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CITY OF IOWA CITY
410 East Washington Street
Iowa Ci *.Iowa_. 52240-18 6
9)_356-.504Q)FTl
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
) 3 ,?)q
(Office Use Only)
First Middle Last
1. Name F- t-i� �nLs1
2. Mailing Address �c> (7X 3 -3 r l zyu— 7 -e-9 , l A 52'1 �ir7
3. Telephone: Home
4. Prior experience in transportation of passengers:
43!) Other:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense l Where When
6. Have yoconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? u n
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
'1('
Where
When
When
8. Has your driver's 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)
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)
cledtnaxidnvbadg 03/2013
hereby erti tha I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
?9 < ':; ( -R`� . 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 Applice n Date 4 —
STATE OF IOWA )
COUNTY OF JOHNSON
S cribed nd sworn o before me by C.�' L T OGc� /� 1 On this V'(4— day of
i�h�i sLon NumbeFTUr 427819
v 'I ;,, com) issibn . Wire Notary Public in and for the State of Iowa
*3*f*#*#RBBB##RRRf RRRRlfffflffff1f3f3f333**f*13**f**t***#R#RRRRRRfffffiffffiffiff#f+N*33#*11*3*t##*ttt#t#R*RRR#RRMif Rfffffffifff#33!333#fitii4
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).
Sign
lJa] re of Poli hief 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.
Signa re of City Clerk or designee
-is -/z
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2' (width) and 5'/s'
(height) and prominently displayed to all passengers.
+#++HxHfxff*x+**#x*##*#YH+x++#x»++++x»+xxx+x++++x+xx+++++x+++++++x+**+##+++++xx++xxx+++xfx+++fxx++++++++++w+xx++xxxxx+++++++++++x++xxx++r++
Office Use Only
Approved application
DCI report
State certified driving record
Website update
c1erk/WAidnabedgeepp2010d - 03/2013
Department
Iowa
Office of Driver
PO Box 9204, r -.s Moin5030"2(24
of Transportation
(roll Free) WO -532-1121
515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 3/7/2013
Name: Fowler, Eric Dean
Address: 122 1/2 N DEVOE ST
City/State: LONE TREE, IA
527557742
Mailing Address: PO BOX 33
Mailing City/State: LONE TREE, IA
527550033
Convictions
DL/ID #: 428XX5189 (IA)
Class: D
Audit #: 6310503
Issue Date: 09/18/2012
Expiration 08/23/2017
Date:
Endorsements: 2
Restrictions: Corrective Lenses, Left
and Right Outside
Mirrors
Date of Birth: 8/23/1973
Sex: M
History Information
Customer #: 4327574
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Citation Date
Conviction Date
ACD Explanation
County
JUR
06/21/2012
08/31/2012
Miscellaneous
52
IA
11/02/2012
11/15/2012
Miscellaneous
70
IA
11/02/2012
11/15/2012
S92 Speed (10 mph & under in 35-55 mph zone)
70
IA
Name: Fowler, Eric Dean DL/ID: 428XX5189
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:
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3/7/2013
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Office of Driver Services
Iowa Department of Transportation
Name: Fowler, Eric Dean DL/ID: 428XX5189
won Apr.10. 2013 10:01AM Div of Criminal Investigation
Apr.' 5. 2013 3:23PM City Clerk - City of lova City
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