HomeMy WebLinkAbout17-055IDENTIFICATION NO. 17-0SS
(Office Use Only)
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APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
C ITY OF IOWA C ITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
410 East Washington Street
Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name (REQUIRED) First 6o661 Middle ,be Lastledei
2. Address (REQUIRED) _ l001 rossPAe- Ic tdNtf G
3. Contact Information (REQUIRED) Email: hs66 /'/ 4t(S a At (• Goor Cell Phone: 319- 3S3- Gygr3
(All written c mmunicaion sent via email)
4a. Driver's License expiration date (REQUIRED) '7 l 2 ( [ / 2 O / 8
b. Taxicab Business Name (REQUIRED) `Ie (10 w CA 6 0 ir 1 Ena.;),4 Ci (v
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? /JO
Type of offense Where When
l7beir Fri t 1 T A C {r i /T�f-%7 rrt)C--
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What happened to the charge? (Circle one)
saaissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? �e 3
Type of offense Where When
1(27 /20/((
What happened to the charge?Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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Type of offense Where en?;
D-4 ,...
04
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pcpt thnams
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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)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa D partment of TransportaI n valid Driver's license number
(0 A� 97G3 issued on S111,ralyexpiring on 7 2/ 2e/ , I understand that if I
falsely answer any 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 taxicab driver is granted, to comply at all
times with all of the provisions of Title 5, Chapter 2 of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Date 7 /
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by D18la Ll.eu on this lday of
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).
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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.
C \
SI re of City Jerk or designee
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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CIeA/rA%IDRIVBADGEAPPL92014ame W.DOC 07/2016
Apr.10. 2017 4:23PM Div of Criminal Investigation No.7932 P. 1/1
04/u//lul/ u;0�rei iow Cab OT iowa a cy (FAX)3193382,vo .-., /002
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Criminal Histor3
Request Forr
To: Iowa DIVId1e11 of Criminal Investigation
Support Opersllons Bureau, Irr Floor
215 B. 7"Slreal
Des Molnes, Iowa 50319
(515)719.6066
Account Number: 9967-F
—" pr.apuaablw
Dmr Yellow Cab of Iowa City
PA Box 428
Iowa City, IA, 52244
one;
Fax: (319) 339-7302
bate of Birth (manderory) Gender
r�(man dato So -T occiaall^Seecuri !Number rrcccoommendea
DZ Zi ��l�7 1! Ie ❑Femie 3J(A~(pz <�^Dl
Waiver Information; Wlthout a signed waiver from the subJect ortho r quest, A complete prlminal history record may not
be releasnble, per Coda or )own, Chapter 692.2. Bop con late criminal hist ry•record Information, as allowed by law, Mvvoys
obtain a welver slgnaluro from the subject of the reauest•
Waiver Release; I hereby give permlttlon for rhe above requ� ns 1114101 m ee 1 an lows Crinin Inory mijam check wirh rhe Division ofcaminal
Invallgedon (DCO. My criminal hisiDry dela eonoomin the! l Ined by 1 D I may a « lesspo P4 allow;)% law,
Waiver Signature,
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Iowa Criminal History Re � d Check results' (Del use only)
As of LA ` it Search of the provided name and date of blr(h revealed:
No Iowa Criminal History Record foand with DCI
d Iowa Criminal History Record attached, DCI #
DCI initials �)
DCi-77 (08/25/10) w
Rprpivhd Timp. Aor. 7. 9017 1'15PM No. 6775
Iowa Department of Transportation
AO Office d Dili f Services (Toll Free) OW -5 V1121
PO Bane 92D4, bels iMOWM, lA SMD"204 515.244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
4/7/2017
DL/ID #:
Name:
Riley, Bobby Joe
Class:
Address:
1053 CROSS PARK
Audit #:
05/01/2013
AVE APT B
None
•
CDL Cert Status:
Issue Date:
City/State:
IOWA CITY, IA
Expiration Date:
NONE
522404486
None
Supplement:
Endorsements:
Mailing Address:
1053 CROSS PARK
Restrictions:
M
AVE APT B
Date of Birth:
Mailing
IOWA CIN, IA
Sex:
City/State:
522404486
Convictions
690AI9763 (IA)
Customer #:
5937812
D
ID Status:
None
6909763
DL Status:
VAL
05/01/2013
CDL Status:
None
07/21/2018
CDL Cert Status:
None
3
CDL Med Status:
None
NONE
Restriction
None
Supplement:
7/21/1967
M
History Information
Citation Date
Conviction Date
ACD
Explanation
icounty
3UR
01/27/2014
05/07/2014
M14
Fail to Obey Traffic
Si n Si nal
Johnson
IA
Name: Riley, Bobby Joe DL/ID: 690AI9763
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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:
4/7/2017
Office of Driver Services
Iowa Department of Transporation