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CITY OF IOWA CITY
410 East Washington Street
Iowa City, ,Iowa_ 52240-1826
�(3" 9) 356-5040 >q/lf
(319) 356-5497 FAX
1. Name
First
B f `+
Authorization Number /3-19
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
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2. Mailing Address i G /, S " $ / 1. IZ re lit , 711 '52.2 t
3. Telephone: Home R - L13)- K1 5 V Other:
4. Prior experience in transportation of passengers: I x) ec
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? t,a
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? ye -
Type of offense Where When
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B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /Vo
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)
d� .idn�dg 03/2013
herebcggrtify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
`� ZZ `✓Orj) 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 49W_f Date I/ -T / i3
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and 71 sworn to before me by �r �� \ \ On this day of
rP plic in and for the State of Iowa 7_L Jt}
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'cif Police Chief or designee
y 9,i 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.
J kjlL6 , /1
Signature of City Clerk or desig en e
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8%" (width) and 51/2"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
dwkftaxjdnwedgea 2010. 03/2013
Iowa Department of Transportation
Office of Driver Services (Toll Free) 80(7332-1121
FO Box 9204, Des Moines, IA 503013-9204 515-244-9424
FAX 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/29/2013
DL/ID #:
811ZZ5041 (IA)
Name:
Riley, Bret Patrick
Class:
D
Address:
1616 5TH ST APT 12
Audit #:
6487483
Restriction
None
Issue Date:
11/21/2012
City/State:
CORALVILLE, IA 522411843
Expiration Date:
05/09/2014
iNo Insurance Card
Endorsements:
3L
Mailing Address:
1616 STH ST APT 12
Restrictions:
Corrective Lenses
52
IA
Date of Birth:
5/9/1981
Mailing City/State:
CORALVILLE, IA 522411843
Sex:
M
History Information
Convictions
Customer #:
2727263
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
_ ,
Speed ..__ _
Citation Date
Conviction Date
ACD
Explanation
County
IUR
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li
_0'_'_
892
Speed _. _ ..
56
IA
07/26/2009
�rvm �
08/24/2009 _
.__ ._._. _._
W_S92 �
_ ,
Speed ..__ _
_ ._
_ 10
IA
...
o7/15/2011
_
:08/15/2011
iNo Insurance Card
52
,IA
10/20(2012
X11/15/2012
._B64
X4
!Fall to Obey Traffic Sign/Signal
52
IA
Name: Riley, Bret Patrick DL/ID: 811ZZ5041
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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3/29/2013
IOWA
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Office of Driver Services
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Iowa Department of Transportation
Name: Riley, Bret Patrick DL/ID: 811ZZ5041
Apr 3 2013 3;40PM Div, of Criminal I n v e s t i gation
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Received Time -Mar. 29. -2013 -10:28W -No, 81
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