office of Drive (Toil Free)800332-1121 PO Box 9204,Des Manes,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/7/2014 DL/ID #: 350AE5187 (IA) Customer#: 5506306 Name: Wagner, Eric Marlyn Class: C ID Status: None Address: 429 SOUTHGATE AVE Audit#: 7481883 DL Status: VAL Issue Date: 10/30/2013 CDL Status: None City/State: IOWA CITY, IA 522404401 Expiration Date: 07/24/2014 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 429 SOUTHGATE AVE Restrictions: NONE Restriction None Date of Birth: 7/24/1959 Supplement: Mailing City/State: IOWA CITY, IA 522404401 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 12/06/2012 01/02/2013 S92 Speed (10 mph&under In 35-55 mph zone) Wapello IIA Name: Wagner, Eric Marlyn DL/ID: 350AE5187 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: *Jl Lfgh, ."-;: .. 1/7/2014 Woi ;¢t. IOWA ",a �_.f "'se eLestik yet D. O. T. :�y �. y��+4� s fbf pR g Iowa Department Office of Driver eoflTransportation Name: Wagner, Eric Marlyn DL/ID: 350AE5187