HomeMy WebLinkAbout13-258 Authorization Number / 3 S E,
r 1 (Office Use Only)
,1t :VIII
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (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) 356-5040
(319) 356-5497 FAX
First Middle „,,,Last
1. Name 1��C` �t L=of ��zeY
2. Mailing Address P3,Z-1 £< CO ' T 5T. :fad' Gilt -i 4 Som `/$
3. Telephone: Home 3i 9 530 3R-05- Other:
4. Prior experience in transportation of passengers: //
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /IC>
Type of offense Where When
6. Have you beenconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? N �
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? N°
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N0
Type of offense Where When
9. Have you ever applied tobe an Iowa City taxi driver using a different name? If yes, please provide the name(s)
Ail;)
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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
clerk/taxidrivbadg 03/2013
I hereby certify th wave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number - --.
4-1:5_5-2-Z/0.0,11> . 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) �'
o ��� / 7- 3
Signature of Applicant Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by � c.c. QJ ---. –6isckril�yl . On this ""7 ti", day of
�)nJ � „-
2u-k1uOt\ i
��w sWENDY S.MAYER
g , Cnmmiacinn Namur 72942s Notary Public in and r the State of low
• My Commission Expires
I
ow `)–t'� -j LP
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).
—i''% /A- /J
Sign ure of Pili'e 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.
(� :_t _ ems— i(/ "7 /).
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2"(width) and 5'/2"
(height)and prominently displayed to all passengers.
****...************...*..*******..**.*.*..**.****************.**..***************.******.******************..**.********************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cler1 taxidrivbadgeapp2010.doc 03/2013
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(FA%)31933e2ua r.uu21002
I
• +q • STATE OF IOWA 1"'1Wig
�P101•� Criminal History Record Check `(•
� •
Request Form
•
•
DCI Account Number:_9967-F
Oroppaenme)
Tot Iowa Division of Criminal Investigation From: Yellow Cab of Iowa City
Support Operation.Bureau,1"Floor P.U.Des 428
215 E.71°Street
Du Moines,Iowa 50319 Iowa City,IA. 52244
(515)725-6066
(515)725.6060 In (31.9)338-9777
Phonal
Fax: (319)339.7302
I am reyuestinet an Iowa Criminal Risto _Record Check ant
Last Name(mandeon) ' First Name(mrssicty)'- Middle Name(rieommrndcd) '
•BRADI. Y Hey Eu.ror
•
Dare of Birth(manamory) Gender(mMarory) • Sociiol•Securr ty Number(rerammeudad)
7/3/ 196/ ®Malo [Female 1/2 / f7 —Aggr 6a?s
Waiver Information:Withoot a signed waiver from the subject of the request,a complete orimtaal history record may not
be releasable,per Code of Iowa,Chapter 692.2.Ivor Fomnlete criminal history record Information,as allowed by law,always
obtain a waiver*lanai ure from the Intim of the request.
•
WaivgrRg/ease:t lien by give plrmkilon lbs'he oboycre uestfogoftielettoConduct art(owacriminal blo ymordcheckgbh the DlvlsionofComina!
Inv arlsailoa(OCT). My miming hinoyd"a eonoem( is ma al by the DCI may to rckand u allowed bylaw.
Waiver Signature: -virode
•
•
Iowa Criminal History Record Check Results (DCI only)
As of t• k3EI I�3 ,a search of the provided name and date of birth revealed: •
•
p• No Iowa Criminal History Record found with DCI • .
❑ Iowa Criminal History Record attached,DCI# •
DCI initials
DCI-77(08/25/10) •
Received Time-Oct. 23. 2013 4: 12PM No. 0100
dirIIIIowa Department of Transportation
c8:, office or lar Services (Toil F-fee)$00-532-1121
PO (3or. 9204, Des Manes. LA r10.10614214
O30f'02 4 515-244-9124
illiP FAX 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 11/7/2013 DL/ID#: 435ZZ1025 (IA) Customer#: 2308987
Name: Bradley, Roger Elliot Class: D ID Status: None
Address: 2327 E COURT ST Audit #: 7383317 DL Status: VAL
Issue Date: 09/27/2013 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 07/31/2018 CDL Cert Status: None
522455218
Endorsements: 3 CDL Med Status: None
Mailing Address: 2327 E COURT ST Restrictions: NONE Restriction None
Supplement:
Date of Birth: 7/31/1965
Mailing IOWA CITY, IA Sex: M
City/State: 522455218
History Information
CLEAR DRIVING RECORD
Name: Bradley, Roger Elliot DL/ID:435ZZ1025
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:
A- 1CUN 11/7/2013
IOWA
s'tr . , hs �r
%h ID. O. T.
1� iii 1"▪ .111-4°-1 Office of Driver Services
,`...."" ---
Iowa Department of Transporation
Name: Bradley, Roger Elliot DL/ID:435ZZ1025