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Home My WebLink About13-109 Authorization Number 4 cA , P1 (Office Use Only) r azul mowo�11 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 I/ 1. Name 1►_ I Y11I/k 2. Mailing Address ►{' l,¢* - : • ' ` __.>►: a I y S 2 `4O 3. Telephone: Home ('.3 r6 52,1 —Otic) 1 Other: 4. Prior experience in transportation of passengers: ' V PC`sl 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? y�� Type of offense Where When • 0, - . C Ct-i\e '_,. , Cil IP'C�� y a S. rt , S 6. Have youi�been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? No Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Ye <. Type of offense Where ( t When 1 Cr -c-IC}1-�s N\oVe r,o is i,\ \, / ,G ,�CA C \A-92 S(42,6(CD 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? YC Type of offense Where When c - ._ �►� a , _AS . % / - 9. Have you ever applied to be n Iowa City taxi driver using a different name? If yes, please provide the name(s) W 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 322 Ar 4I /3 h reby certify t at I h vft issued to me by the Iowa Department of Transportation a valid Chauffeur's license number W S . I understand that if I falsely answer any questions in this application, that this application may be d lied. 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 Applica r Date 7/!y/ ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by PT! 3ej�d*wi 5a7,(//t . On this ,/" I/ day of 72: i f J • Notary 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). fir/3 Signat re 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. Sign ture 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 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 grIowaDriver Department of Transportation Office of services (roll Free)800-532-1121 PO Box 9204,Des Moines,IA 503(16-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/27/2013 DL/ID#: 322AE4845 (IA) Customer#: 4037579 Name: Hopkins, Aric Benjamin Class: D ID Status: None Address: 1018 B AVE NW Audit#: 5356492 DL Status: VAL Issue Date: 07/08/2011 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 06/28/2014 CDL Cert None 52405 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1018 B AVE NW Restrictions: Corrective Lenses Restriction None Date of Birth: 6/28/1973 Supplement: Mailing City/State: CEDAR RAPIDS, IA Sex: M 52405 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/17/2010 05/25/2010 ',Injurious Material on Highway 52 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 01/14/2011 03/03/2011 D53 Non-Payment of Iowa Fine IA IA Name: Hopkins,Aric Benjamin DL/ID: 322AE4845 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: v 111"14 t ,$t. •..4"i 2/27/2013 :•i IOWA ii '� itri ic!y 0 3a;D. O. T• :W • deten4 we,. Of; $ �' IowaeDepartme DepartmentServices ortatlon e6. 21. 2013 3: 12PM Div of Criminal Investigation No. 4140 P. 4/5 reb. 12. 2013 2:42PM City Clerk - City of Iowa City No, 3218 P. 2 • - -- iSU.p!%p� --- -- - - - .--- - - . .._ . . .._. :it ta.�r1•I STAflIO OW 44,42;:; olaX}i, v •S a% �}: ii. • brhaaija�a .JF istoryReeorol Check '±a ?:wy1aid g:r, . 'r � t r Requeet'Forasa `.y>,�4{t4 d,/ , • DC/AccoantNllmbar: LICO --P , • . 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