HomeMy WebLinkAbout20-025� r 1
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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
IDENTIFICATION NO.
(Office Use On y
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
(319) 356-5497 FAX
1. Name(REQUIRED) (16Lt-r. p Marcus, wt01OL/A 1
2. Address (REQUIRED) %S Vv PI Bet-totA sh-yi4,413, TomYL ILL Dun. 5=4{0-5q-3
3. Contact Information (REQUIRED) Email: Cell Phone:
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) k
b. Taxicab Business Name (REQUIRED) - I -CL Jt
5. Prior experience in transportation of passengers:
6. Have you ever been
Type of offense
(O�LOIL985�
What happened to the charge? (Circle one)
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any misdemeanors and/or felonies in
Where
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or elsewhere?
When
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Convicted Dismissed Deferred Suspended Plead Guilty Other ND(v &1\412044n
Have you been arrested ! charged with any traffic offenses in the last five years? Cl .
Type of offense Where When "
What happened to the charge? (Circle one)
o_
Convicted Dismissed Deferred Suspended Plead Guilty Othe��
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N,0,
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)
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 D pa ent of Transportation a valid Driver's license number
ti 50 P 58? 3 issued on CO) ltA42Mexpiring on 0440?4C'Z , I understand that if I
falsely answer any questions in this application, that this application may be denied. I a ree 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, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature ofApplicant� Date 0-1)2C,
----------------------- ------- �^.. ...........,..............
STATE OF IOWA ) 1A-3ai'VfA '�-O COVID - /q {?Ut=4ic-
COUNTY JOHNSON ) (�jy�CQ� yts. Y -.r-
Subscribed and sworn atoLe me by an this
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 Drivers
03
Signature o ice Chief or designee Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWAC_TY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
n / r Irl
Approved application
DCI report
State certified driving record
Website update
Office Use Only
Dates
GeMgA%IDRIV& DGWPL9201tla del DOC 04/2019
V.11 r...rrry •�.... ,.rrd bOY
V�Wisa a.,._
STATE OF IOWA
Criminal History Record Check
Request Form
r
DLI Accoant Number. 9967,E
r Pzx feted foffis to:(ifepvlasble)
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Iowa Division of Criminal Investigation
ftPPert OPeratlons Tioreau, la Floor
215 2,"8treet
Des Moines, Toga 50319
(515) 725-6066
(515) 725-6060 Fox .
Name ]'endo Gs6 of Tows '
Addrete P.O. Sox 4241
Tows City, Tows co
5ZZJ4-
Phone 98-97 -
Pax Rim
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DCI -77 (vpdated 06-26-2o1g)
Received Time Mar. 26, 2020 2:07PM No, 5866
Pego I of 2
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As of �' a search of the provided namea>�2irthrevealed:
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No Towa Cttminal History Reooni found l}d
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Iowa G�iminai History Record attached, �Q�i , , i ,
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DCI -77 (vpdated 06-26-2o1g)
Received Time Mar. 26, 2020 2:07PM No, 5866
Pego I of 2
CZ10WADOT ,Nww iowado ov
SMARTER I SIMPLER I CUSTOMER DRIVEN g
Ddv/f a Iwurllicanon Smbim
PO Box 9201 I Des Moms. IA 50301
Phone 515-254-91241 Fax 51'5-29&1837
Certified Abstract of Driving Record
Inquiry Date: 3/26/2020 DL/ID #: 250AP5873(IA) Customer #: 6727356
Name: Carr, Marius William Class: D ID Status: None
Address: 905 W BENTON ST Audit #: 2505873 DL Status: VAL
APT 13
Issue Date: 01/30/2018 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 04/20/2026 CDL Cert Status: None
522465935
Endorsements: Chauffeur 2, CDL Med Status: None
Motorcycle
Mailing Address: 905 W BENTON ST Restrictions: NONE Restriction None
APT 13 Supplement:
Date of Birth: 04/20/1954
0
ry
Mailing IOWA CITY, IA Sex: M o
City/State: 522465935 .. 2 b
History Information �"�
C') N
CLEAR DRIVING RECORD �rrT 'o I r l
o s
Name: Carr, Marius William DL/ID: 250AP5873 c.Jl
rn
Pursuant to Iowa Code 4321.10, 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: Carr, Marius William DL/ID: 250AP5873
3/26/2020
Driver & Identification Services
Iowa Department of Transporation