HomeMy WebLinkAbout13-082SO®��Il
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(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.)
13- 8 -�"
(Office Use Only)
First Middle Last
1. Name 5 rt/FW Aelz)?H'IAy /t� rTTEw�ElV
2. Mailing Address -2W0 H r.✓ Y (1 19 /'j i 3 0/ Z
3. Telephone: Home I / 9 - 6 Z / - / 3 i G Other.
4. Prior experience in transportation of passengers: A10 A/
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
THFf7
Type of offense
Where
When
fl -Z-9 - 7
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 0
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years? SPC- Flt 10 1'9 P l'f 2N0'UNoFPZ
Type of offense Where When
Za ( f
3'CA7'19FC7— ?q- Zo 1 I
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
111C Al 10197MFN1'cF Zob✓A Fr'AF ZOWA tray 1Z -20,!l Ta
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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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
ded@axidmbadg 09/2012
hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
v 3 yam. F O 6 3h . 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 , d�ri; r ���ih Date –8 — / 5
H###H##Yi##H###fR%R#Rlff+RRH11ff f fif##ff 11H######HH#YH#R######RRRRH##HRRRRRHRffHRHfflffHfHffIHHHHH#iH#HY*t###RRRHRHRHH
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by On this day of
<k�v„ sv
ttary blic in and for the State of Iowa --r 1 31 Iv
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 Chie or designee
;;71 �r//3
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.
Ir e . � � /�
SignMwe of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards.
««}##««##+##+#+###+##+##«####R##++++}RR««RRRRR««##«###«#«##«#}H###+##############################################«###«#«RRR««RRR«RR«««#}#««##H
Office Use Only
Approved application
DCI report
State certified driving record
Website update
dedvladdvbtlgeapp2010 dw 09/2012
Page 1 of 2
Iowa Department of Transportation
Office of Drier Services (Toll Free) 800332-1121
PO Box 9204, Des Milnes, IA 5030"2134 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
1/16/2013
DL/ID #: 434AF0535(IA)
Customer #:
5624323
r
I4���,�'yr`pp�
Name:
Crittenden, Steven
Class: C
ID Status:
VAL
Office of Driver Services
at�r
Abraham
Address:
2401 HIGHWAY 6 E APT Audit #: 6537086
DL Status:
VAL
3012
Issue Date: 12/12/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration 11/22/2016
CDL Cert
None
522406786
Date:
Status:
Endorsements: NONE
CDL Med
None
Status:
Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE
Restriction
None
3012
Date of Birth: 11/22/1980
Supplement:
Mailing City/State: IOWA CITY, IA
Sex: M
522406786
History Information
Convictions
Citation Date
Conviction Date
ACD Explanation
County
JUR
04/08/2011
S92 ;Speed (10 mph & under In 35-55 mph
zone)
23
IA
05/29/2011
104/14/2011 _
06/22/2011
F04 :Seat Belt Violation
�52
IA
Sanctions
Type
Effective End
ACD Explanation
Occurrence JUR
JUR
Suspended
=.12/20/2011 ;04/10/2012 D53 €Non -Payment of Iowa Fine
IA
sIA
Name: Crittenden, Steven Abraham DL/ID: 434AF0535
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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1/16/2013
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Iowa Department of Transportation
1/16/2013
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Div of Criminal Investigation
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