HomeMy WebLinkAbout12-052Authorization Number 1a- 53 -
(Office Use Only)
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(3 19) 356-5497 FAX
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
c1 First Middle I Last
1. Name S�epAe� F -,,M I Sto-,ebryKe,
2. Mailing Address q3_7 SQr, y R Zy , t/r:vc
3. Telephone: Home 31q -53o - N 7 3 Other:
4. Prior experience in transportation of passengers: 2 yeu.p GS
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO
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? No
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? it S
Type of offense( Where When
5eec.�',.-7 s2.010'
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Na
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)
N.,
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)
dedlt dnvbadg 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
_'2, 3te DO O 5`lt. . 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 �/ �i%r arW `� Date 2 z7 z
4414YY4«Yw«Y*+*wwYwwwwwww11w4ww111ffefY«f«fY+YY«*Yw«**+«+*««w«awwY«fww«*w*www**«wfwwwfwwf*wf*Rwwww*fwwwww**ww*www*fwwwwfwwwwwff4w4fw4ffwrffwlwww
STATE OF IOWA )
COUNTY OF JOHNSON )
and sworn to before me by
Commission
On this day of
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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).
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Date
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.
««««Y««««w«w*..w4.141144ffYY4««««««ww«w*«w*Rwf*411.wf.fYYY*4.««1fY««fY«Y«««Y«««wY«««w««w««w«Yw««ww«ww««w*wwww«1ww*fffflfff*f**f4w..f4.f44f41f4«
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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f'
CA
Iowa Department of Transportation
Office of Driver Senyices (Toll Free) 800-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/24/2012
DL/ID #:
236DD0596 (IA)
Customer #:
4243013
Name:
Stonebraker, Stephen
Class:
D
ID Status:
None
05/06/2008
Franklin
S92_
Speed (10 mph & under in 35-55 mph zone)
90
IA
Address:
846 Basswood Lane
Audit #:
3959938
DL Status:
VAL
03/15/2010
;04/12/2010
Issue Date:
12/19/2009
CDL Status:
None
City/State:
Iowa City, IA 52246
Expiration
05/22/2013
CDL Cert
None
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
846 Basswood Lane
Restrictions:
NONE
Restriction
None
Date of Birth:
5/22/1985
Supplement:
Mailing City/State:
Iowa City, IA 52246
Sex:
M
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
]UR
05/19/2007_
,0_5/23/2007
S92
Speed
52
IA
05/06/2008
S92_
Speed (10 mph & under in 35-55 mph zone)
90
IA
_05/09/2008
02/04/2010
03/15/2010
S92
,Speed
52
IA
03/15/2010
;04/12/2010
S92
Speed
52
IA
Name: Stonebraker, Stephen Franklin DL/ID: 236DO0596
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:
�1°""'•:?'/4r
2/24/2012
IOWA
Office of Driver Services
Iowa Department of Transportation
Name: Stonebraker, Stephen Franklin DL/ID: 236DD0596
Feb.20. 2012 9:59AW Div of Criminal Investigation No.4646 P. 2/5
Fhb 14 i c vo.voa i vuvw gab o1 tuwra s uy 319-338-2708 p.[
t
, IOWACriminal HistCheck
1441]
1 a / 1 Request Form
To: Iowa Division of Criminal investigation
Support Operations Bureau, 1't Floor
215 X 7" Street
Des Moines, Iowa 50319
(515) 725.6066
(515) 725-6080 Fox
I am rwraestin2 an Iowa Criminal 1listory Record Check nn:
DCI Account Numbcr: 9967-F
(if applicable)
From: Yellow Cab of lows City
P.O. Box 428
Iowa City, IA. 52244
(319) 338-9777
Phone:
Fax: (319)339-7302
Last Name (manduory
First Name (mandatory)
Middle Dame (raeonmended
S�
Date of Birth (mandatory)
Gender (mandato)
'Social SecurityNumber rmnimended)
S- 2''-2,— )9
®Male UFemale,
-1 e - O� 7C. 1 L(
i'iW alverAfortnation: Without a signed waiver IYom the subject of the request, a complete criminal history record may not
be raleasahle, per Code of Iowa, Chapter 692.2. For comolete crlminal history record information, as allowed by law, always
obtain a Waiver signature from the suh eel of there ueat
WaiverAelease: f kmby g,ve parmissioa for the ebovc mque.1ing officialto conduct an lox'e ddminal h4loly record ehmk will the Division of C6,31M
i Inoesagation(DQ, Any oominnl Pinery dela conceming me that is munmlmd by''the may b: m1cascd m Nlowcd by law.
ffDCl
Waiver Sign attire:
Iowa Criminal History Record Check Results (Dc,u ena,y)
As of a search of the provided name and date of birth revealed: —,
No Iowa Criminal History Record found with DCI
Iowa Criminal )-listory Record attached, DCI # '
r�.
DCX initials
DCI -77 (08/25110)
Received Time Feb. 14. 2012 9:08AM No. 9091