HomeMy WebLinkAbout12-086Authorization Number \7-- %0
% 1 (Office Use Only)
■■
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
41 0 East Washington street between 8 a.m. to 3 p.m., Monday — Friday.)
Iowa Cit ,Iowa 52240-1826
(319) 356-5040
(31 549 FAX
,_first 1dle Last
1. Name >s�+ . �-,'� "C�= ht c
2. Mailing Address L' `( �c vne Q iJ Lei i
3. Telephone: Home _ I t('9' Other:
4. Prior experience in transportation of passengers: A /q
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /yo
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? (�S
Type of offense Where When
c � i�7j"IS-J,)&
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /P
Tvoe 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)
derMaxidrivbadg 09/2010
1
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
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 N / 13/(,'2-
###f#fYY#*H41Hf###Y*YF4#fe4ffYMY#N#i***fff f»fffH#fN#YHY##Y**4*f#44HHfHHfH*N1N#NH4YNYYR**4#**H44HfffHfHHfNNNY#f#i#»**4F
STATE OF IOWA )
COUNTY OF JOHNSON )
$Gbs,nbed land sworn 1to before me by_? -C ,\I I� (�� On this I?D day 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%,
Signature ol Police Chief or designee
�Ziv��.hi . &ZAd/
Sign ure of City Clerk or designee
Date
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
der .,dniW ,.,2010 do 09/2010 ,
Iowa Department
Office of Driver Services
PO Box 9204, Des Moines, IA 50306-9204
Inquiry Date: 4/3/2012
Name:
Riley, Bret Patrick
Address:
409 JAMES BLVD NW
County
UNIT 6
City/State:
OXFORD, IA 523229305
Mailing Address: 409 JAMES BLVD NW
UNIT 6
Mailing City/State: OXFORD, IA 523229305
Convictions
of Transportation
(Toll Free) 800-532-1121
515-244-9124
FAX: 515-239-11137
Certified Abstract of Driving Record
DL/ID #: 811ZZ5041 (IA)
Class: C
Audit #: 5516473
Issue Date: 09/17/2011
Expiration 05/09/2014
Date:
Endorsements: L
Restrictions: Corrective Lenses
Date of Birth: 5/9/1981
Sex: M
History Information
Customer #: 2727263
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
JUR
03/16/2008
04/29/2008
S92
Speed
58
IA
07/28/2009
08/24/2009
S92
.Speed
10
IA
07/28/2009
08/24/2009
B51
Expired Driver's License
10
IA
07/15/2011
08/15/2011
B64
No Insurance Card
52
IA
Name: Riley, Bret Patrick DL/ID: 811ZZ5041
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:
...... :;l
4/3/2012
f �RiYER S=
Office of Driver Services
Iowa Department of Transportation
Name: Riley, Bret Patrick DL/ID: 811ZZ5041
• Apr. 12. 2012211:45AtM Div of Criminal Investi;ation
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Received Time Apr. 10, 2012 3:42PM No, 410