HomeMy WebLinkAbout12-263CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-504 <ZA�L WED . PM
(319) 356-5497 FAX
1. Name
2. Mailing Address
3. Telephone: Home 319 (DZID-35`13
Authorization Number \a ` ^^� V'3
(Office Use Jnl— y)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
4. Prior experience in transportation of passengers: I
GJ
Other:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �) Q
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?�
Tvpe of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? hc)
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)
00
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)
uHvbadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number'll,
I understand that if I falsely answer any questions in this application, that this
application may be denied. I un erstand 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_ Dat�� -
STATE OF IOWA )
COUNTY OF JOHNSON ) p
Subscribed and swom to before me by r i c1 / rd rr) r C -k, 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).
/7- 'J - /;L-
YOU
%
Sign ture of Po ice Chi r designee
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
7�- 1� //- '6� - /c:p-
Signdture of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
derkna W�adge 2010dm 09/2012
C
Iowa Department of Transportation
Office of Drier Services (Toll Free) S M -532-1121
PO Bax 9204, Des Moines, IA 5030fi 9204 595-244-9124
FAX-, 515-239-1837
Inquiry Date: 10/25/2012
Name: Hardwick, David Scott
Address: 275 JUNIPER CT
City/State: NORTH LIBERTY, IA
523179200
Mailing Address: 275 JUNIPER Cr
Mailing City/State: NORTH LIBERTY, IA
523179200
Convictions
Certified Abstract of Driving Record
DL/ID #:
430WW4335 (IA)
Class:
B
Audit V:
5518998
Issue Date:
09/20/2011
Expiration Date:
02/22/2016
Endorsements:
LPS
Restrictions:
NONE
Date of Birth:
2/22/1965
Sex:
M
History Information
Customer rF:
716612
ID Status:
None
DL Status:
VAL
CDL Status:
VAL
CDL Cert Status:
None
CDL Med Status: None
Restriction None
Supplement:
Citation Date Conviction Date ACD Explanation County JUR
__........... . .. .._..._... _._..... r.__..... ,
09/08/2009 10/05(2009 ;592 ;Speed MO
Name: Hardwick, David Scott DL/ID: 430WW4335
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 beenauthorized 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:
. ;.Z4I,t
10/25/2012
IOWA' Top,
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Office of Driver Services
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Iowa Department of Transportation
Name: Hardwick, David Scott DL/ID: 430WW4335
Crct.30. 2012 3:32PMDiv of Criminal Investigation
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Received "Time Oct.25. 2012 2:02PM No. 6040