HomeMy WebLinkAbout12-084CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 3S6-5497 FAX
n First
1. Name `a-Vmc"A(
2. Mailing
3. Telephone: Home
4. Prior experience in
I
lV;i�ioV?�z ( r
of passengers:
Authorization Number. 1,,-2-94
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
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Last L
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? J&
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? Nt
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Ni�'
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)
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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)
GeM.iddi badg 0912010
I berebY certi that have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
L 4� - 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 � \ Date
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STATE OF IOWA )
COUNTY OF JOHNSON )
SM scribed and sworn to before me by Ka timet C%Z On this �� day of
o aura, KELUF K. TU
i Y Commission Number 22781
M ssio Ezp es otary Public in and for the State of Iowa
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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).
Signwaturd of Police Oef or d sign'eee
71 i4-zc� .tit
Signature of City Clerk or designee �
Date
:L- 5 - a G /-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
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Received Time"Mar, 30. 2012 2:42PM No.3230
0�/'� Iowa Department of Transportation
�M//'' Office of Driver Services (Toll Free) 806-532-1121
PO Box 9204, Des Manes, IA 5U3(F6 92Ud 515-244-1924
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/30/2012
DL/ID #:
062BB4559 (IA)
Customer #:
4007420
Name:
Guest, Raymond Isaiah
Class:
D
ID Status:
None
Address:
430 SOUTHGATE AVE
Audit #:
5403197
DL Status:
VAL
Issue Date:
07/28/2011
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
12/17/2016
CDL Cert
None
522404425
Date:
Status:
Endorsements:
2
CDL Med
None
Status:
Mailing Address:
430 SOUTHGATE AVE
Restrictions:
NONE
Restriction
None
Date of Birth:
12/17/1982
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522404425
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
02/07/2012 03/14/2012 �B64 No Insurance Card 52 IA
Name: Guest, Raymond Isaiah DL/ID: 062BB4559
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/'4
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3/30/2012
IOWA
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Office Driver Services
OF �AiS�
of
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Iowa Department of Transportation
Name: Guest, Raymond Isaiah DL/ID: 062BB4559