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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 (REQUIRED) t
2 Address (REQUIRED)
IDENTIFICATION NO. / , CL
(Office Use Only)
APPLICATION FOR TAXICAB 1 MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday)
Failure to complete the "required" information will result in denial of the application
First
3. Contact Information (REQUIRED) Email: $rea ' 'r cXwo Cell Phone: 3/mays T.G=7�
(Ali wfitte6 communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) 1ZZa //2 r /6
b. Taxicab business Name (REQUIRED) v�i3 &t/ C 4� /F
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?
Type of offense
114 /2
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense
n
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? -r'.., v
Type of offense Where When....' .77
9. Have you ever applied to be an Iowa City taxi driver rising a different name? If yes, please provide the name(s)
4)
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).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereb ce�tl that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�(j G f' `C issued on III expiring on ?/J%/J 0 . I understand that if I
falsely answer any questio this ap a' this application may be denied. I agree that in making this application, I
consent to allow agent r employe t Cit o I Ci • , Iowa, in their discretion, to examine any and all records and
documents relating this applica an furt r ree tha if authorization to be a taxicab driver is granted, to comply at all
times with all of th provisions itl 5 hapt ity Code. (Needs to be signed in front of a Notary Public)
Signature of A licant Date
v
STATE OF IOWA
COUNTY OF JOHNSON
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).
i
Signature of oli Chief 6r designee
'0' s'_ /l,,o�s�
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.
THE EFFECTIVE DATE WILL MATCH THE CHAUFFEUR'S LICENSE EXPIRATION IF LESS THAN A YEAR.
W ac/ ,e. e q
Signa City Clerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
3 -/4" -/5
Date
cierkrFAXIDRmBADGEAFPL92014amended.Doc 02/2015
Mar. 3, 2015 4:17PM Dlv of Crlmina' Investi;ation
I a a I .. L. � L V I J I V. U V n l r l I L y U I U I K t, I L Y V I 1 V M d " I l y
u"
STATE (OF YOVVA
Request Form
Tot Towa bivislou of Criminal Investigation
Support Operations Bureau, 1" Floor
215 E. 71h Street
Du mohtet, Iowa 50319
(515) 725-6066
(515)725-6080 Fax
T nm , nomN.,.. o., 7n1r. /'+.1.11....7 v:,.6— n....,...A" -1
Nu. Juoo4 I . [1 1
DCJAccountNumbor; XWOC�,� —F
(Itepyllcebla)
F"oml Clty of lova City
City CielrlP9 Office
410 L. Washington Street
Iowa Clty, TA 52240
1'hono: 319396.5041
Fax: 319-356.5491
Last Name (mnrdelo )
I First Name (mandatary)
Middle Name rocommende
AA -Cat
)late of N mandato
Gehder (uendaWry)
Social SccuritV Nnmbor aommendad
/n 3
male UFemale
73 5a(/
Waiver Information: without a sighed Waiver from the subject of the request, a complete criminal hfskory record may not
be releasabla, per Coda of Iowa, Chapter 692,2. For complete criminal history record information, as allowed by law, always
obtain a waiver sl naturo from the subject of the re pest.
Waiver Release; lhmby glvo pemdsrlo orihaebovero ling oftial[owndact an rowe-alninakbis(orytccord chcck%Yhfi dlcl)ivision ofCriminai
rnvcsligalion(ACQ. Myeriminalhislarydat rgnwmhigm rlfineio ne bytbe DC aybereleasednsallowedbyle,o.
Wnlver5ignafu e: p�.-��_t �p� �
(DCI "se oa4)
As of
:� 13 1 IV -, a search of the provided name and date of birth revealed:
No Iowa Criminal history Record found with DCI
Iowa Criminal HistoxyRecord attached, DCI #
DCI initials AL
Received ime7Mar"`..02015 9:58AM No. 1422
Iowa Department of Transportation
t 04iffirr it Ury t *S0fy1Ge il'olI Mrecl�100''02 1121
F L 3�UT, f �[a hAtAriul:, . N,sf"3.rlrr3,f `1E °44 9t'2 -f
l ,2 1`'� 4418_it
Convictions
citation Date
Certified Abstract of Driving Record
]UR
Inquiry Date:
3/16/2015
DL/ID #:
154BB9768(IA)
Customer #:
639535
Name:
Albright, Ryan 5cott
Class:
D
ID Status:
None
Address:
107 S 6TH ST LOT
Audit #:
7707736
DL Status:
VAL
25
Issue Date:
01/17/2014
COL Status:
None
City/State:
KALONA, IA
Expiration Date:
09/01/2016
CDL Cert Status:
None
522479718
Endorsements:
3L
CDL Med Status:
None
Mailing Address:
107 S 6TH ST LOT
Restrictions:
NONE
Restriction
None
25
Supplement:
Date of Birth:
9/1/1963
Mailing
KALONA, IA
Sex:
M
City/State:
522479718
History Information
Convictions
citation Date
Conviction DateACD
]UR
Explanation
Count
]UR
103/03/2012
04/03/2012
592 Speed
IDes Moines
IIA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
]UR
09/11/2013
757123
IA
11/22/2013
770413
IA
11/02/2014
824865
IA
02/03/2015
843475
IA
03/09/2015
849593
IA
Name: Albright, Ryan Scott DL/ID: 154BB9768
Pursuant to Iowa Code §321.10, I, 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 witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
:" IOWA
a.0.0.T.
Name: Albright, Ryan Scott DL/ID: 154889768
eY it
Office of Driver Services
Iowa Department of Transporation
3/16/2015
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Office of Driver Services
Iowa Department of Transporation