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IDENTIFICATION NO. Zd' d5 5
(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)
CITY OF IOWA CITY
410 East Wasl ington Street Failure to complete the "required" information will result in denial of the application
Iowa City. lorea 52240-1826
(3 19) 356-5040 Last
(317) 356.5477 FAX
1. Name (REQUIRED) _<
2. Address (REQUIRED)
3. Contact Information (REQUIRED) Email
4a. Driver's License expiration date (REQU
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of pa
First
Middle
Cell Phone K— 6^ 2 1 - �UDb
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
i
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? /Jo
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other_
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? d
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)
//d
(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 herebyertlfy that I have Issued to me by the Iowa De a entof Trans ort a vvalidDrive understand unse thatmbf I
ig�er
� � 88 f-7 Issued on /..expiring
falsely answer any questions In this application, that this application may be denied. I agre 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 taxlcab driver Is granted, to comply at all
times with all of the provislo of Title 5, hapter 2, of the City Code. (Needs to be signed In front of a Notary Public)
Date —L
Signature of Applicant
1RY4NYt}#4Y4#I#}11Y4R4#4#Yf1l4YY44##R4R4thh4R441444 M,44HYRh41'k#1#tYfh#4f#4M144#I4f#Y}4!4#4#h14t}#R14fH#t44RNlk44k}#htM#ff#4f#t##h###f#4YY#'Y
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by
on this day of
Cei�S'F]
4#4hhhkhkk4'hhkkkhk#-k4h*k4k4#kfF:44,tMhhh#kM#Fh#d#k4R#fkM:khkhhk4kMktkkhkk###*#kkk#4k'#YhhhkNkk+#k444,1#hk#hhf4khhf14#h#kkhkR#k}hkk#h4*Rkk4hkhhM#kk
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 47
t /ZY r a r 2_0
SIgnalIFFe of Police Chief or designee Date
G
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWACITY FOR NO
MORE THAN ONE YEAR FROM THY -DATE LISTED BELOW.
ylz� 'T-
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f .IT'ty CInr nr deslanen Date
Office Use Only
Approved application
DCI report
Slate certified driving record
Website update
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DISCLAIMER
DCI IOWA
No, 5309 P. 2
This response can only Include public criminal history data. Under lows law, moat
Juvenile records are confidential. Confidential Juvenile court records, if any, cannot be
included In this response. A signed release authorization Is not sumclent 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 flied pursuant to Iowa Code
section 292.147(18).
Additionally, criminal history data concerning convictions for certain Juvenlle sex
offenses can be found on the Iowa Sax Offender Registry:
hH-6.51' Jowaaaxoffendar.com/. However, even though some Information is available
on this Siff, the actual records forJuvenllas may at/// be confidential and any confidential
Juvenile records cannot be provided with this record. In order to request the release of
confidential Juvenlle records, If any, an application must be Bled pursuant to Iowa Code
section 292.947(18).
C410WADOT,Nwwiowadot ov
SMARTER I SIMPLER I CUSTOMER DRIVEN g
Dinar a lama leaYon $0100e0
PO Boot SM i Des Moines, IA S09 &SM
Phone- 515-2414-9124 IF= 5152991837
Certified Abstract of Driving Record
Inquiry Data: 11/23/2020
DL/ID #:
Name: Kacer, Geoffrey Neil
Class:
Address: 2110 N DUBUQUE
Audit #:
ST
Issue Date:
196AD8857 (IA) Customer #: 3646257
D ID Status: None
3468586 DL Status: VAL
12/14/2018
City/State:
IOWA CITY, IA
Expiration Date:
12/04/2024
522451624
Endorsements:
Chauffeur 3
Mailing Address:
2110 N DUBUQUE
Restrictions:
NONE
ST
Date of Birth:
12/04/1975
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522451624
History Information
CLEAR DRIVING RECORD
Name: Kacer, Geoffrey Neil DL/ID: 196AD8857
CDL Status: None
CDL Cert Status: None
CDL Med Status: None
Restriction None
Supplement:
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
Departmentof 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: Kacer, Geoffrey Neil DL/ID: 196ADS857
11/23/2020
A212ebL
Driver & Identification Services
Iowa Department of Transporation