HomeMy WebLinkAbout12-178CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Last
(Office Use Only)
1. Name rrl n r 1` t �
2. Mailing Address U 4 0Pk (,� r, { k z--
3.
3. Telephone: Home a rA — 4 7t 2 Other. /1
4. Prior experience in transportation of passengers:
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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? ko
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years? I
Type of offense ( Where When
Jf 4 �^d(QG `orti ly, �(� 2 o D 6'
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense Where When
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9. Have you ever applied to bean 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)
6�immcaag 06/2012
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license munber
/�f� f 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 ✓� /a Date 9 )2--2--)1-2
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STATE OF IOWA )
COUNTY OF JOHNSON 1
B
b cribed and �wornAo before me by l fY i VCy On this �- day of
I�
KELLIE K. TUTTLE`-�—
i commission Num9 r 2218IMotary Public in and for the State of Iowa
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).
Date
�-a7-/a.,
Date
NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names 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
derWlexidrrvbadgeapp2010,d
06/2012
Dai Aug.17. 2012 9:56AM Div of Criminal Investigation No.9444 P. 1
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DCI Account Number: y-62.
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215 E. I,, Street
bashfyinujolva 50319
(515)725.6066
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CITY CLERK'S OTBICE
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Phone: 319-11i6-1041
t+ax: 319_356-54,97 -
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Iowa Crimin al HIstory Record Check Results.
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As of 11 `, V a search of thoprovided name and datc of both levcalcd;
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DCt inifials��
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Received Time Aug.13. 2012 1:37PM No..1233
C Iowa Department of Transportation
AO Office of Driver Services (Toll Free) 800-532-1121
PO Box 9204, Des Manes, IA 50306-9204 515-244-9124
FAX: 515-239-1937
Certified Abstract of Driving Record
Inquiry Date:
8/21/2012
DL/ID #:
961AA2587 (IA)
Customer #:
4105025
Name:
Vaxter, Barrington
Class:
D
ID Status:
None
Frank Fowler Jr
Address:
409 6TH AVE APT 2
Audit #:
5467309
DL Status:
VAL
Issue Date:
08/24/2011
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration
04/04/2014
CDL Cert
None
522412338
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
409 6TH AVE APT 2
Restrictions:
NONE
Restriction
None
Date of Birth:
4/4/1986
Supplement:
Mailing City/State: CORALVILLE, IA
Sex:
M
522412338
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
03/15/2008 04/08/2008 B20 Driving While Suspended, Denied, Cancelled, Revoked '.52 IA
Name: Vaxter, Barrington Frank Fowler Jr DL/ID: 961AA2587
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:
1"""•: �2/p�
8/21/2012
IOWA':: Q
�/
11=44-07
D. 0. T.;�
•'••^''
Office of Driver Services
Iowa Department of Transportation
Name: Vaxter, Barrington Frank Fowler Jr DL/ID: 961AA2587