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HomeMy WebLinkAbout13-093 Authorization Number i -9�j r i (Office Use Only) 41 As ma Air 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 52240-18276 (f 356-5040 - 4 IS (319) 356-5497 FAX Firs A _Middle,1 1. Name �L►rtSEoQ IY ►1.ELast �r�Y Tta7�v 2. Mailing Address o, C.rass pp(ic t. 3C /ow<) 07-y 1.{i Sot.?46 3. Telephone: Home Other: Ctrl/. ' /5 -c1-1a-5515 4. Prior experience in transportation of passengers: Non-- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 16I t,SCI�+~,e rj.no r 0 550 S of\, I\, Y kith,; .2 OOa 6. Have you been convicted 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? ,)7� Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? No 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) clerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4 ,')Qi SA C) . 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 /// STATE OF IOWA COUNTY OF JOHNSON ) 1 1 }u scribed and, sworn to before me by h r i -tzi p k r 1 © r . On this r day of - Of I 1 ` 1lJ KELLIE K.TUTI LE /\ e ( ( / ( r �{-c p Ymm?ssion Number 221819 otary Public in and for the State of Iowa 's my Ca m s_slo� txp res 1 �! 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). Signature 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. Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 Yz" (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 0312013 Apr. 16. 2013 4:24PM Div of Criminal Investigation NNo. 0500 PP. L1/2 I I rip I. I L. L V I)I LJ L e111I 1.I t y v I c I n vi t y v i Il v It a vi if I • I I 1 i I . • I 4 ' . I I 1 • • �4 '.',../.': '�, S TATA ®kg Ian ,..cr.. ... a ,1ti • tt Rn �I/ �rovi s .1z.1( t I(y it y w.w J %T '�' <6,,„0.y/to 't �C ) �/ R.YAIUY L�4� WQ•i� d Check g �ll.`Ln •e,�i..�( .� ICF eque 1lOrg ivII`G�.510LyV ,minp. ..1 )2CIAcoountNimber; 2/-COD — • Ofopplrrenlo)^ To; TowAXJfr1alonofCambia TuvextlgatfOG Vromt Ur in 011 TOPAA cnTc7 &wort 0perattbnsBacons,l'IJBloor k . CITY MIMICS °FFICE 213E17ieS(reot; 410 1;. WASFTLNGTON'STRUT beg]vlytner,Iowa 50319 • (915)129.6066 IOWA. CITY TOG1A 2740 (515)12$-6080 Vat , Mina: , R19—S56-•5n41 • . Max, qiq-956-5497 ram tc.uastin zaulowdCrilntnafIii o Record Cheat on; . ' Last Nano(ntmdafop? ' b'Jra6Namateonerdatoty) ' Middle Name(rmeckdJ • R later dnrc . 04g- LeA or ' Pete otSil'th(manderoty) (Johan'Craandole0 6'0o?p1 Sewatt MIA 1yor(}coemmeeleJ • . ala 70 `} 1MsXe • EIr+'emame • as 6 r 32 •-•.a 9 59 a )advel"X#jormlatfotyyWithouta,31msawaiveritemfhasubjectotthoregnee4 a eotogolo Wei fnplhlsfoty reeot4maymat berroleaaabletperCadoetYawl,Chaktet,69Z.2YorcomplotnarlminuilliletoryrecordfnlbrnintJon,asaItowed$y1AYw,aaye a ' a•Nal i AiVOUI nnteroltI /1o.9u• oc o are' , • WattrerPetegiett lflcyaysryepafminfonhrthdabnreregrmc0oucullofeltocon#votynToweodm/nolhgtety ccldcherkw11timenuarenofComfeel • Thvogtaodon(Del).myarimfngUipmtydemcgawmfngete,hnrlamaretalnedbylhenmaybeoftescda9eltowedhym% • • Wil(ver$ maturer a.,�/ - • .• S mirib `Iowa Criminal]f stot�v'Eetoorci CheekResuults, , ' ptCleseonb) -Au of_ .4I4/0 /.3_,aseptCh ofthe)rovided name O Jago dbit.'thaevealed: ' icr . = 1 No Tem Criminal iiistoryRecosd fotuidwith,DCI 0 Iowa U4iminalHistoxyReCordattached,DCI# ` Doikitialy V l_ Received Time-A r. 12. -2013-10:32AMt-No, 9'dt to;t..ri nlxl9.,ptu1 ARTS Page 1 of 1 • Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/26/2012 DL/ID #: 595AH8992 (IA) Customer#: 5954683 Name: Taylor,Christopher Class: C ID Status: None Branford Address: 801 CROSS PARK AVE Audit#: 5958992 DL Status: VAL APT 3C Issue Date: 05/03/2012 CDL Status: None City/State: IOWA CITY,IA Expiration 02/02/2017 CDL Cert None 522404493 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 801 CROSS PARK AVE Restrictions: NONE Restriction None APT 3C Date of Birth: 2/2/1980 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522404493 History Information CLEAR DRIVING RECORD Name:Taylor,Christopher Branford DL/ID: 595AH8992 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: -,gE9lelf�4 ' 11/26/2012 3 :IOWA 'lo' c lre:17 „�g < ces Iowa Department oof'Transportation Name:Taylor,Christopher Branford DL/ID: 595AH8992 http://172.29.254.55/drivers/reports/eustomerhistory/certifieddrivingrecord.aspx 11/26/2012 • tl • • 4 IOWA ' °S^ i DRIVER.LICENSE -TAYLOR - '` - , ^y. , " CHRISTOPHER BRANFO 3 x '1'a 801 CROSS PARKr A ,.- IOWA CITY,I. 2240 '4 DL No.595AH8992 iss 04/2312013 EXP 051;.4 120131:. ' Class D • End 3. Het - R' . ` 5,0eNO ns E%SERO ` 0080210211980 - DO 8588587801C1419M0202110 • • • • • • • IOWAusA _ . r`n D'IV 'LIC N'E _ 'mry TAYLOR— ' CE7' , 4:CHRIS1 PffiRBRATIFOJD .• :801 CROSS-P-ARKAVAR-r3O'- -_ -'E., S IOWA CITY,IA-52230=— - • DL Ne.595AH8992 1` 153 0510312012 EXP 021021201 CiassC. End NONE 3 - Restrictions -9 Y� , _• i NONE `y,� _ BRO • •/y''t �DOE 02/02/198I 11, DD 859589920TC1149M. 0217N