HomeMy WebLinkAbout16-117kakms`s
CITY OF IOWA CITY
410 Last Washington Sneel
Iowa City. Iowa 52240-1626
(319) 356-S040
(319) 3S6-5497 VAX
IDFNTIFICATION NO,_ E U— 1l
(t✓tiwv use Vnyr
APPLICATION FOR TAXICAB I MOTORIZED PFDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
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1- Name (kL(]UIRED)
2 Addiess (REO:ARK) _
3. Contac! Information (PF-)UIRED) Email:
4a.Chauffeur'sLicen5e expiration dale (RLCiUIRED) _
b. Taxicab Business Name (RFQUII-,L-D)
5. Prior experience in transportation Of oassennerc
Ls
Phone -
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5' Haveyou ever been`3rreMed /charged with any misdemeanors and/or felonies in this State Or elsewhere? !
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended <Ed Guilt Other
Have you been arrested/ charged with any traffic offenses in the last five years? \L2-21
(Convicte�j Dismissed Deferred Zuspended Plead G illy c
8. Has your driver's license or chau`fI/ear's license peen suspended or revoked in the last five years?
(bpe of offense . —Where — When
9 Hav you eve applied to be an Iowa City taxi driver using a different name? If yes, plerse prSt�Bth iP�jamei--
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT"EPTMED g
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C19IEF RENEW
You most apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I herepby. ce 2 at I have issued to me by the Iowa Dep m nt of Transportation v id Chauffeur's license number
117 issued on xpidrig on 4I understand that if I
false y a s er any questions in this application, that this ip ica on may be denied. II 9gride 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 Cade. (Needs to be signed in front of a Notary Public)
Signature of Applicant + &&4L4at0_. Dale -42�r-
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STATE OF IOWA )
COUNTY OF JOHNSON )
S riber and orn to before me by
91 ✓ 1D r-ro co7
on this -9, day of
Public in and for the State of Iowa
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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 orwelfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City C da),
Expiration date of Chauffeur's license 03 Z ._2 D
c5l2.2(5
Signature of Mice 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.
,2� �.
Sign of City Clerk or designee
9�?0? �_
Dat
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CnWl AXii FL92014an,nded. a 0312015
Office Use Only
Approved application
DCI report
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State certified driving record
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Website update
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WhETER I SRII L;fi I CUST0 4 1
01(iCR of €diver Services
PC Boy 5204 1 Des Wines. IA X348-9211.1
ishonet 515-1144-9124 18001 3^t E.15-235-1837
WWW wiadOLgOy
InOWn Date:
3/Iaimis
Customer #1
3617557
Name:
Morrnr+, Fret Allen
Address:
916 207H AVENUE R APO 2
City/State: CORALVILLE, A 522413423
Malllnp Arlon...: 916 20TH AVENUL FL API 2
Maillne CORALVILLE, IA 522911123
City/5tata:
Dated Birth: 0/3/1961
Sex: M
Cmtvictions
Certified Abstract of Driving Record
DL/In e:
015AA1530(IA)
CIaa7t
A
Audit #:
8981557
Issue Dace:
Oa/01/2035
Elrpirannn Date:
WfU3/2020
Endarae—r :
NFL
Rastdbuns:
CerrecNve tenses, CDL lntrastato
DL Statue:
Only, No Class A Passenger Vehicle
ResWction
None
slzyplement
12/12/2012
History Information
CDL PermIr CIA";
Nene
CDL Permit Josue Date:
Nene
CDL Permit Expiration
None
Data;
03/0842011
CPL Permit Endnreemenrs:
None
Cm Permit Reith,tem:
None
ID State.:
Name
DL Statue:
VAL
C1ll 5aatus:
CDL Permit Statue:
CDL Cert Stator:
CDL Med Status:
VAL
ELG
txccpFeO lrlbastale
Nene
Cro-'6on Leto
C Inn na».
ACU
Fxplanatico
County
y6ty
021ONP1111
03/0842011
Not
Fail to yield Light of Way
johnzm
1A
08/31]2012
12/13/2012
Fog
'Seat 6ett VbWtlan
]ohnzm
'4A
11108l2U12
12/12/2012
S92
15peed (10 mph &under In 3555 mph .no)
-Linn
1A
Accidents - Accident Involvement indicated does NOT man the Individual was at fault or given a citation.
A,:otGealt U`atm _.
Case Number
IDR
0912E120W
_ 368997
lA
a2j'D6/20i1
:617535
:In ...
Name: Morrow, Bre Allen DL/ID: 075AA3630
Pursuant to lewd Cabe §321.10, 1, Km Snook, Dlrettor M Onke of Driver Services, Iowa Department Of lransportatlpn, do beraby onetlfy that I am Me custodian of the records braid by the Office
or Omer Serviws, that U1is Is a true and accurate copy of as show reyord currently m the custody of said office, and that I have again authorized by the Director of the Inwa Department of
Transportaben to so worry,
In witness whereof, I have caused my signature and the seal or the Department to he set upon this doolmenq at Ankeny, Iowa this due
Name. Morrcw, Bret Allen DL/Ie. 015Aa1630
N
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9/18/2015
10 INA
y D. 0. T.;
i a i
yyOf` "`
ine
of Driver nerys
-yylsv����-rte
Iowa
lows DePartrnmt of Transportatbn
r,3
Name. Morrcw, Bret Allen DL/Ie. 015Aa1630
State of Iowa
R��„r�etino an 1"vq criminal hictnn, rrrnrri check nn'
Fill in all shaded area~.
LastNameaFAussop„mnaw"ryl
First l\rantevrrmetrro,nb.evmandewrvl
Middle Name
Date of Birth Fecha Nr.:ix,ier,tn (maodazorv)
I Gender 6enai'o fmaoAa?nrv'I
Male ❑ Female
SOClaI Security lvt1Q)ber lrecoraniendedi
Waiver Signature Firm ( If the request is an yourself, plzasc sign, if the re3uest is on someone else,
write N/A-) �
Results
As of a name and date of birth check revealed:
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❑ No record found
vs
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[Record attached DCl #�
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rn
ca
T)CT initials
D
Receipt
Number ol'requests ( x $15.00 per last name = Total amount $ 15,6c>
Method ol'paymenl: ash money order check # r MantercklT l ur Visa
a
Cardholder's name
} v
DCl initials--__-- 1 -_ —_______
Credit Card #I Exp. Date
I)CI-83 (09/09/10; Revised 10/1/10; form reviewed U8/ 11/14(
IOWA CRIMINAL HISTORY DCI 00299366
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 7 -
DATE PRTNTED-
2015/09/18
DCI -00299366
NAME: MORROW,BRET ALLEN
DOR Srx RAC HGT WGT EYE HAIR SY,N POH
19640403 M W 602 345 G3N RED MED IA
ADDITIONAL IDENTI77FES
SC CHEST
CCH. RECORD *"
01 ARRESTED 19830115
AGENCY: IA0520100 CORALVILLE PD
CHARGE NO- 01 1A STATUTE IA706 I
ASSAULT
TRI'V: L23192401
COURT DISPOSITION
AGENCY- IACSZO15J JOHNSON CO DIST COURT
COUNT 140- 01 IA STATUTE: IA798-I
ASSAULT
CHARGE CLASS: MISDEMEANOR CON'JICTION
TRK#: L23192401
SENTENCE LISP EFF DAT
JAIL 30D 19830413
CCURT COSTS $9 19830413
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO ISDN -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD
IS
BASFD ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRI".
-.
-
DIVISION OF CRIMINAL INVESTIGATION
9
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