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Home My WebLink About15-270` r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX IDENTIFICATION NO. /S-o2L (Office Use Only) APPLICATION FOR TAXICAB / 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 Middle 1. Name (REQUIRED) , 7ZL II 2. Address (REQUIRED) a S (5 LAY 1 Aw 3. Contact Information (REQUIRED) Email m ipz[ Q_ Y'aty-Pt (All writtpRcplrt rlunicati&SE V 4a. Chauffeur's License expiration date(REQUIRE(�Q/)�lJl(�_cc>> II _'D b. Taxicab Business Name (REQUIRED) )-) ('(L -M 5. Cell Phone: via 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 95 What happened to the charge? (Circle on Convicted ismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years?y LO Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 1� " 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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 niame(s) ca DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE (CERTIFIED 6 ; DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C$bE'F RNIEW r� - You must apply for an individual Department of Criminal Investigation Report (form availab(e up1 4 regtQ. (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARYj, : r ' —d N 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid h uffeur's license number LQ� ri Citi Uri J issued on Ip -9i -1J5 expiring on /1'o'� r7 I understand that if I falsely answerlany 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 cab driver is granted, to comply at all times with all of the provisions f Title 5, Sha r 2, of the ode. (Needs to be ign d in ront of a Notary Public) Signature of Applicant Dat �1 )5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 5,j r, on this 50 day of Qi- ;701,5- Expiration 7otS 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 Chauffeur's license �1 ��"�f Signature of P611cd 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. I� k. k Signature of City Clerk or designee l _21el/ ate Cl.dk TPJ(IDRIVBADGEAPPL92014amended.DOC 0312015 r� Office Use Only -+ Ca Z Approved application "": ' ' DCI reports s State certified driving record Website update ry Cl.dk TPJ(IDRIVBADGEAPPL92014amended.DOC 0312015 C�JIOWADOT ov SMARTER IS I PIPLIER I CUSTOMEs". DRIV ' Office of Driver services PO Box 9204. € Des Moines, !A 50 30 6-9 20 4 Phone. 545-244-9124 1800-5k-11121 {l=ax: -515-239-1837 www.iowadot.gov Inquiry Date: 10/28/2015 Customer #: 884476 Name: 'Brayton, Suzi Address: 1728 GLEASON AVE City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Certified Abstract of Driving Record DL/ID #: 642YY0437 (IA) Class: C Audit #: 7731073 Issue Date: 01/24/2014 Expiration Date: 07/26/2017 IOWA CITY, IA 522405915 Endorsements: NONE 1728 GLEASON AVE Restrictions: NONE Restriction None IOWA CITY, IA 522405915 Supplement: 7/26/1972 F History Information CLEAR DRIVING RECORD Name: Brayton, Suzi DL/ID: 642YY0437 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: t-'� ID"Status: None DL Status: VAL CDL Status:- None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None 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: gpl®a: •""••:;v,G:'�� '�9 10/28/2015 5w.IOWA Clio D. 0. T.;fto t-'� h 6r• r '••••••' � l., Office of Driver Services �wQRI!EB—'- Iowa Department of Transportation Name: Brayton, Suzl DL/ID: 642YY0437`' . [v Oct ,29. 2015 1:54PM Div of Criminal Investigation No. 9809 P. 1 10/28/2015 11:01yellow Cab of Iowa City (FA%)31K382202 P100211002 STATE OF IOWA Criminal History Record Check Request Form DCI Account Number; 9967•F (if appllcnble) To: Iowa Division of Crlminnl investigation Froml Yellow Cab of Iowa City Support Operations Bureau, 1" Floor VO, Box 428 215 U. 714 Street Des Moines, WVA 50319 Iowa City, IA. 52244 (515) 7Z5-6066 Y51 319) 335-9777 Phona: Fax; (319) 339.7302 ❑Male WFamale I C/Rl---��Q Watver,fr(jormatlonr Without a signed waiver ham the subject or the request, a oomplgte grlminai history record rpay not be yelaasabie, per Code of Iowa, Chapter 692,2, For complete criminal history -record Information, a; allowed by )aw, always Walver Release; I hereby glvo parmiarlon for she abobe requealing omelet to oondVel An Iowa er)minal hlslory record check with the Dlvlelan aMitilnal Inra,llgetloa (DCI), Any erlminal hksory data concomia9 mo Ihet la maintained by the DCI may be released As allowed by law, p � A is .•, ti � Waiver Signature, 0 Iowa Criminal History Record Check Results (DCi uaa only) As of l , a search of the provided name and date of birth revealed;'.r No Iowa Criminal I Iistory Record found with DCI ,� EJ Iowa Criminal History Record attached, DCI -9 -F- r DCI initials ry 110 DCI -77 (09125110) Rprpivpr Tire Orf 9A )01; 11 -ADAM hln nglif