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Home My WebLink About12-283� r 1 -4 MIW®��Il CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name Authorization Number !d - a 83 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) ME 2. Mailing Address 15t5 %JPLA�^ Cil ih 3. Telephone: Home 3[9- 47/-73 5 Other: 4. Prior experience in transportation of passengers: 3e . (Office Use Only) Last A w 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? tL1;'5 Type of offense Where Vis- LC(L>"Y L,fiL When /9 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? h)6 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? TVpe of offense Where When 360 11J50 i,' Cv - 0 qr —/2- 8. /2 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) 1 0 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) derWta [dnv adg 09/2012 I hereby ,errt2 tl�at�l a/v issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 3 ) �fb . 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 ####k##+###44##H#####4##**FF#*#F4Ff**F**f*Y***f*F**#'k***4***#****F###*4i#4#####4+##1fff11f Yf1fff11f1ff1N41f11NfYf11111f1111ffYfYlffffffYYf#1f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by bAvin 1V.1Ww£S On this !! day of �o4AA1 SONDRAE FORT ' �,`" " Iz Commission Number 159791 w •y1�L F*vb My cos . Esrey Notary Public in and for the State of Iowa 3l> mrf oa ffi4ffiffiff*iffififfik#f*f**kf**}*R*RRkkk****RR*RRffRfkR*RR*ff*hR}RRRRf}if}kfkiffiif}}ifff##fFif}i#kf**ki#f}i*ffiifi*}**********}*f*f}}}}}}itit 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). /2imi- Signa ure of P is Chief or designee IC2 -/a_ /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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Date a###++###++#f###a+++#++##++##*++****FF***FF*}FF****F***FF**FF**FF**F+*F##4*F*****+#+*+#+##+++###a++#Yaf+Y##+####a#a#aa+aa#++##+#++++oaf#ff++++++ Office Use Only Approved application DCI report State certified driving record Website update de�adgeaW2010.d 09/2012 : ARTS Page 1 of 2 Iowa Department of Transportation AC Office of Driver Services 1Toll Free) 800332-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX. 515-239-1337 Certified Abstract of Driving Record Inquiry Date: 12/11/2012 DL/ID #: 302AE9146 (IA) Customer #: 5468656 Name: Hawkes, David Class: D ID Status: None 04/22/2009 _ Raymond Sr S92 ;Speed _ _ _ 52 IA Address: 545 POTTER ST Audit #: 4290038 DL Status: VAL 11/12/2011 2/26/2011 Issue Date: 04/21/2010 CDL Status: None City/State: TIFFIN, IA 523409439 Expiration 02/23/2014 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 545 POTTER ST Restrictions: NONE Restriction None Date of Birth: 2/23/1956 Supplement: Mailing City/State: TIFFIN, IA 523409439 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 04/02/2009 04/20/2009 _ M14 Fall to Obey Traffic Sign/Signal 52 IA 04/22/2009 _ .05/18/2009 S92 ;Speed _ _ _ 52 IA 06/06/2009 06/25/2009 -12/26/201 1 S92 Speed (10 mph &under In 35-55 mph zone) 52 _ IA 11/12/2011 2/26/2011 ,F04 _ .,Seat Belt Violation 52 'IA 10/20/2012 _ �11/26/2012 M14 Fall to Obey Traffic Sign/Signal 52 IA Name: Hawkes, David Raymond Sr DL/ID: 302AE9146 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: .......... 12/11/2012 10WA 'a- % 6 i D.O.T.' . s= Office of Driver Services Iowa Department of Transportation Name: Hawkes, David Raymond Sr DL/ID: 302AE9146 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 12/11/2012 Sep.25. 2012, 10:15AM Div of Criminal Investigation . No.6013 P. 5/15 •--r•..• ..... i. v✓...1 ..i., vi r.I. vi\, ✓i ,una oi\Y IYU. Lo`f1 I. a J y y/ iJAAPa•. � igaanra��.A3��5 o yrl$��o�f Check Request ]Form TO; Io4YAV912i0hOfCriminal lh'Veni(9at(on Support Operaflons Ruronal, ]',Bleat 2i8 �, 7'h Street baxlY�ytna4,XolYfl 5'O�j9 f�ls) �zs•do66 (5j� 925--6000 I7px Last !!y -.OF lna. e 01 lN4iiaur4'�: V�. pCI Accountblom6Br: � O Oa -1 ' Xl•OM: CM OR 'ro'VA C.LTL. CITY CMRTC119 OnICL 47O R. r1d WM7 ,TON STRRh� khade7 I:,ig_g5� SnG.i l(A)d 14a(,.) k-e.S Zav 1 d Ra vn v 3r, r DafoofBirth mo,demJy �ehdex(mnl,dalo) SocfalSectTritylVuhiber ro[ommendBa) Wndvehlilfol9nni't0yl;yfithout�sfgnArlpVpiYe1•frohtthesubfcOtofthoYeglresf�4COmplof0clffAinplfif5faryr�eoydmoynol• %s xolealables per Coda orYialvA, Chapter 691.2.J 0Y eomnTofa'arlmina7lustoxy record InCormat(ox, asallow6d by rpVi, pltypys n �rfaJM h urn irro✓..Inwnln✓., n...�. ef.. ..d.J..a -ugh. -. �Yal'veF.IzeleaSB.• (Ae[oDyglYo permiss(on @rlhontaya rFQeesRdgoAlciof Jo rogduof erJ Tawa crlminaf hhlory[eaord c4er$svilh the A�tn(on OPCriminaf Ynr011861164001). Any[J(n1f441 hls1otydate OnRU111119 Malhn[IsYnafAlo(n d6ry,hell01m9y6o rcicased aS effMcd byL1W. As of a search ofthepxo'vlded name and date 0.fbitti11-revcalcd: ® NOr8waCzhilnaZRiseotyRecord folindwdthbC1 ��Towa Criminal �ilsfoxyltecofd attached, ACT#�^ 3eCeived Time"Sep. 14, 2012 1:06PM No.3256 Sep.25. 2012 10:15AM Div of Criminal Lnvestigation IOWA CRIMINAL HISTORY DCT 00954227 COURT DISPOSITION PENDING PAGE 1 OF 1 CONVICTION STATUS UNKNOWN DATE PRINTED - 2012/09/25 DCI:00954227 NAME: HAWKES,DAVID RAYMOND SR DOH SEX RAC HGT WGT EYE HAIR SKN POB 19560223 M W 602 210 HA2 CRY FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCN RECORD ", 01 ARRESTED 20120414 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA124,401(5) POSSESBTOM OF A CONTROLLED SUBSTANCE TRK#: 1B0004Y01 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOUIRY. DIVISION OF CRIMINAL INVESTIGATION No.6013 P. 6/15