HomeMy WebLinkAbout14-066410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. game First
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2. Mailing Address / 5
3. Telephone: Home 3
J-,7 S-. x
4. Prior experience in transportation of passengers:
Authorization Number—LL
(Office Use Only)
APPLICATION FOR TAXI DRIVER �
(Police Department review must be made
U,• Mondayid
lVfici e 5r, J, // Last
Other:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? alo
rl� =
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? h.o
Have you been convicted of any traffic offenses in the last five years? _
Where
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 11)
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
You must apply foran Individual ana INE
it w
00WP ar bMq 03/2013
i herb rtify th t I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
15 �AF 5 7 � ! . I understand that if I falsely answer any questions in this application, that this
application maybe 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 and all records a documents relating to this application, and I further agree that, if a license
is granted, to comply a tim with all of the ovi ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary PublicVnt Signature of Applic Date
STATE OF IOWA )
COUNTY OF JOHNSON )
ascribed and sworn to before me by TG . " a, �" a�'"' On this fir) day of
bra" �'-
MM
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).
Signatur ofFT0Iicfhrord6sIgnee
Date
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.
Signature of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/d' (width) and 5'/z"
(height) and prominently displayed to all passengers.
3*33333333333*MM#**#**kYe*333*3*:!#*#***#333333*kl1eM**3#*3*3333333****3#333333333#####33*{3***333*1t**k*##33**3:k3M*#�R***#{***333#fe***fe#1e**#33*33333
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dtea1VWgeapp2010.doc 03/2013
°11 °11e Mar. 11.2014 1:17PM
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Iowa (�r^8 "nad History Rccotd attached., M1 #.
fleceived Time --Mar, 10.-2014— 2h1OR No•,4130'
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Certified Abstract DF DrIll Record
InRullry (Date.
3/14/2014 DL/ID at:
154SE9768 (YA)
Customer SN
639535
Name:
Albright, Ryan Scott Ciasse
D
ID Status.
None
Address:
1205 LAURA DR LOT 21 Audit D.
7707736
DL Statum
VAL
Issue, Data.
01/17/2014
CDL status:
None
City/State:
IOWA CITY, 1A 522.451526 Expiration
09/01/2016
CDL Cert Status. None
Date.
Enddrsamenen
3L
CDL Ned Statues. None
Mailing AddremN
1205 LAURA DR LOT 21. RestrictlDna.
NONE
Restriction
None
Date of BIrtW
9/1/1963
Supplement.
Mailing City/State. IOWA CITY, IA 522451528 Som
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Lot
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y..antier........ ...._C...cecaty .........
R4/61M29117 597SjFeed i)cM M luas .
I
n,
AccIdelnts ... Accident Involvement 11#5dicated does NOT rnea!n'three individual was aa't'fauuit wur given a aitatiion,
Acckl nt ]Date Case Numbew
DauR
IY�I/I 11�2&9I3 75712,3 .. .... IA.
.. ........ ........ ....... .........._ ..
II.&/22/2011:4 .... ..-7s"IX➢4n:i_...... ........
INarnea A lbrig ht, (Ryan Scout l 154114B9768
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do here
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 offic
currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportal
certify.
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thin
e ,
3114/20114
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Office of Driver
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