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HomeMy WebLinkAbout16-191CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 826 (319) 356-5040 (319)356-5497 FAX IDENTIFICATION NO.! O —19 I (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 1. Name (REQUIRED) 2. Address (REQUIRED) Middle S,,- e V Last `'%0, 3. Contact Information (REQUIRED) Email Jl XAA6,• :0;A. Cell Phone:?i 5 (All written communicatiofi sent via email) 4a. Driver's License expiration date (REQUIRED) "//I/ LC L / b. Taxicab Business Name (REQUIRED)ye11U L41 C f a ,-e.. L- f y 5. Prior experience in transportation of passengers: 3'7 �zr 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? IiU Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended PleadGuil Other Have you been arrested /charged with any traffic offenses in the last five years? I/ S Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead G ' Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ' �-/ Type of offense Where When n- 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, pleas@pr*7 idelii t r-; �'']� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE 'CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE (CHIEF- iEVI"EJ'�('.tttt You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I h fV certfy that I have issued to me by the low hep of Transportaton a valid river's license number �sg/ �5�� 17L 4 issued on Zc expiring on ZU? I understand that I falsely answer any questions in this application, that this app icat n may be denied. I agr a that in making this application, I consent to allow agents or a"yees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I furtheragree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of T' Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) I � ✓ � i' C Signature of Applicant � Date,��� +++r+fHlwwlxw}f+xxwH}+a+++++H##wllwlHrr}wf+x}}Hf++f+++}H+H+r+++++HHRH+H!11HlwwxflxwHw+#Hrr#aH#f+a##rHrHHlHlHHHxH+!l11f 1f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 14�" Qu S , R`4 U'I ,zjw' on this LP day of 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 Driver's license et(i L �f 0 )OP -- Signature of Police Chief or designee ,l4 /l6 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. ��Iau�A4/ � • �� Signature of City Clerk or designee q/� AG Date perk/rA%IDRMW)CEAPPL92014anwWW OOC 07/2016 N O f 1rHfflHwfH+H}1H1f+#f#ffHlHfYfHf f xwH+HH}fHIHH}HHrf!lrHlHlHlHf w1f f}!H}H}H+HHH11f1f�_W ###f#1f4i;i##HYfH#HffHHHHH Office Use Only i� M =a n rn =rv M Approved application ? � DCI report o State certified driving record _ Website update —' perk/rA%IDRMW)CEAPPL92014anwWW OOC 07/2016 �, ►ooT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: Address City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Convictions 9/6/2016 639535 Albright, Ryan Scott 107 S 6TH ST LOT 25 KALONA, IA 522479718 107 S 6TH ST LOT 25 KALONA, IA 522479718 9/1/1963 M Office of Driver Services PO Box 9204 1 Des Moines, lA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 www.iowadol.gov Certified Abstract of Driving Record DL/ID #: 154BB9768(IA) CDL Permit Class: None Class: D Audit #: 1211581 Issue Date: 08/09/2016 Expiration 09/01/2021 Date: Endorsements: 3L Restrictions: NONE Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: 04/03/2012 CDL Permit None Restrictions: IA ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County )UR 03/03/2012 04/03/2012 S92 Speed Des Moines IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 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 0 m Name: Albright, Ryan Scott DL/ID: 154689768 cn Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Depar"t o6ranspdrtation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this 19--d �- le and accurtdt��opy of an official record currently In the custody of said office, and that I have been authorized by the Direct6f-4-ihe Iowa Deent of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this�documentr-at Ankeny, Iowa this date: Name: Albright, Ryan Scott DL/ID: 154669768 �:........�' 9/6/2016 IOWA D. 0. 9f DRIVEN $ Office of Driver Services `��.......--- Iowa Department of Transportation Aug.3l. Zino S49rM uiv or t,riminal Investigation No. 3018 P. 1/1 _,From:C;11y of Iowa oily Clerk wince :a114 ae a a..ar Oe/26/2016 10:n, -646 ..---/002 STATE E ®TN IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 L 7" Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6000 Fax I am renuestinn an fnwa Crirninsl Histnry Recnrd Chenl nn - DCI Account Number; L%VOZ (if applicable) From: City of Iowa City City Clerk's Office 410 E. Washington Street Iowa city, IA 52140 Phone: 319-356-5041 Fax, 319-356-5497 Last Name Onwilatory) First Name (mandatory) Middle N210C (reconaended) G��a. C>< UC t spa Qn Date of Birt (mandatory) Gender (nisndaiory) Social Security Number (recommended) Q 1 7Male ❑Female d 093 - ?-Cr,13 Wniver Information: Without a signed waiver from the subject of the request, a complete crimh+al history record may not be releasable, per Code of lona, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Release: i hereby give ptnniu o r she above re vesting omcial to conches an lows criminal history record check with the Division of Criminal brvesliga(ion (DCI). Any criminal history dal ncemlng me itis mainmincd by the DCl may b: released as stowed by lsa. WaiverSigna7y F Iowa Criminal History Record Check Ritsults r > Q1o16alsty" As of_J7I -) to a search of the provided name and date of bitch revealodi �,.U5 No Iowa Criminal History Record found with DCT F U11 ,v © Iowa Criminal History Record attached, DCI 4_ DCI initials)_ 1 -Ti -77 rosnsno) Received Ilme Aug. 26, 2016 10:24AM No -2694