HomeMy WebLinkAbout20-002I l l
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
IDENTIFICATION NO. _',-t;p - �7bd-
(Office Use Only)
APPLICATION FOR TAXICAB / 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
First
Middle
1. Name (REQUIRED) FA dnI C zf/ A kc� S/ 'I t/C t-
2.
2. Address (REQUIRED) S. +h /j Jr /c �4 c , T-� 1,4
5 .2-2c/0
3. Contact Information (REQUIRED) Email: oer4 c:l5 t°SPs Cell Phone: 3/1I -%Y/ - t/62
(All written communic6tion sent via email)
4a. Driver's License expiration date (REQUIRED) G2-/ (A /2 S
b. Taxicab Business Name (REQUIRED) `�& L -t c ,; Cq n
5. Prior experience in transportation of passengers: r 'tx/ D2 i ,rc w- i ,v rn.-r k c i T"
F )}t dYL 2 4 DC (-A
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? AUU
Tvce of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? ^IC)
Tvce of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N�
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)
AJJ
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
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 Department of Transportation a valid Driver's license number
h�4 �a5.�� issued on'L/-'+/1 f expiring on c) /r'2/-2 . I understand that if I
falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions of Title 5, Chapterjthe City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Date
STATEO� FIO )
COUNTY OF JOHNSON ) 3
Subscribed and sworn to before me by Ta u f S S . �C� 65rau 5 on this day of
�,,W�o� i -o
d'�F. ro W tsNDY ars S E29�28 t -A) !L p� S
Notary Public inAnd for the State of I
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that
there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Driver's license /:R
/ l Iao
Sig atur I' Chief or designee 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.
:ar
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Ge*N"DRNBADGEAPPL9201Beme ded.DOC
I - 3 -1oJ
Date
04/2018
Criminal History Record Check-
DISCLAIMER
Tpis respohso can only.include public criminal. history data, Under Iowa law, most
jOvenile records are confidential: Confidentlal juvenile court.records, If any, cannot be
included In thlb response. A signed release authorization Is not sufficient to obtain this
Information from the Division of Criminal Investigation, In order to request the release of
confidential juvenile records, if any, an application must be filed pursuant to Iowa Code
section 232.747(76).
Additionally, criminal history data conceming convictions for certalnjuvenile sex
offenses can be found on the Iowa. Sex Offender Registry.
hnp://wwwdowasexoffender com/. However, even though some information is available
on this site, the actual records for juveniles may still be confidential and any confidential
juvenile records cannot be provided with this record. In order to request the release of
confidential juvenile records, if any, an application must be filed pursuant to Iowa Code
section 232.147(18).
C'JIGWADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN
www lowadol"gov
Driver a Iderifficaftri Sonic"
PO Box 92011 Des N*,M IA 6()966.9201
Phone; 516.244.91241 FioG 618.239.1637
Certified Abstract of Driving Record
Inquiry Date:
1/3/2020
DL/ID #:
434ZZ0578 (IA)
CDL Permit Class:
None
Customer #:
4732685
Class:
D
CDL Permit Issue
None
Date:
Name:
Parsons, James Samuel
Audit #:
4102518
CDL Permit
None
Expiration Date:
Address:
801 S 7TH AVE
Issue Date:
08/21/2019
CDL Permit
None
Endorsements:
Expiration Date:
02/12/2025
CDL Permit
None
Restrictions:
City/State:
IOWA CITY, IA 522406205
Endorsements:
Chauffeur 3
ID Status:
None
Mailing
801 S 7TH AVE
Restrictions:
Corrective Lenses
DL Status:
VAL
Address:
Restriction
None
CDL Status:
None
Mailing
IOWA CITY, IA 522406205
Supplement:
CDL Permit Status:
ELG
City/State:
Date of Birth:
2/12/1981
CDL Cert Status:
None
Sex:
M
CDL Med Status:
None
History Information
CLEAR DRIVING RECORD
Name: Parsons, James Samuel DL/ID: 434ZZ0578 (IA)
Pursuant to Iowa Code 4321.10, I, Darcy Doty, 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: Parsons, James Samuel DL/ID: 434ZZ0578 (IA)
1/3/2020
A212
Z -)L
Driver & Identification Services
Iowa Department of Transportation