HomeMy WebLinkAbout13-101 Authorization Number ) 3 - 1 0 I
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Anarrarlibit
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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 tt()rys t 1- e_ 1 \eves
2. Mailing Address --,(p t, Qa �\ C Ct- -�O wG, C t 1 ./ _Tie; tea? L'O
3. Telephone: Home 3i-I C('Co- S7r Other:
4. Prior experience in transportation of passengers: dr Ian G( e I►P✓J tS
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
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? O
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /V 6
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).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
derk/taxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
aZ 't AD L/32.0 . 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` ((�1�. Date $-3"—)0i 3
STATE OF IOWA
COUNTY OF JOHNSON ) _
R-C �� . On this 3 dayof
&Mc i ed and sworn t9,before me bynh; �
,r° s KELLIE K.TUTTLEC 1 (-
.klptary Public in and for the State of Iowa
rommiccinn Num r 991ft
My Cprilsslo Expires
********************************************************** *************************************************************************************
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). 73 C/•a
!gnat e oChief or
designeeD
gate
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.
72 • 7C. W 3 - /3
Signatures f City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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
clerkltaxidrivbadgeapp201 o.doc 03/2013
11111
Iowa Department of Transportation
0ffice of Driver Services (Tdl Free)899-532-1121
PO Box 9294,Dos Manes,IA 59306 9204 515.244-9124
FAX:515.239.1837
Certified Abstract of Driving Record
Inquiry Date: 4/22/2013 DL/ID#: 284AD432O(IA) Customer#: 475390
Name: Reyes, Robin Lee Class: C ID Status: None
Address: 2619 INDIGO CT Audit#: 5172906 DL Status: VAL
Issue Date: 04/21/2011 CDL Status: None
City/State: IOWA CITY,IA Expiration Date: 10/24/2013 CDL Cert Status: None
522406810
Endorsements: NONE CDL Med Status: None
Mailing Address: 2619 INDIGO CT Restrictions: NONE Restriction None
Supplement:
Date of Birth: 10/24/1964
Mailing IOWA CITY,IA Sex: F
City/State: 522406810
History Information
Accidents -Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date Case Number IUR
04/15/2009 502913 IA
Name: Reyes, Robin Lee DL/ID:284AD432O
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:
fd t4 4/22/2013
,IOWA/W
D. O. T.A.
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-May, ' 1. 2013 ; 4: 15PM City Clerk, - City of Iowa City6'x, 3436 P. 4
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IOWA CRIMINAL HISTORY
DCI 00708915
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
2013/05/02
DCI:00708915
NAME: DENNIS,ROBIN LEE
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19641024 F W 506 195 HAZ BRO IL
•
ADDITIONAL IDENTIFIERS
TAT BACK
TAT CHEST
TAT R HND
CCH RECORD ***
01 ARRESTED 20031006
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA726-6
CHILD ENDANGERMENT
TRK#: 100973901
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA723.4 (2)
DISORDERLY CONDUCT - LOUD AND RAUCOUS NOISE
COURT CASE ID: 06521 FECR066674
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 100973901
SENTENCE DISP EFF DAT
FINE $50 20040114
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION Or GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE E OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON MATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE UBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
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May. 2. 2013 1 :48PM Div of Criminal Investigation No. 2018 P. 4/4
IOWA CRIMINAL HISTORY DCI 00706915
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
PATE PRINTED-
2013/05/02
DCI:00708915
NAME: DENNIS,ROBIN LEE
DOB SEX RAC HGT WGT EYE HAIR SRN FOB
19641024 F W 506 195 HAZ BRO IL
ADDITIONAL IDENTIFIERS
TAT BACK
TAT CHEST
TAT R HND
CCH RECORD •••
01 ARRESTED 20031006
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA726-6
CHILD ENDANGERMENT
TRIO: 100973901
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA723.4(2)
DISORDERLY CONDUCT - LOUD AND RAUCOUS NOISE
COURT CASE ID: 06521 FECR066674
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK$: 100973901
SENTENCE DXSP EFF DAT
FINE $50 20040114
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 t NCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED 4w ;- ORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS 'E SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION