HomeMy WebLinkAbout21-008IDENTIFICATION NO. 21- Q Q
(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
4 10 Easl Washinglon Slreel Failure to complete the "required" Information will result in denial of the application
Iowa City, Iowa 52240.1826
(3 19) 356-5040
(319) 356-5497 FAX Last First Middle
(
1. Name(REQUIRED) _OOf hEAD R6DEkIC (< C
2. Address (REQUIRED) % L / kiR1(Woop til•( E
3. Contact Information (REQUIRED) Email: rocicl O6 C- %�c . (,orn cell Phone: 173
(AN writbaln oDmmunichbon sent via email)
4a. Driver's License expiration date (REQUIRED) Zr� p� • m
b. Taxicab Business Name (REQUIRED) 1rELLou) ('AK ioYJfl Gr7Y
5. Prior experience in transportation of passengers: USER ��1llF K tg @ 9 X981
City er
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
DWESTI <. ('NICAUa�1L lac
What happened to the charge? (Circle one)
Convicted ismissedl Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? /V
Type of offense Where When
RA
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?
Type of offense Where When
FW
hen
1ti1 Iv1Cr4L r6SPoIjS(FGITY ��lrc�rc L�
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
No
(SECOND PAGE FOR REQUIRED SIGNATURE ANn NnTerxvi
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 here certify that I have issued to me b ithe ssuedon/ tlartment of 0<' xpidng ono Transportation aZ02Driver's
l understand that If I
�o9A N G0, 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 empJpyon,saof the City
rth r agre at, Iowa if author zat on t, Iowa, in their o beea taxicab driver is granted, to comply at ation, to examine any and all records ll
documents relating to this app ii
times with all of the provlsio s o itl/��5 Ch�apt 2, of a City Code. (Needs to besignedIn front of a Notary Public
f
Date I � 0LlO
?44
Signature of Applicant
f1HtfHIHlIffNH1YHHYfff HHefif fH1ff YffHNfflMtf Hf Hlfff111ffH11HNffltffMlHfNfff}fR11111N1N11f I,khflNlfllfl.HlfHHtNfHNf1f
STATE OF IOWA )
COUNTY OF JOHNSON )
on this day of
Subscribed and sworn to before me by
Public in and for the State of Iowa
fHflfNltffl*itNN1ff11f f
I have reviewed this application, DCI report, and the State certified driving record of this applicant and It , jele"Med that
there is no information which would indicate that the issuance would be detrimental to the safety, heal or welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code). ;,,y 1
r ,owa City, Iowa
Expiration date of Driver's license /� " �!> '�
CMZ �j- 7
Signature of Police Chlef 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 DAT ISTED BELOW.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Date
Cie WAKIDRNBADGEAPPLMiSe nded.DOC 0412018
CJDOT
SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov
Driver d Idonliftation SetVkes
PO Box 92011 Des Wines. IA 5030&9204
Phone 515-254-91211 Fax 515-239-1&17
Certified Abstract of Driving Record
Inquiry Date: 2/8/2021 DL/ID #: 509AS6031(IA) Customer #: 7036023
Name: Moorehead, Class: C ID Status: None
Roderick Christoph
Address: 721 Kirkwood Ave Audit #: 5096031 DL Status: VAL
Issue Date: 11/04/2020 CDL Status: None
City/State: Iowa City, IA Expiration Date: 11/05/2028 CDL Cert Status: None
522404667
Endorsements: NONE CDL Med Status: None
Mailing Address: 721 Kirkwood Ave Restrictions: NONE Restriction None
Supplement:
Date of Birth: 11/05/1967
Mailing Iowa City IA Sex: M
City/State: 522404697
History Information
�F I , 01
CLEAR DRIVING RECORD
Name: Moorehead, Roderick Christoph DL/ID: 509AS6031
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: Moorehead, Roderick Christoph DL/ID: 509AS6031
2/8/2021
C�
Driver & Identification Services
Iowa Department of Transporation