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CITY OF IOWA CITY
410 East Washington Street
Iowa City, -Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
2. Mailing Address
3. Telephone: Home Other: n
4. Prior experience in transportation of passengers: °i�'S /3V-r.dL t aie d�
/C�-/ )_
(Office Use Only)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AA0
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?
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 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 name(s)
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)
uewta.md�baaB 09/2010
�1 is
I hereby certify that I hays issued to me by the Iowa Department of Transportation a valid Chauffeurs license numbe4•
,,jf . I understand that if I falsely answer any questions in this application, that this
application may be denied. 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 of Applicant / v "/� Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 2��'-ei �+ On this day of
kFi i ie K. Turne Notary Public in and for the State of Iowa
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).
of Pdtidb Chief or
of City Clerk or desig
/-11f_- /a,
Date
- AF -ia
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
d�mn ge W2oio.m 09/2010
1$,Dec. 16. 2011,3 3:14 PM
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Div of Criminal Investigation
DCI 10' No. 3656
STATE OF IOWA ' l '''' 1
Criminal History Record Check 3
Request Form
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Iowa Criminal History Record Check Results (octmdar)
As of f 1 b — 1 . a search of the provided tame and data of birth revealed:
`0— No Iowa Criminal History Record found with DCI
❑ Iowa Cominel History Record att*ad, WJ #
I)CI IDldals'r � ,. ,
Received Time Dec. 9. 2011 12:09PM No. 5802
Iowa Department of Transportation
C&) Office of Driver Services (Toll Free) SM -532-1121
PO Box 9204, Des Moines, IA 50305 -9204 515-287
FAX: 515-239-1837
Inquiry Date: 1/13/2012
Name: Scheib, Bruce Kent
Address: 1904 JEFFREY ST
City/State: IOWA CITY, IA 522464328
Mailing Address: 1904 JEFFREY ST
Mailing City/State: IOWA CITY, IA 522464328
Certified Abstract of Driving Record
DL/ID #: 261TT6941 (IA)
Class: D
Audit #: 4882667
Issue Date: 12/14/2010
Expiration Date: 12/08/2015
Endorsements: 3
Restrictions: Corrective Lenses
Date of Birth: 12/8/1948
Sex: M
History Information
Customer #:
3420226
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number 3UR
04/29/2007 _..�._ ,369153 _W IA
Name: Scheib, Bruce Kent DL/ID: 261TT6941
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:
'•%��/�V
1/13/2012
IOWA
). 0. T.,; �g
� QRS S�'
Office of Driver Services
Iowa Department of Transportation
Name: Scheib, Bruce Kent DL/ID: 261TF6941