HomeMy WebLinkAbout12-267Authorization Number /3- a6 7
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CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.)
Iowa City. Iowa 52240-1826
(319) 356-SO40
(319) 3S6-S497 FAX
Firs Middl Last
1. Name r
2. Mailing Address 'vv l S� �Oti✓A �v 2 oto
3. Telephone: Home -3m-tfoo -If `O Other.
4. Prior experience in transportation of passengers: 2 • 5 Y E5 Gab CxDeri eI Ce I A lOw0.
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 4A
c '
Type of offense Where When
6. Have you br 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?U 5
T e of offens Where When
vlll - z 2
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1 V
Type of offense Where When
9. Have you ever applied to ffrl Iowa City taxi driver using a different name? If yes. please provide the name(s)
/V o
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)
dem dwbada 09/2012
ft
I hereby certify �(�t J fag j�suee rhe by the Iowa Department of Transportation a valid Chauffeurs license number
S LG f+Y" I . 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 t provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) I
Signature of Applicant 'G //L� Date % I I l L
STATE OF IOWA )
COUNTY OF JOHNSON )
ub cribed
and swam to before me by �Ya� �tu.— On this day of
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1L(-- 4{Q�
`z Notary Public in and for the State of Iowa
z KELLIE K. TUTTLE e
My issi n Ex fres
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).
Sign aty e o Poliq ief or designee
zz) y -a
Date
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.
Signat0re of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Date
dedN idrivbadgea 2010 dm 09/2012
' Iowa Department of Transportation
C 9 Office of Driver Services Noll Free) 804332-1121
PO Box 9204, Des Moines, IA 503115-9204 515-244-9124
FAX: 515-239-1837
Inquiry Date: 11/7/2012
Name: Rew, Bradley Kenneth
Address: 302 W BENTON ST
City/State: IOWA CITY, IA 522465505
Mailing Address: 302 W BENTON ST
Mailing City/State: IOWA CITY, IA 522465505
Convictions
Certified Abstract of Driving Record
DL/ID #:
322AE6971 (IA)
Customer #:
2804420
Class:
D
ID Status:
None
Audit #:
4513566
DL Status:
VAL
Issue Date:
07/14/2010
CDL Status:
None
Expiration Date:
06/02/2015
CDL Cert Status:
None
Endorsements:
3
CDL Med Status:
None
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
6/2/1982
Supplement:
Sex:
M
History Information
Citation Date
Conviction Date
ACD
Explanation
County
JUR
12/19/2007 _
_ _01/07/200B
_
M70 _
Improper Passing
52
'.IA
04/29/2009
05/15/2009:Speed
(10 mph & under in 35-55 mph zone)
52
IA
05/14/2009
.05/27/2009
S92
Speed
52
IA
02/04/2012
02/22/2012
592
.Speed
52
IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
01/26/2011 614924 ;IA
Name: Rew, Bradley Kenneth DL/ID: 322AE6971
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:
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•IOWA
11/7/2012
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Office of Driver Services
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Iowa Department of Transportation
Name: Rew, Bradley Kenneth DL/ID: 322AE6971
io.Oct. 16. 2012711: 53AM
Div of Criminal Investigation , DOI IOIN9.9584 P. V1,
STATE OF IOWA
Crimius! History Record Check }
Request Form
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LaatNa ac FirotName ro�mr f
Date ofBtrth Gender Social Securi Number
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be releeeable, per Code of Iota!, Chapter 6➢25, Forte crim4al Wary rewrd Idonnatiov, me allowed by IM aUnra
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iF'ot►rr Sign alru e; =`"'
(Va an only)
As of 'lLUG 1Xtri a search of the provided name and date of blrtft revealed: ;
L. No Iowa Criminal History lsecord found with DCI ..•: i '''' _'.'
❑ Iowa Criminal History Record attached, DCI fi s ' = :: n
DCC initials N
Received Time Oct, 9. 2012 10:29AM No. 6361