HomeMy WebLinkAbout12-057r-
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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
First
1. Name
2. Mailing Address
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
�� - s/1
(Office Use Only)
3. Telephone: Home 13ici - S-.7,1-06111 Other:
4. Prior experience in transportation of passengers:'�r,XjLAI-crvjZJ— NLLI Ql, 199u1 +e3 PfeSevi
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �2S
Type of offense Where When
6. Have you en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? ) e5
Where
When
When
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? YEn
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)
dab .,dnry adg 09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
32a i� 4g S . I understand that if I falsely answer any questions in this application, that this
application may be denied. 1 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 Applica�i Date 1
STATE OF IOWA )
COUNTY OF JOHNSON
Subscribed and sworn to before me by f�r:�L—{�gm',�n R\1o�k;h3y� . On this '.)-dday of
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).
a-as'-ia
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.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
darona.,ww ,.app2010 a 09/2010
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Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Box 9294, Des Manes, IA 5O30&92O4 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/23/2012
DL/ID #:
322AE4845(IA)
Name:
Hopkins, Aric Benjamin
Class:
D
Address:
1018 B AVE NW
Audit #:
5356492
Injurious Material on Highway
'.52
Issue Date:
07/08/2011
City/State:
CEDAR RAPIDS, IA 52405
Expiration
06/28/2014
Date:
Endorsements:
3
Mailing Address:
1018 B AVE NW
Restrictions:
Corrective Lenses
Date of Birth:
6/28/1973
Mailing City/State:
CEDAR RAPIDS, IA 52405
Sex:
M
History Information
Convictions
Customer #: 4037579
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert Status: None
CDL Med Status: None
Restriction None
Supplement:
Citation Date
Conviction Date
ACD Explanation
County
SUR
02/19/2009
03/06/2009
B51 Expired Driver's License
57
IA
03/17/2010
05/25/2010
Injurious Material on Highway
'.52
IA
Sanctions
Type Effective End ACD Explanation Occurrence TUR TUR
Suspended 01/14/2011 03/03/2011 D53 Non -Payment of Iowa Fine IA IA
Name: Hopkins, Aric Benjamin DL/ID: 322AE4845
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:
Name: Hopkins, Aric Benjamin DL/ID: 322AE4845
a•r•••••••7cay� 2/23/2012
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Office of Driver Services
Iowa Department of Transportation
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Zeceived TM e5irA, 23, 2012 11:39AM No. 9951
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