HomeMy WebLinkAbout19-101�tJ4_
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319)356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED) _
IDENTIFICATION NO. (�
(Office Use Only)
APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
Failure to complete the "required" information will result in denial of the application
Last
3. Contact Information (REQUIRED) Email:
4a. Driver's License expiration date (REQU
b. Taxicab Business Name (REQUIRED)
First Middle
"oM
19 r/, ,&07 Cell Phone: Xf - q1d -SI, Z3'�
(All written communicatio sent via email)
5. Prior experience in transportation of passengers:
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
w
0
'., -
What happened to the charge? (Circle one)
Convicted Dismissed Deferred
— n w
Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense
What happened to the charge? (Circle one)
Where
Convicted Dismissed Deferred Suspended ead Guil Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
9. Havq you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
(SECOND PAGE FOR REQUIRED SIGNATURE AND
04/2018
Page 2
APPLICATION FOR TAXICAB VEHICLE DRIVER
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).
I hereby certify. that I have issued to me by the Iowa Depa ment of Transportation a valid Driver's license number
q 33zz q 6�6 issued on-4
expiring on e I understand that if I
falsely answer any questions in this application, that this applice ion may be denied. I gr 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 authorization to be a taxicab driver is granted, to comply at all
times with all of the provisio s of Tit , Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant ' Date 1Ti 23 /
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STATE OF IOWA )
COUNTY OF JOHNSON )
before me by I', 4,0,x, c71� �S on this 2 day of
ASHLEY A JAY-PLATZ
Commission No. 785030 Notary Public in Od e St o owa
July 14, 2020
I have reviewed this application, DCI report, and the State certified driving record of this applicapi and had determined that
there is no information which would indicate that the issuance would be detrimental to the safety_, R it or weHareof resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code). r
Expiration date of Driver's license
q col d�
Signatur Poli Chef or designee
L L'3
Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
of City Clerk or
Office Use Only
Approved application
DCI report
State certified driving record
Website update
��-a3-►
Date
O.NTA ORIVBADGEAP L92018amen0etl.DOC 04/2018
l2jDec_1 2019.11:•IOAKCab DCI IOWA fAR)9'IB3382No.2566 P „ J021002
STATE OF IOWA "
Criminal History Record. Check
Request Form
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DCI Account Number; 9967,F
• or Fax =210ted (Ifapplie�6le)
1ma to: i147rd#�Lta to;
own a oa o nm n v ga onName Yell w Cat of fowa Clty
Support Operations Bureau, V Floor
215.K Te Street Addran P.O, Box 428
Des Moines, Iowa 50319
(515)123.6066 Iowa City, Iowa 52244' " o
(519) 7254090 Fan g
Phone 1 (319)339-9177 W
Fax 319.3594142
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Aa of d�' fi' R a search of the provided name and.Atlxta;oveyltQf's
., TATE OF IOWA/t7P`•'i
No Iowa Criminal HWXY Record found with Dciaa DEC 1 6 2019
:,I,tStory re5u\ LhIV Of CRIMIn�AL. 1MV; :-"l
❑ Iowa Criminal History Record attached, DCI #
yV
Mlinidals_SIZ_ e'Yi7li4fl,t1�11{J'
DCI -77 (updated 06,26-2018)
Page 1 oft
Received Time Dec. 16. 2019 9,264 Na. 2063
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l10WADOT
www.iowadot gov
SMARTER 1 SIMPLER I CUSTOMER DRIVEN
OrH4t 6 IdmUftadon Sa viim
PO Box 92041 Des Moines. IA 50306-9M
Phone 515-244-9124 1 Fax 515298-1837
Inquiry Date:
Name:
Address:
City/State:
Certified Abstract of Driving Record
12/16/2019
Stokes, Christian
Cole
1432 VINE AVE
RIVERSIDE, IA
523279083
Mailing Address: 1432 VINE AVE
Mailing
City/State:
Convictions
RIVERSIDE, IA
523279083
DL/ID #:
433ZZ4046 (IA)
Customer #:
287962
County
Class:
D
ID Status:
None
Seed
Audit #:
1696997
DL Status:
VALo
Issue Date:
03/23/2017
CDL Status:
O Noneo
Expiration Date:
10/08/2022
CDL Cert Status: �lonp
I
,-�
-.
Endorsements:
Chauffeur 2
CDL Med Status:,.
Restrictions:
NONE
Restriction
- Non&
T
Supplement:
—� =
Date of Birth:
10/08/1971
Co
Sex:
M
W
0
History Information
Citation Date
Conviction Date
ACD
Explanation
County
JUR
04/28/2013
05/30/2013
S92
Seed
HenryIA
03/06/2019
03/27/2019
Improper
Registration
Johnson
IA
Name: Stokes, Christian Cole DL/ID: 433ZZ4046
Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation,
do hereby certify that I am the custodian of the records held by Driver & Identification 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:
Name: Stokes, Christian Cole DL/ID: 433ZZ4046
12/16/2019
, : -
Driver & Identification Services
Iowa Department of Transporation
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