HomeMy WebLinkAbout12-279'Amp I1
7kr'lll��
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name h,
2. Mailing Address
3. Telephone: Home
Authorization Number /j- - -719
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Other: 3/ /` _361e-63"
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
6. Have you beeQ convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
When
Type
of f offense
Where
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /06
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)
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)
derM4 dr.dg 09/2012
I hereby certify that I havy issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
Z 3 LD C ( GJ °1 . 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 Date
»RR»ff»»»f»»»»#**1f»f*#»##*####**»*##»**##**##**»#*»#*##*##***#f*###**4#»»»f»»#»»#»f **t*!1f#»**#*»»**»f*»»*»f*R*R*
STATE OF IOWA )
COUNTY OF JOHNSON )
,$*scribed and sworn to before me by i\o ma} �ti C On this (� day of
`] 131 H
R#f#*R#**4i14!»441fR!»kR*RRRRR*R*R********#**RkR*4k*4k****k**kk#*RR#*R*******kRRRkRR**RR*R*R*R*RRRR*RRRk***RRR»f***R*kRRR*R»R4l4RRR*RBBB**#*
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).
ig��of Police
-Chief or designee
:7 /0-/Z
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.
Sign 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
/oZ-
Date
dR Vbw d�2oiod 09/2012
J Dec. 4. 2012 3:29PM Div of Criminal Investigation No. 6704 P. 1/2
?012-:I'I'C'I VY:IU AIKPURT 4HUI ILI_ ShKV s7vs621094 » 5,15' (45 608u P z/2'
I
STATE OF ZON)VA
Criminal History Reedrd Check
Request Form
r
Mf Account Nurnber: q qto —�
j (irepplieable)
TO: Iowa Division o{tlCriminal luvesggadou From: ooy- S �46y" ]C-c—j
Support operations Bureau, l" Floor
2152.7'"Street a i 1 r I
DesMclne%Iowa 50319 0_ Ff
(51s) 725.6066 C'd f. l]I y rJ
(615) 725.6080 Fae 9 65 0�
Phone;
�'--rE S I'
i
Social
to �% / I Male ❑Felnale I / 51..5.(9 • /!o Z(9
l7�atverhlformalloa: Without a rlpnad Wolvprfrom the subject of the request, a complete criminal history, record may not
be releasable, per Code oflawp, Chppter 692.2, For act, ndlela criminal history record ibformation, as•allawed'by law, always
obtain a watversivnat ,. n.., i�,...,�.�e.....�,._
U
r'i�aFVBY.IiBiBaSe:fitltv6ygira peRnisslon tarme pbovoleQae9t1pg plpcisl to condpuan loua uindnel hlnpry record gibed whh lAe Dh�islan olComtnal
Invesllgallod(PCh, Anytriminal history dale conttmi elpat is matntpncd by ale DCl may be eased as aflawd by lase.
I. WaiverSigitature:
owa Criminal Histor , Record Check Results (Dal UPI),)
As of a search of the provided name and data of birth revealed:
No Iowa Criminal History Record found with DCI ' ,r , r,
L1 Iowa Criminal History Record attached, DCT # ;,
ACT initials, N
nCI.77 tds/zsn o>
Received Time Nov. 21. 2012 1:50PM ND, 5069
i
I
0
Iowa Department of Transportation
CE3Office of Driver Services (Toll Free) 800-532-1121
P4 eaK 9204, Des Moines, IA 50306-9209 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
12/5/2012
DL/ID #:
243CC1584 (IA)
Name:
Gates, Robert Eugene
Class:
8
Restriction
Sr
Supplement:
Address:
6706 WATERVIEW DR
Audit #:
5713270
SW
Issue Date:
12/30/2011
City/State:
CEDAR RAPIDS, IA
Expiration
06/09/2013
524047715
Date:
Endorsements:
NONE
Mailing Address:
6706 WATERVIEW DR
Restrictions:
Corrective Lenses
SW
Date of Birth:
6/9/1948
Mailing City/State:
CEDAR RAPIDS, IA
Sex:
M
524047715
History Information
Convictions
Customer #: 1747283
ID Status: None
DL Status: VAL
CDL Status: VAL
CDL Cert
Excepted Intrastate
Status:
CDL Med
None
Status:
Office of Driver Services
Restriction
None
Supplement:
Citation Date Conviction Date ACD Explanation County IUR
05/07/2008 05/14/2008 Speed (10 mph & under in 35-55 mph zone) 52 IA
Name: Gates, Robert Eugene Sr DL/ID: 243CC1584
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:
:+"""•;Tippy
12/5/2012
IOWA
D.O.T.'
i'* •"•••'
SCJ
Office of Driver Services
�„RRIYEO,a
Iowa Department of Transportation
Name: Gates, Robert Eugene Sr DL/ID: 243CC1584