HomeMy WebLinkAbout13-072CITY OF IOWA CITY
410 East Washington Street
(�—+ a 52240-IS26
(319) 356-5040
(319) - 7 FAX
1. Name
2. Mailing
Authorization Number /,:� — %a
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. Telephone: Home .3I q—Lir7 —06'03 Other:
4. Prior experience in transportation of passengers: 3(yc#01-/,;� %m Y�f
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /70
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? nO
Type of Offense Where When
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7. Have you been convicted of any traffic offenses in the last five years? .12(a
Type of offense Where When
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i'/D
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)
Ger Ne driWadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number.
15 �,6 q,�6 �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 I of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) %
1
Signature of Applicant Date_L�11
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STATE OF IOWA
COUNTY OF JOHNSON
meq. rd ed d swn�n to before me by 1 1�-- 4) bn . On this �P�v� day of
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KELLIE K. TUTT� E� Notary Public in and for the State of Iowa
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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).
natur 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.
Signa0re of City Clerk or designee
ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 Y:" (width) and 51/]"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
d0khaxidmbad�W2010 oa - 03/2013
Mar,22, 2013 3:58PM Div of Criminal Investigation
Ma r. 14. 2013 4;37PM City Clerk - City of Iowa City
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•�^ .Iowa Department of Transportation
tlf] Office of Driver Services (Toll Free) 600-532-1121
PO Box 9204, Des Manes, IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 3/14/2013 DL/ID #: 154BB9768 (IA) Customer 7f: 639535
Name: Albright, Ryan Scott Class: D ID Status: None
Address: 303 1/2 S GARFIELD AVE Audit Jf: 5708521 DL Status: VAL
Issue Date: 12/28/2011 CDL Status: None
City/State: BURLINGTON, IA Expiration Date: 09/01/2016 CDL Cert Status: None
526014272
Endorsements: 3L CDL Med Status: None
Mailing Address: 303 1/2 S GARFIELD AVE Restrictions: NONE Restriction None
Date of Birth: 9/1/1963 Supplement:
Mailing City/State: BURLINGTON, IA Sex: M
526014272
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
03/03/2012 04/03/2012 S92 Speed 29 IA
Name: Albright, Ryan Scott DL/ID: 154BB9768
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:
•;M"4'
3/14/2013
IOWA *0
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Office of Driver Services
Iowa Department of Transportation
Name: Albright, Ryan Scott DL/ID: 154BB9768