HomeMy WebLinkAbout14-245i
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319)356-5040
(319) 356-5497 FAX
1. Name (REOIDIRED)
Authorization Number ® _
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
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2. Mailing Address (REQUIRED)
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3. Contact Information (G2tl.=OUIR D) Email: Cell Phone: •W -Q1
4. Prior experience in
of passengers: "oK
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Baa
Type of offense
Where
When
6. Havevicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years=
Type of Offense
Where
Have you been convicted of any traffic offenses in the last five years? A/c)
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,iyo
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
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCQ REPORT AND STATE G 1FI
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C EV
,e
DepartmentYou must apply for an individual ,
(OVER•R REQUIRED SIGNATURE AND NOTARY)
09/2014
I hereby certify that I have issued to me by 'ihe lo�wa Depariment of Transportation a valid Chauffeurs license number
Y e �1-- . I understand Mai if I false) answer an questions in this application, that this
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application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
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 a license
is granted, to comply at all times xvIjth all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) `
t./
Signature of Applicant Date /I._
YOU ARE NOT VALID TO DRIVE A'iAXI IN ICVVA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city ivebsite at icgov.org.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me byti ° r „__ _ On this day of
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
tl
o
__76lice Chief or designee
-
I
yyl-D to
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
e
Si nat reof City Clerk or designee
4�
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and o' %"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIe,WrAXIDRIVBADGEAPPL92014=wded.DOC 09/2014
jo/Qct. 27. 20141,12:481'Mcal, Div of Criminal Invest igat on
STATE OF IOWA
kequest Form
Tot Iowa DIvIslon o(CrInninal Invudgatlon
Suprort Oparallons Bureau, I" Fictor
215 S. 7h Street
Des Molneff, Iowa 60319
(fi1fi)'7U.d0SG ,
(919) 728-6980 Pax
(FAX)31933827No. 2747 P. 1/1/002
DCI Account Numbar:..,.-9967F -- ' '
Fromm Yellow Cab!
P4. Box 428
—ralya chyt XA. �52244
-{M) �339-9777
Phone-
.
Fax, (319) 339-7302
(Oct U14 only)
a search of the providad nwo and date of birth ravoolod-
No Iowa Criminal History accord found with I)CI
13 Iowa Criminal Malco M000rd attached, DC1 0
DCX
L------ A
DCI -77 (09/25/10)
Received Time Oct. 22, 2014 12:17PM No, 3657
Iowa Die pa rtrne nt of I
rain
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Certified Abstract of Driving Record
Inquiry Dialeu
10/22/2014
DL/Io
435ZZ1025(1A)
Name:
Bradley, Roger Elliot Class:
D
Address:
2327 E COURT ST
Audit :
7383317
a r
None��
Restriction
Issue Date:
09/27/2013
City/State:
IOWA CITY, IA
Expiration DI
07/31/2018
522455218
Endorsements-
3
Mailing Addiream
2327 E COURT ST
Neatrla"tions:
NONE
Date of Birth:
7/31/1965
Mailing
IOWA MY, IA
Sex:
M
City/State:
522455218
f . r
urmy rISTAUkf f f'.. f #.
Customer #:
2308987
ID Status:
None'•-'
DL Status:
VAL
CDLStatus: -
None:"'S;;,
tt;z
CDL Cert Statusc
None m
CDL Med Statue:
a r
None��
Restriction
None '%"
Supplement:
- "-
Pursuant to Iowa Code §321.10, Y, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do
hereby certify that I am the custodian of the records held by the Office of Driver 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 wltness whereof, I have caused my signature and the �Fwai of the Department to be set upon this document, at Ankeny, Iowa
this date:
10/22/2014
lei �lia�
R.
G. Tl
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�m iii�i 4•+'' Office of Driver Services
n�nxuru"�Iowa Department of Transporation