HomeMy WebLinkAbout12-113fir ®a'1
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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 d • c
Authorization Number /-01-113
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
2. Mailing Address: A), 4>&/&k, �� �%% c a c ' c5, u< I ( c' �f� .�7 �d 6
3. Telephone: Home J 3-5 3a - G G 8 Other:
4. Prior experience in transportation of passengers: e 2 llr S
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ti v
Type of Offense Where When
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7. Have you been convicted of any traffic offenses in the last five years? % S
ly
e of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A ! C'
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)
de"dnvbadg 09/2010
I hefeby cert)fy that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
— . I understand that if I falsely answer any questions in this application, that this
application ay 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 ail 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)
!tel •OWN
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 2: cAg, K.,,44E On this 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).
G -/-7- /Z
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
d�Wa d�aPP2010.� 09/2010
STATE OF IOWA
Criminal ffistory Record Check
Request Form
To: Iowa Division of Criminal Investigation
Support Operations Bureau, 1' Floor
215 E. 7`° Street
Des Moines, Iowa 50319
(515) 725-6066
(515)725-6080 Fax
I am renne_etinu nn Tnwn ('.riminal AictLmv Rrr•n,-A rq....1, —
DCI Account Number: 9861-F
(if applicable)
From: City Clerk's Office
City of Cedar Rapids
3851 River Ridge Drive NE
Cedar Rapids, IA 52402
Phone: 319-286-5060
Fax: 319-286-5130
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Iowa Criminal History Record Check Results
As of a search of the provided name and date of birth revealed:
❑ No Iowa Criminal History Record found with DCI
❑ Iowa Criminal History Record attached, DCI
DCI initials
DCI -77
(DCI use only)
11 9WGProcess.asp
Page 1 of 1
Criminal Histo Bac round Check
ast Name aiders Name First NaroeDOB SN
Selection Criteria ennett [Richard 1940 -March -17 85469052
Results
Further research is required. Please await DCI's final response for criminal history.
Please note: There may be multiple individuals with similar search criteria, requiring more research.
Background Check Complete As Of 3/16/2012 9:19:16 AM
Billing Account 9861-F Cash Deposit Currently at $829.00
Generate PDF
httns://www.iowaonline.state.ia.us/SING/SINGSOLProcess.asnx 3/16/2012
.Ma r. 20. 2012 4:09PM Div 3f „r,T i 1a1 Investigation
Submitted 2012-03-16 09:19:16.503
IOWA RECORD CHECK REQUEST
To: Iowa Division of Criminal
Investigation
Bureau of identification
215 E. 7th Street
Des Moines, IA 50319
(515)725-6066
(515)725-6080 (fax)
FORM.S
REQUEST
(* indicates a required field)
I am requesting an rotYA.CRiMINA1,11ISTOAY recordcheck on:
No. 2131 P. 1/1
Page 1 of 1
ACCOUNT NUMBER: 9861-F
CITY CLERK - CITY OF
From: CEDAR RAPIDS
3851 RIVER RIDGE
DRIVE NE
CEDAR RAPIDS, IA
52402
Phone 319-286-5060
'Fax 319-286-5130
Contact Preference: F
BEI1'NETT RICHARD AUDIS
Last name* First name* Middle name
NO
Maiden/Other Last name Volunteer
3/17/1940 M 4SS469052
Date of Birth* Gender* Social Security number*
(DCI use only) RESULTS
As o[3/2012012 200:39. PM, a name and date of birth check revealed.-
CCH
evealed:
CCH Record Attached_ DC1 # 'No CCH Record Found X
DCI initials W niver on File_ yes
T hereby give permission for the above requesting official to conduct an Iowa criminal history record check
with the Division of Criminal Investigation. Any information maintained by the DCI may be released as
allowed by law.
Iowa Department of Transportation
Office of Driver Services (Toll Free) 8M-532-1121
PO Box 9204, Des Moines, lA 50306-92844 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/16/2012
DL/ID #:
604XX5399 (IA)
Customer #:
640272
Name:
Bennett, Richard Audis
Class:
D
ID Status:
None
Address:
213 N Walnut
Audit #:
4117444
DL Status:
VAL
Issue Date:
02/22/2010
CDL Status:
None
City/State:
Mechanicsville , IA
Expiration
03/17/2015
CDL Cert
None
52306
Date:
Status:
Endorsements:
3L
CDL Med
None
Status:
Mailing Address:
213 N Walnut
Restrictions:
NONE
Restriction
None
Date of Birth:
3/17/1940
Supplement:
Mailing City/State: Mechanicsville , IA
Sex:
M
52306
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
07/13/2010 08/17/2010 M14 Fail to Obey Traffic Sign/Signal 52 IA
Name: Bennett, Richard Audis DL/ID: 604XX5399
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:
•:!d%'h
3/16/2012
10WA ¢I
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a
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Office of Driver Services
Iowa Department of Transportation
Name: Bennett, Richard Audis DL/ID: 604XX5399
Cedar Rapids DL Station
K-Mart Plaza 152 Collins Road NE Cedar Rapids, IA 52404
Statement Receipt: 25882786
Customer Information
Name: Bennett, Richard Audis
Address: 213 N Walnut Mechanicsville , IA 52306
Phone:
Fax:
Email:
Attached Customers
Bennett, Richard Audis
Transaction
Office Information
Date: 3/16/2012 8:46:56 AM
Location: Cedar Rapids DL Station
Name
Type Description
MISC Finance Transaction - Bennett, Richard Audis
Product
Sale of Records - Certified
Payments
Payment Method
Cash
Amount
$5.50
Total Due:
Amount
$5.50
$5.50
Payor Payor # Number Amount Tendered
Bennett, Richard Audis 640272 NA $6.00
Total Tendered: $6.00
Cash Back: ($0.50)