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HomeMy WebLinkAbout23-002 11,1 r IDENTIFICATION NO. 23'0 0 Z A - i (Office Use Only) 4!� V tl Application Fee: $15.00 u i t 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) I INV Ong I Y Ylh Co vt71 2. Address(REQUIRED) 1 -t v1( P F- YaG buC 1/.61 6p ed �opv8 (,c,4y11J C 2 2 L, c 3. Contact Information (REQUIRED)Email: Cell Phone: 3 1 1-;,�0-(.LI C (All written communication sent via email) 4a. Driver's License expiration date(REQUIRED) 0 b/0 ..0.Z 6 b.Taxicab Business Name (REQUIRED) 0 'j t G{ -Te rt —rGLx I 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?,PO Type of offense Where When':... `' Ce t' —' '_xi What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other ' S 7. Have you been arrested/charged with any traffic offenses in the last five years? ./e ' Type of offense Where When ru.:I -tG ( la / V ! c j;3 i1 So 1,,,,,-:,6 n I I/( 1-1/.z o i 1 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? //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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 Pi* 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 a e issued to me by the Iowa De art ent of Transportatio a valid Driver's license number 9 3 2 Z C 7 � issued on Ct7/2.z�` expiring on ©" 0 2 . I understand that if I falsely answer any questions in this application, that this applic on may be denied. I gre 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 ° `i/41'j' INIAnine., Date l) - :4 5 as ** STATE OF IOWA ) COUNTY OF JOHNSON ) SRbscribed and sworn to before me by -T(1 v1\h tR UO 0 on this 25 - day of H A$HLEY A JAY-PLATZ o Commission No.785030 _ Notary Public in a d to of I My Commission Expirou July 14,202.� .,y *******************************************************************************************.******************* ,:*******tea.***** ***** I have reviewed this application, DCI report,and the State certified driving record of this applicant and have determinJd that there is no information which would indicate that the issuance would be detrimental to the safety, health di*elfare af resi- dents of the City of Iowa City(Title 5,Chapter 2, City Code). .ii Expiration date of Driver's license (e/ I / 207- I --, I (---‘, Sign ture of Police ChiePor 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. r ; Signs re of City Cler b designee Die Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018 • MOTOR VEHICLE DIVISION PO Box 9204 Des Moines,IA 50306-9204 1. 15-244-9124 tphl 515-239-1837(fax]. www.iowadot.giov Certified Abstract of Driving Record Inquiry Date: 3/17/2023 DL/ID#: 433ZZ6758 (IA) Customer#: 1542644 Name: Truong,Trinh Cam Class: D ID Status: None Address: 1404 PRAIRIE DU Audit#: 4282777 DL Status: VAL CHIEN RD Issue Date: 10/26/2019 CDL Status: None_4� City/State: IOWA CITY, IA Expiration Date: 06/01/2026 CDL Cert Status: None. 4.7 522455614 - Endorsements: Chauffeur 3 CDL Med Status - Nonk.) ' ""°" ,....N C-; Co """"" Mailing Address: 1404 PRAIRIE DU Restrictions: NONE Restriction =; None CHIEN RD Supplement: `._t :"i* Ill Date of Birth: 06/01/1970 Mailing IOWA CITY, IA Sex: F 11`" City/State: 522455614 til o History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/10/2019 11/14/2019 M14 Fail to Obey Traffic Johnson IA Sign/Signal Name: Truong,Trinh Cam DL/ID: 433ZZ6758 Pursuant to Iowa Code §321.10, I, Melissa Gillett, Director of Motor Vehicle Division, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Motor Vehicle Division, 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: •:t N' ur 74,4 3/17/2023 *7 t taw ,-.6 24 fr((d -U't' LL & W ;_ , � Motor Vehicle Division Mar. 22. 2023 12 : 05PM DCI IOWA No. 5390 P. 5 03r i,r zu,, wish io: aL FAX -•-•-. ui.i laj0021003 STATE OF IOWA. -'' ,��'"� "',, • . 1; Criminal History Record Check `,.' mill 4,. , ~�;.i Request Form 'dta� „v« ?,'`� DCI Account Number: — eap -r (ifapplicnblc) Mail or Fax completed forms to: Send results to: Iowa Division of Criminal Investigation Name Cit y-__O Iowa City_ -' Support Operations Bureau, 1"Floor City Clerk'a 61fice :°'t 215 E.7"'Street Address 410 Tat WashingCdn St Des Moines,Iowa 50319 co (515)725-6066 Iowa City, TA,52240 (515)725-6080 Fax /• :' ilbOue 319-356-5041 -" - Fax 31.9-356-5497 I am recLuestinft an Iowa Criminal History Record Check on: Last Name (mandatory) _ First Name(mandatory) Middle Name(recommended) )('urn \s {ilr. _ R - Date of Birth ,mm�datory) Gender(mandatory) Social Security Number(recommended) - • ()G -- Or' 1 -O ❑Male female a 5" '" v Release Authorization, Without a signed release from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information, as allowed by law, always obtain a signed release from the subject of the request. ***This form ICI-77 is the onl a• •roved release authorization form for this s ur ose.*** Release Authorization: I hereby give permission for the above requesting official to conduct an town criminal history record check with the Division of Criminal Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released se allowed by law. I understand thin can include information concerning completed detoured judgments and arrests it lout diapositi s. v Release Authorization Signature: \ f)-/ —0-)L1--- -t. .Att— ~ Iowa Criminal History Record Check Results (DCI...If0. As of ' -?-g-''a-3 , a search of the provided name and date of birth revealed: N z o � `"`d�pWuuttntuutrrrnrriiri, O CO Z F No Iowa Criminal History Record found with D�"��p. •�•,�••• f ., ti .-+ `��r .•• t O cd' tr ••• ••.• c 1— La 0 Iowa Criminal History Record attached, DCz#d :.�f d • ^ 1-- c) _— Li/4DCI initials__________. \ U °�4, • � — n s =� e 14 : ms . g l •'•. C\ O ,.... \ \ h ,",0 'ectit ````,c 1 ' i �a�\` I)CI-77(updated 06-26-2018) Page 1 oft Trinh r 1 1 First Name —rl__ Cam 40.O City oP Middle Name 414 r- TRUONG Last Name Big Ten Taxicab Business Name 23-002 — 414 Iowa City Permit ID 04/26/2024 Permit Expiration Date , ' ti . , Trinh r First Name i tel 111 "tirm'ai Cam �`'"` ie. City oP� Middle Name 04, C\ TRUONG Last Name Big Ten Taxicab Business Name i.. ,, 23-002 Iowa City Permit ID • 04/26/2024 Permit Expiration Date