HomeMy WebLinkAbout12-080�r III a
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CITY Of IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-5040
[3 19) 356-5497 FAX
1. Name
Authorization Number, /C�—' `9110
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
vt
(Office Use Only)
2. Mailing Address 1 Gy6L— P',: l'wr city,
3. Telephone: Home �r'%—S'%S —6ee Other.
4. Prior experience in transportation of passengers: J r7 ✓nil` �i �� L� "�
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A/&
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? /VCS
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Tvoe of offense
8. Has your driver's
Where
l ZCrncr (�.
When
Ci
When
�/Z3 OOR'-
`1 /?Sr (?moo `7
I l O'7 r
been suspended or revoked in the last five
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)
deck drivbadg 09/2010
I heybcer1 that I havg issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
_Z_
76� S . 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 -Vy Date �/X 11 Z_
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by Arj v E K7 / h vvhaS . On this a 7 day of
}44144***f#######ii#it#i44****#*#ftitti##t4444t#4t4f4f4****4****%*****#*%33***#**3**%4*####ti#ti*ttitti#ttitttiti4444t#t444tt#444H444 %*444%%*#3
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).
ig�e of Police Chief or designee
0 !� � - .
SignaWre of City Clerk or designee
Z
Jq Date
` moi' t
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
d.".idmb.d,eapp2010.tl 09/2010
M
02,F a b. 20. 2012 910: 07AM
Div of Criminal Investigation
i DCI 1oiNo. 4648 P. —1/7./007
�s
STATE OF IOWA
Criminal History Record Check r
Request Form '
'ro: lows DWklos arCriminal taveftfiliea
Support Operstlonr Euroao, l" Floor
215 & 7a Street
Dermaloes,Iowa 50319
(515) 7;5.6M
(515) 7254059 FSK
DC1 Account Numbar.
' From: IMavlc,sT�xl
phanet ,��la� 338^
Fust.• .jlq 9S1
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LaSiN■me
'First Name Middle Nome mewan,oea
1 'taWLd>�J
A"iV-W e7
Date ofBirth invAun
Gender wean Sodaall Security Plru�mbeer(monmeweA
paw y
Walvorinformallon. Witheataalpedwalverfmanthe evb)ectoftheregaertlaaomplaleodmlaalbleroryremramay not
be raifautbla,per Code of lows, Chapter 692.2. For tYJNDWa criminal hirtary record Infurmsiiop, so stowed bylaw, always
o leaasWere st�refro seobeeto/ther oeaG. '
lK'aHer $elease:7 he,eDydrr pm,alealbrdr.tova w0�^Y o�ic"al bcood[[a wro,rac.4oral fumy rtootd aback rich de niri.be ofCdMed
ravaapt(oatocn- �roa�auwm,4[rau.ooac«at,s�meam.s�,�tyunoctm.yteRte,..ad.umaatylw.
WaiverSignalare: !'
As of-9---P--o --Lam-, a search of the provided name: end date of birth revealed:
No Iowa Criminal History Rtcord found with DCI ,
��,13
111 Iowa Criminal history Record uhochedr DCI ll
DCI
Received Time Feb, 14. 2012 2:17PM No. 9179
(Dawn Orly)
,
C.
CA
Iowa Department of Transportation
Office of Driver Services (Tall Free) SOU -632-1121
PO Box 9204, Des Manes, to 503DS-9204 515-244-9124
FAX; 515-239-1837
Inquiry Date: 3/27/2012
Name: Thomas, Andrew Aaron
Address: 1915 TAYLOR DR
City/State: IOWA CITY, IA 522407244
Mailing Address: 1915 TAYLOR DR
Mailing City/State: IOWA CITY, IA 522407244
Convictions
Citation Date Conviction Date
08/07/2006 09/23/2008
11/03/2011 112/13/2011
Sanctions
Certified Abstract of Driving Record
DL/ID #: 433ZZ8765(IA)
Class: D
Audit #: 5074710
Issue Date: 03/11/2011
Expiration Date: 03/30/2015
Endorsements: 3
Restrictions: NONE
Date of Birth: 3/30/1987
Sex: M
History Information
Customer #:
2169524
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
;IA
ACD Explanation
_ rM 14 Fail to Obey Traffic Sign/Signal
Improper Registration
B64 ,No Insurance Card��
Improper Registration
Fail to Obey Traffic Sign/Signal _
County IUR
52 _ _ =IA
............. .......u. 392 .....__-..._.a�A .... . ,
Type
Effective
End
ACD
Explanation
Occurrence 3UR
7UR
Suspended
07/24/2009
07/19/2010
'D53
INon Payment of Iowa
Fine
IA
;IA
Suspended
;07/31/2009
.07/19/2010
653
Non-Paymentof Iowa
Fine
;IA
_IA
Suspended
;08/04/2009
;07/25/2010
,D53
Non -Payment of Iowa
Fine
_IA
IA
Suspended
;08/12/2009
;07/25/2010
_
;D53
Non -Payment of Iowa
Fine
;IA ..
_ _ _ IA_
Suspended
-� _
Y08/20/2009
._.___.._ _
:09/09/2010
_
,D53
,Non -Payment of Iowa
-Fine
_ JA
IA
Suspended
_
;08/20/2009
;09/09/2010
'1353
.Non -Payment of Iowa
Fine
'IA
IA
Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765
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:
i pQ F9�CIf AkX
".: v r
IOWA
't2'c
%o_ n A T .V 3/27/2012