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Home My WebLink About12-271t ��®air �III� CITY OF IOWA CITY 410 East Washington Street Iowa city, Iowa 52240-1826 356-5040 �y�GS II 13 X Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) /o -Z-0-7/ (Office Use Only) Fi t Middle Lasa[ 1. Name ORFR1 Si(JjT PV�f R 2. Mailing Address )_$h5 ii Ag Ls Mp, FAIRNEW,1A 5255 6 3. Telephone: Home 07/— 7 11 * J 637 Other: 4. Prior experience in transportation of passengers: 'tA k 1611 PIE06 E L2 MRA Qi' �S 7AMN6 PEA?LL ON M110TOURS 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Nn Tvpe 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? y; S Type of offense Where When � rR1I.U6E- 10 ntkjihocif.7►II 1t �ICI�f6,,a ►z.lyhn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? No Tvpe 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) deNtaxidrivbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number AFFa�bd . 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 ��r✓/GUt Date ll�l9%I STATE OF IOWA ) COUNTY OF JOHNSON ) (� p p Subscribed and sworn to before me by i`oy S�1* On this day of of Iowa "7111 *{*{{*******k*******k*k*kk****#***kk*kk}kk#*}t*t*}*************k***********kk***}}*t}}t*************k****}##}##}t#}t##}tt#t**********k*****k#*## 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). 4- Signiture ,::; 6 04 olioe Mef or designee 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. `74 r s w / /l • r Signa re 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 derkAaxic4iwad8mpp201o.dm 09/2012 Nov.16. 2012 1:51PM Div of Criminal Investigation klov, 6, 2012 4:11PM City Clerk - City of Iowa City d No.4339 P. 1/2 No. 1991 N. 1 I �cr//AhAA\�+'�P�• �; • .1'' • I If : rfi Qlt`�S�n _ �il,rJ v� L�111'I'sT® • q�emarf� 3�� tfi6 U27Y waivet�l -e rthufiAY1, Wffhoutaa(gnedpcAivorA'omthesu[rJeatoftharegpnsh a rompla[9orim(npihlsforyrccotciufpynot %o>•e[ea9nbley�ierCatTeo�%prp,Chaptep69x2•.boY e[eurlminalhisto{yraealdh71'oxMai%n�psallowod�ylpW,glpVpyS T�ayver,?rerad58: iAvroDyafVo pariniss(ott 1DC1honDoyereque,gngoftfoial W condual pnYolva odm(nnt fits[ory[eootdahxkv/ilh IpoDllislad oPCtiminef Ynvestigatian(DCU, ppyprlrofnslhlaWrydataaonC�minnntafha[7{ma/ntalnedgy�henOfmay6arete sedasnffoytadDyteW. R A 1 111{�Cd LUl d'+•GQ:UI: rI-V�d{CA: ,A'4CSIUIL.Y (MM t,r0 only) , As of a search of lhoprovlded name and data of b1iih.Ywcalod: :''• ' �it.�', •tom IJjr! No rbwa a-iminal HistoxyAocord found Wa D a D xawaQMnalHistowRoeordttaahed,DCO • r— N bCZ�iflals nrr�� rnpy�5/Ing - Received Time Nov. 6. 2012 4:12PM No,6539 a XXX AooaritNfimber: Lf i Uo �-' f' ' • (%rupplimblo)— To: Yolv011v7s1ot1 of Criminallb'Veftation b`romt OSTM OF iOTWA OITY SOppoYtOperatlonsEaronu,l°tploor OxTX OLWIXIS oFFTOE 21SE,1481raet 1 410 F'. VASHT014 STRIigT AesMyinaS,Ioiva 30319 (515) 7254006 (515) 72S-bOBfl U'e� - )')lane(, 31 iraXl X19-9.56-5/9.7 ,. ••L ! pn1 re uostIn anlowa COMMAIBiato Racord Cheelc on; XR1116 (mandatory) ' �iYSErldfbf! niBitdA10 MfddloName (recommended) ' _ �il,rJ v� L�111'I'sT® • q�emarf� 3�� tfi6 U27Y waivet�l -e rthufiAY1, Wffhoutaa(gnedpcAivorA'omthesu[rJeatoftharegpnsh a rompla[9orim(npihlsforyrccotciufpynot %o>•e[ea9nbley�ierCatTeo�%prp,Chaptep69x2•.boY e[eurlminalhisto{yraealdh71'oxMai%n�psallowod�ylpW,glpVpyS T�ayver,?rerad58: iAvroDyafVo pariniss(ott 1DC1honDoyereque,gngoftfoial W condual pnYolva odm(nnt fits[ory[eootdahxkv/ilh IpoDllislad oPCtiminef Ynvestigatian(DCU, ppyprlrofnslhlaWrydataaonC�minnntafha[7{ma/ntalnedgy�henOfmay6arete sedasnffoytadDyteW. R A 1 111{�Cd LUl d'+•GQ:UI: rI-V�d{CA: ,A'4CSIUIL.Y (MM t,r0 only) , As of a search of lhoprovlded name and data of b1iih.Ywcalod: :''• ' �it.�', •tom IJjr! No rbwa a-iminal HistoxyAocord found Wa D a D xawaQMnalHistowRoeordttaahed,DCO • r— N bCZ�iflals nrr�� rnpy�5/Ing - Received Time Nov. 6. 2012 4:12PM No,6539 a Iowa Department of Transportation Office of Driver Services (Toll Free) OM -532-1921 FO Box 9204, Des Moines, IA 5ff30"204 515-244-3124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/6/2012 DL/ID #: 076FF8460 (IA) Customer #: 1093734 Name: Puffer, Robert Scott Class: C ID Status: None Address: 2565 OASIS BLVD Audit #: 5038561 DL Status: VAL Fail to Obey.Traffu: Sign/Signal .... _........_.. _ MI ....... Issue Date: 02/24/2011 CDL Status: None City/State: FAIRFIELD, IA Expiration 03/10/2016 CDL Cert None 525568821 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 2565 OASIS BLVD Restrictions: NONE Restriction None Date of Birth: 3/10/1950 Supplement: Mailing City/State: FAIRFIELD, IA Sex: M 525568821 History Information Convictions Citation Date Conviction Date ACD Explanation County Jun 04/26/2009 05/07/2009Speed (10,mph & under in 35 55 mph zone) 51 IA 06/29/2009 _.__ 07/17/2009 ...............:S16 Speed .............. ... _...._.......... ........ . ...... :...... ......_ OK._....... 12/04/2010 ..... 12/09/2010 _._ _ M36 Fail to Obey.Traffu: Sign/Signal .... _........_.. _ MI ....... 03/31/2011 �OS/11/2011 ;M34 Fall to Obey Traffic Sign/Signal 51 ;IA Name: Puffer, Robert Scott DL/ID: 076FF8460 Pursuant to Iowa Code §321.10, 1, 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: ;: """.ZIP/4V • 11/6/2012 IOWA D. 0. T. ?l 7f Office of Driver Services O...... Iowa Department of Transportation Name: Puffer, Robert Scott DL/ID: 076FF8460