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HomeMy WebLinkAbout22-005 4, IDENTIFICATION NO. 22 -00 S t r 1 (Office Use Only) 4: .=1-40r;ilia,1 ft. moan/Ply ��_ 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 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1 826 (319) 356-5040 Last First Middle (319) 356-5497 FAX 1. Name(REQUIRED) C. Wf r , 1 \ Xrt'clus , \1V 1 11 auk ) 2. Address(REQUIRED) CID S W PA TekkAciv._ scb.eee, # 4.3i `t t..& C. Cake, ' t 3. Contact Information(REQUIRED) Email: Cell Phone31q'La>' 58.- (All written communication sent via email) Te� // 4 viess�e_i p�z, 4a. Driver's License expiration date(REQUIRED) © `t'1 `�01`tT -,b . f b. Taxicab Business Name(REQUIRED) 131 Ol my. Tdt)c I Coo A 5. Prior experience in transportation of passengers: OW.- C‘ 'e-LIoW Tc- \oo l. ‘no-- ckt-;veA-- 7 pass e-4- \ , C 043 p; `1-,e W.Q SPr' C e W u/L. rived- iCIS i)as- re "� 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Febgi .QrnseSiOKIV ivy .�o ae.;u9l-, ( Cote � , �, j} 5, 6 �� I scl ixor- F wti I our- itom K. P l� Ike 0 " ' j�e ,. What happened to the charge?(Circle one) — CJuS 1 r Convicted Dismissed Deferred Suspended Plead Guilty they WD to 7. Have you been arrested/charged with any traffic offenses in the last five years? KI 0 1 Type 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? K-01 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) No , (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 certifythat I have issued to me by the Iowa D pa ent of Transportati n valid Driver's license number ra co5 13 issued on 0 07, expiring on p 7.017.0X10. 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, Chapter 2,of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ,r � 4� *ii ? /7/?. Date QS cs(W�r STATE OF IOWA ) COUNTY OF JOHNSON ) 6 Subscribed and sworn to before me by I\ub(A13 Li . �� on this 6/51 Zz-- day of rWENDY S.itAAYER729 Cornmipion Numi7u 42$ 1 • MY Go iseio�l No ary Public in a for the State of lowa(3 1 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 07 /aO/0-?Vo?lO / yt,-:11 7V. 3—/C/e,112- ' Si..- . - of -,:ice 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. .._ cle /2 -2.— i / I Ni.. ...0 Signature of (���.r . gnee O¢.,,.Uer Date ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 mY I SMARTER I SIMPLER CUSTOMER DRIVEN, _w DriveT S icialffication Seivklas I Deslit sIn i 5 4 '.lime;5"15-244 912 4 J Fax 10-23$-18 Certified Abstract of Driving Record Inquiry Date: 5/5/2022 DL/ID#: 250AP5873 (IA) Customer#: 6727356 Name: Carr, Marius William Class: D ID Status: None Address: 905 W BENTON ST Audit#: 4928804 DL Status: VAL APT 13 Issue Date: 09/02/2020 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 NOi'te APT 13 Supplement: `H.-;'„.,. Date of Birth: 04/20/1954 Mailing IOWA CITY, IA Sex: M City/State: 522465935 0-1 History Information CLEAR DRIVING RECORD Name: Carr, Marius William DL/ID: 250AP5873 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: {„,sqe OF rfq, 5/5/2022feD, Driver&Identification Services oNt DEC Iowa Department of Transporation Name: Carr, Marius William DL/ID: 250AP5873 May, 3. 2022 12: 39PM DCI IOWA No. 0835 P. 4/7 fendy Mayer CityofIowciCity (2/2) 05/02/2022 09; 11 : 15 AM -0500 IF V" STATE OF IOWA ,� : 04, - Criminal History Record Check Request Form ‘ -, rpn,v DCI Account Number:,. 4 1"-r. , (if.applicable) _ ,jy W,j•-• - • . , Send results..to:,, Iowa Division of Criminal Investigation Name , iCY 0 ow r=n -Cd4 ,,,,,,.-- . Support Operations Bureau,1't Flour City Clerk's face 215 E.7 Street th Address t 4,1.4 Iiii. pielal ° - i ,,,,K.., Des Moines,Iowa 50319 (515)725-6066 ;;Iowa..,•Citv,i.,Zil ,52. (+Q " (515)725-6080 Fax phone • 6: ,, _r _ •-,_ .-- I amW', if"- ,0" n'mn1,?a1 ' . ,t. , - -- . , , ,.. .tile dame otemended • Cherk on;r de : First Name r ,--.. .., .�.^, Las-IT-Name .� :� . .. n_ r ender(mrindetnrY afal ` .i .a Number Z.; s i 1:"v4 - ,.., Date of Birth �� �,.. .. .�_.,.,,,,-• �... `R 'r '�.• •,a ,•, r S ` ❑Femaie - — m : :.RedeascAutl�orization:Without,'signed release Frain the subject of the request,a complete criminal lilstory_record may not be releasable,per Code of Iowa,Chapter 692.2.For'' : ;'.eriminel history record information,as allowed by law, h always obtain a signed release�from the subject of the request, i i *W*This form t i •- .77.:is the o - , i !roved , ;se authorize I on form for this ., 5Ifs e*.***-._.,..- Release Authorization: I hereby give permission for the above remits ring official to conduct an Iowa criminal history record clock with the Division of Criminal Investigation(DCI)c:,Any criminal Mot),data*oncoming me that is mainttaimsd by tltc DCI may he released a allowed by law, I understand this can include ! information concerning completed deferred judgmento and arrests without dispositions. Release Authorization,Signaturet �•.. r,- -- ,4 .�4,a,, r: ,• -4.,;.^Lf a�_ �,{b.it^tl ; • nnun , r= ' R Iaecord Cheek.:: •e $-' (DCI osa only) 1 As of -�,r '.,9 a___ a search of the provided name and date of birth revealed: ;1 o . z 114 No Iowa Criminal History Record found with DCI . .IL C7J \\\\\,. Ukk Wtutl1ultrtr1444/u >_ U �. tic�Of Cn1 j El Iowa Criminal History Record attached,DCI# . DCI initls ,, Enlva sUl ts• � "s ACI-77(updated 06-26-2018) �'s,.. 07 -...••e,�-•,0�' `��. age 1 of 2