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Home My WebLink About13-077Authorization Number 1-3— —1 (Office Use Only) �► VIII �� ►„ MIW®DCII 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-SO40 (319) 356-5497 FAX A ` First Middle Last 1. Name Alla Y.�✓ Aa /-C") T -4D w 3 2. Mailing Address C",m L7 S 22- Y d 3. Telephone: Home ��5^ 6&- 0 y -� -7 Other: II 4. Prior experience in transportation of passengers: 6 � 4h , 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /i/o 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?/T�) 7. Have you been convicted of any traffic offenses in the last five years? Yt 5 TVQe of offense Where When Ed tl 06e.� < S s l icy, cry ��7/7e0'�r drive s license or chauffeur s license been suspended r revoked in the last five years? 1/ 8. Has �01u5 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) /V 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) derk4midwbadg 03/2013 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `I Sri ZZ X76 f . 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) i Signature of Applicant `� / � Date 11111!411»1*4f4*44****t***-*****a*111!1111af11141t*tft**t*ft*ftt******+*1111+114f1f»f1f4»fffttttt*ttt**tf**f******fe*feflflfeffftflftatf441f14 STATE OF IOWA ) COUNTY OF JOHNSON ) s ribed d sworn to�efore me by l C/t� PP i l� J r `O rn a On this c�� day of KELLIE K. TUME 1 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). Signa re of P Ii CRe or designee S� J 1 (7— /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. Signatur City Clerk or designee -a9- 13 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/z' (height) and prominently displayed to all passengers. tt**t*t**141fNfffffffftftt*441*t**t*****Y**111Hff11f#f1114Nt4Nffftf*t**ft*****}4f*4f+M'1f1f14ffftfit*ft4t**N*ti*f***!hf*1f11fflrlffRlff4ff11tR Office Use Only Approved application DCl report State certified driving record Website update da idnmadya WW 10.d« 03/2013 ��_YM ;* ANDREW AARON s` 2743 TRIPLE CRO![- N IOWA CITY, IA 52240 oL No.433ZZ8765 iss 03/29/2013 EXP 041 12013 cuss D end 3 S.> ReMmt'..x N91 i�NONE eves au OONOR:Y D01303/30/1987 00 8681%817TA1339M3W3150 USA IA b3/[Mar. 13. 2013, 11:55AM Div of Criminal Investigation + ACI IowNo. 7063 P. 1/3 zrgs 3-aP•l3 STATIC OF IOWA Criminal History Record Check Request Form Ta: Tom D"lonofCrlmioalInvestigation 5uppori operailone Bumu,10 Floor 315 K 70 Sired Do Mama, Iowa 50319 (515) 775-" (sis)7254M Fax r� r Iy. .i er ncl Account Number. 938JIN��FG Fromm JA revs Too 116 4vtAs Do- tiu, CAW, 18 saaK 0 phone; ,(31q) 33P- "q - Lot Nome Fiat Name Middle Name Date of Birth auu4a Deader .ud m Social &carlkNumber 349/19k7 Urmale 13Female 3 /1- K`-1- D f(3 Waiver%rlfermadore: Wllhoai a algaed waiver hom the soblect of tae requut,atomplele citmhid Military record rmy not bs relemabla, per Coda of lows, Chapter 59:,7. For r9 glean criminal Wary record Information, as allowed by law, atsn7a obMae Awk1wersladfiture from the aubectofthe xML Wolvg/Releasr haft the pamman rot" &Ln a:Twing ol&W eomaaoa oa raueahaml meemymw,ddWAVAletr uhiSmafCmelnd hnanpml04(3Cq. Anyaanmrihhloydwmmmlry np aM b meia,Fador Ne OCI aW'h rtmQ,adralla>.pe Dy lay. WaiperSlgnala!e;. As of 3 —1t3 0- , a search of the provided name and date of birth revealed: No Iowa Cominal'History Record Ibund with DCI ❑ Iewe Criminal $istery Record attached, CCI N DCI Received Time Mar. 7. 2013 11:00AM No. 6575 pMuaoNy) , r Iowa Department of Transportation Office of Driver Services (Tdl Free) OW -532-1121 PO Box 9204, Des Mtlines, LA 5G306 -92G4 515-244-9127 FAX: 515 239-1837 1*0 Certified Abstract of Driving Record Inquiry Date: 3/29/2013 DL/ID #: 433ZZ8765(IA) dame: Thomas, Andrew Aaron Class: D Address: 2743 TRIPLE CROWN Audit #: 6819681 CDL Med LN APT 2 Issue Date: 03/29/2013 City/State: IOWA CITY, IA Expiration 03/30/2015 �S93 _. 522407244 Date: IA ........,' .. ... 11/03/2011 ..: _._ .... 12/13/2011 Endorsements: 3 Mailing Address: 2743 TRIPLE CROWN Restrictions: NONE LN APT 2 Date of Birth: 3/30/1987 Mailing City/State: IOWA CITY, IA Sex: M 522407244 History Information Convictions Customer #: 2169524 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: y CDL Med None Status: No Insurance Card Restriction None Supplement: 04/28/2009 _ Citation Date Conviction Date ACD Explanation County IUR 08/07/2008 09/23/2008 ._._ M14 ..... 'Fall to Obey Traffic. Sign/Signal ..1r. .... 2 .. .._. .._ y _ .2, 03/27/2009 ...... .... 05.... 09 -B64 No Insurance Card 52 .......................I1A .......5... IA s 03/31/2009 04/28/2009 _ �S93 _. Speed ... ......_... .........._ .. ......_.... 92 ._._.._._._ ._.. ......._.. IA ........,' .. ... 11/03/2011 ..: _._ .... 12/13/2011 . _._. :M14 Fail to Obey Traffic Sign/Signal 52 IA Sanctions I.Type Effective End ACD Explanation ., Occurrence 3UR IUR Suspended ,08/04/2009 07/25/2010D53 Non -Payment of, Iowa Fine Suspended :08/12/2009. 07/25/2010 D53 Non Payment of Iowa Fine Suspended i08/20/2009;09/09/2010 D53 LNon Payment of Iowa Fine Suspended €08/20/2009 '09/09/2010 D53 ;Non -Payment of Iowa Fine Name: Thomas, Andrew Aaron DL/ID: 433ZZ8765 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: e pOitHICLf ONyiii ��t_ _'•;,Aqy, 3/29/2013