The URL can be used to link to this page

Home My WebLink About20-027ir'lll� CITY CITY CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) - IDENTIFICATION NO. a0-0,72--1 (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 3. Contact Information (REQUIRED) Email: 4a. Drivers License expiration date (REQL b. Taxicab Business Name (REQUIRED) Middle Phone: i/'521 I?--K'�(oZ sent 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 0 What happened to the charge? (Circle one) Convicted smissed Deferred Suspended Plead Guilty Other 7. Have you been arrested I charged with any traffic offenses in the last five years? /V! D Tyoe 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? TVDe 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) KP (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 ebby certify that I have issued to me by the Iowa Department of Transportation a valid Drivers license number q5 TA Ru9 .5— issued onzexpiring on �6,1L7 / S`2 I understand that if I falsely answer any questions in this application, that this appli ti May be denied. I agree at 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, Chapte;,2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ��%� Date &- 5-- Zd STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by on this Public in and for the State of Iowa day of I have feviewe lihis-iWiicalion, DCI report, and the State certified driving record of this applicant and have determined that there is no info -R ation which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the CIN of Iowa City (Title 5, Chapter 2, City Code). \I Expiration date of Driver's license lc)lz--Z-4�;2 g� of Police 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. Office Use Only Approved application DCI report State certified driving record Website update Date Clerk/rAXIDRN GF PL9201B .m ed.DOC 04/2018 ONJ un. 8. 2020 9:32AMpb DCI IOWA i.l_:�►fDFvl Sa�q M Opi 215 $ 7'bft 50319 (6{>)Q,7U4M Fax fAMa79B9No. 2775 r; 'STATE OF IOWA CrtmftW El(story Record Check Request Form P. 2%"Uoo3 iureogadan Lu, laruor •DQ Account Number: 9967-F ofs pliad,ia) Name YeBd'w,Cab of Iowa Ca Addraa P.0.8ox478 Iowa City, Iowa 51744 Phone 19 338yn7 Fax 319.359.4142 —' ..fi i�co ulW (IX9twtd� As of JUN 0 A 2020 a w search of the provided n.a and date ofbirth ravealod: `` `' > zit ji---No Iowa CnMfi A] History Record found with DCI w Fr Iowa Caiminal History Record attaehad, DQ #;r-klp r' }�.`;, 0 DClinitial8.� ,,r, rtipg rr"rr4+annum DM -77 (updated 06-26.2019) Received Tiffe Jun. 5. 2020 12'.11PM No. 2700 Page 1 of 2 C410WADOT www iowadot ov SMARTER I SIMPLER I CUSTOMER DRIVEN g DrhW 6 ldwwxa~ $Mims Cn PO Box 9204 i Des Moines, IA 5090&WU phone 515-244-91241 Fall 515.299-1897 1. �� Certified Abstract of Driving Record I Ifigdiry Dates ` 0/5/2020 DL/ID #: 438AR0195 (IA) Customer #: 6973938 Nadte: c UKir�-Tempest, Class: C ID Status: None o Xawer Jason Anton Address: 624 Summer S[ Audit :C: 4380195 DL Status: SUR Issue Date: 12/06/2019 CDL Status: None City/State: Burlington, IA Expiration Date: 10/22/2027 CDL Cert Status: Excepted Interstate 526014054 Endorsements: NONE CDL Med Status: None Mailing Address: 3575 McCormick Restrictions: Commercial Learner Restriction None blvd # D203 Permit, Corrective Supplement: Lenses D203 Date of Birth: 10/22/1979 Mailing Bullhead city, AZ Sex: M City/State: 86429 History Information Convictions Citation Date I Conviction Date I ACD Explanation iCounty JUR 112117/2019 101/29/2020 S92 I Seed I HenryIA No Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 05/13/2019 05/14/2019 W00 No WI Corresponding Iowa Offense Suspended 05/28/2019 06/05/2019 W00 No WI Corresponding Iowa Offense Name: King -Tempest, Xavier Jason Anton DL/ID: 438AR0195 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: C) 3... CI NKing-Tempe Xdvier Jason Anton N d N DL/ID:438AR0195 6/5/2020 P1112orm Driver & Identification Services Iowa Department of Transporation