HomeMy WebLinkAbout12-003�r
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa S2240-1826
(319)356-5040
(319)356-5497 FAX
First
1. Name
2. Mailing Address
Authorization Number I OA ^ 3
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle
Fcle-2)IJ
3. Telephone: Home 3 / 1- 62 ?- - 6 P-1 3
4. Prior experience in transportation of passengers:
Other:
Last
dui
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? '77 G
Type of offense
Where
When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? Y 0
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where — When
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Vo
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 name(s)
`�7 D
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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derMuid wi dg 09/2010
I hecertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
reby
-Z� 1 3 Y V C5 y . I understand that if I falsely answer any questions in this application, that this
application may be enied. I understand that if I falsely answer any of the questions in this application, that this application will
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 a license
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 ofApplicant;8. lt-- Date /-/Q,2Q(Z
STATE OF IOWA )
COUNTY OF JOHNSON )
S !bcrribed and sworn to before me
2-o 1 Z
a:1s_
by np-4�u Z— . On this )0+-1'` day of
-e )'�- f L'cy
I 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).
Date
/—lo '/ 2
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
dedN dnvbadgeapp201 0 doc 09/2010
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11
Iowa Department of Transportation
Office of DomerS&Aces &M -Free) -6M-6324121
PO 60x9204, Des Manes, [A503MD2U4 515-244=9124
FAX. --515-239-1637
Inquiry Date: 1/3/2012
Name: Ruiz, Ruflno
Address: 208 KNOTTY CIRCLE DR
City/State: WEST LIBERTY, IA
527761042
Mailing Address: 208 KNOTTY CIRCLE DR
Mailing City/State: WEST LIBERTY, IA
527761042
Convictions
Certified Abstract of Driving Record
DL/ID #:
713YY6581(IA)
Class:
A
Audit #:
2364485
Issue Date:
07/24/2008
Expiration Date:
08/22/2013
Endorsements: N
Restrictions: Corrective Lenses
Date of Birth: 8/22/1955
Sex: M
History Information
Customer #:
925165
ID Status:
None
DL Status:
VAL
CDL Status:
VAL
CDL Cert Status:
None
CDL Med Status: None
Restriction None
Supplement:
Citation Date
Conviction Date
ACD
Explanation
County 3UR
06/10/200806J30/2008
D. 0. T... -O'
11MI31
_
;Careless Driving
{NJ
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 3UR
07/16/2003 3045918 JIA
Name: Ruiz, Ruflno DL/ID: 713YY6581
Pursuant to Iowa Code §321.10, r, Kim Snook, Director of Offce 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:
... `/,p 4iiz
IOWA1/3/2012
IOWA
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Office of Driver Services
Iowa Department of Transportation
Name: Ruiz, Ruflno DL/ID: 713YY6581
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Jan. 10. 2012 9:55AM Div of Criminal Investigation
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