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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
Authorization Number /(;�— 02l-5
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
First Middle1 La t (� ll
1. Name �t✓r-e( tJard tkett(�
2. Mailing Address 2 7�6 ,j ooi S �..,5� �o J�� �r 17?/ 67 9g6
3. Telephone: Home .3, y-663-S?4/ Other:
4. Prior experience in transportation of passengers: Ma(7e� 7a,✓,C4 h t )ooB-aio/U
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /7 D
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? n D
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? y) D
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 442 '
Type of offense Where When
1111.;�u;J Eihes 10,) e— oc,,;a)1
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
ne)
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)
Ger / idwbadg 09/2012
I hereby certifryy that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
�� 3 y �165/y . 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 withall of the visions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant a Date
STATE OF IOWA )
COUNTY OF JOHNSON )
$rncrib{ed and - sworn to before me by j_ �L/l,� t `) y_e �u1
On this a day of
Y I
-LO)
KELLIE K. TUTTLE
4t"i_ Commission Number 221819 Notary 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).
SSgnatur of Police Chief 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.
�.fiAitr/ K q�Csf/!/
Sig 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
derkrte dNbadgeapp2010.tl 0912012
ii/Nov.21. 20125 4:48PM Div of Criminal Investigation.
I
i DCI IonNo. 5125 P._ 1/1
n
r • 1
STATE OF IOWA `'
Criminal History Record Check
Request Form
To: Iowa Ulrblea of Crimlaal reveMlQ.,tla
Support Opentlows Barter. Y T9oor
ns L r sheet
Dai Motaee, fowa M319
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DCI Account Numbers Nag) — FG
praedi�)
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116 644-s dr,
Phone: . 3I9 ) 33f- rM " , ` \
Fart.. 319 551-3,0 \ '
Lut Name t
First Name
MlddteName
Date of Birth muaw)
Gender
SwW Seeurf ember emmwmded
f 4��
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13Femaie
7{
Waive rInformalfamr Wftmt a alped waiver froze the sabloct ortbe regmert, it complete eftloal blatary record may aot
be releasable, per Code of loth, Chapter PL1, For complete criminal library record laramwden, as allowed by law, always "
-obtain a waiver Niza afore Rom the raw act of the requam
WWW RdfeNO:I hmebl[Ive neminim thrda above rwicabs uffkw w aorAm m tow, almteu bmmr r rd doer OM doDirieim ofCrimim
imwdVdanfDCI>.rW'crimimi4irwrdrn Qm=Ab1=d411
1�m"hW re Dci m,ybsrtbed u droverty ww.
WafvtrSlikkil �f�/
As of d much of the provided name omd date of birth revealed:
No Iowa Criminal HistoryRecord found with DCT
Iowa Ctiminel History jlccord attached, ACI N
DCI initials_
Received Time Nov. 14. 2012 11:58AM No.3915
I
(DC[mG eni�r
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ARTS
Page 1 of 2
Iowa Department of Transportation
Office of Driver Services (ro8l Free) 500-532-1121
PO Box 9204, Des Maines, IA 593M204 515-244-9124
FAX: 515-239-1837
1*0
Certified Abstract of Driving Record
Inquiry Date:
11/14/2012
OL/ID #:
713YY6514(IA)
Customer #:
1246223
Name:
Oxenford, Daniel
Class:
D
ID Status:
EXP
Edward
Address:
2766 500TH ST SW
Audit #:
6372621
DL Status:
VAL
Type
Issue Date:
10/10/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
03/31/2013
CDL Cert
None
of Iowa Fine _ _
522408565
Date:
Suspended
Status:
12/13/2010
'D51
_`NonPayment
:Non -Payment of Child Support
Endorsements:
3
CDL Med
None
:09/25/2012
�D53
=Non -Payment of Iowa Fine
.IA
Status:
Mailing Address:
2766 500TH ST SW
Restrictions:
NONE
Restriction
None
Date of Birth:
3/31/1982
Supplement:
Mailing City/State:
IOWA CITY, IA
Sex:
M
522408565
Convictions
Citation Date
Conviction Date
ACD
08/14/2009
;09/01/2009M14
02/21/2011
03/24/2011
_ 1864
09/20/2011
10/21/2011
820
History Information
Ito Obey Traffic S_lgn/Signal_
Insurance Card _
ving While Suspended, Denied,
Revoked
County JUR
.52 . _ .IA _..
52 .IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
Case Number
JUR
01/21/2009
1490484
:IA
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence JUR
JUR
Suspended
;02/24/2010
03/03/2010
ID53_
of Iowa Fine _ _
SIA
,IA i
Suspended
'06/19/2010
12/13/2010
'D51
_`NonPayment
:Non -Payment of Child Support
IA _
IA_
Suspended
:06/27/2011
:09/25/2012
�D53
=Non -Payment of Iowa Fine
.IA
iIA }
D53
Name: Oxenford, Daniel Edward DL/ID: 713YY6514
of Iowa Fine IA
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:
http://172.29.254.55/drivers/reports/eustomerhistorylcertifieddrivingrecord.aspx 11/14/2012