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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa S2240-1826
(319) 356-5040
(319) 356-5497 FAX
First
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Authorization Number /3— G° 5-
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
2. -*
.Mailing AddressZN I�wSC�{th� �/t. 0
3. Telephone: Home Other: ('el
4. Prior experience in transportation of passengers: Z ho-ue /Jy? iLe
J,(' u�✓I P�^ v� S
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5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? bo
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?_ N
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
Wa L,
When
When
Zo I? -
8.
Z
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AJ o
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)
cJerkllexiddvbadg 03/2013
I hereby certi�j( at I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
D % Z 10 I I S �Jq 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 t4e provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
—4
2
Signature of Applicant Date—
STATE
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STATE OF IOWA )
COUNTY OF JOHNSON )
cribedC�and sworn to before me by t �o� �L �P S On this ) � � day of
Yt ' '� �(J)
e . /r !
KELLIE K TOME otary 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).
Signs ure of P 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.
Signature of City Clerk or designee
3 -i3 -
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'h" (width) and 5'/2"
(height) and prominently displayed to all passengers.
1f HRHffHR*R*RR*fHRff*fR*#1**1HFf*HRH*#R#####F###HH#H######1Hf 1f#H.1HHf1H#H####11HHHf1RHHHH*RffHHfHHHHHfHHHHH.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
den mid,ivtadaeapp2010 d o - 03/2013
Page 1 of 1
Iowa Department of Transportation
AO Office of Driver Services (Toll Free) BM -532-1121
PO Box 9204, Des Moines, IA 5030&9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/1/2013
Name:
Guest, Raymond Isaiah
Address:
2430 MUSCATINE AVE
Issue Date:
APT 30
City/State:
IOWA CITY, IA
Date:
522406652
DL/ID #:
062BB4559 (IA)
Class:
D
Audit #:
6045575
Issue Date:
06/13/2012
Expiration
12/17/2016
Date:
Iowa Department of Transportation
Endorsements: 2
Mailing Address: 2430 MUSCATINE AVE Restrictions: NONE
APT 30 Date of Birth: 12/17/1982
Mailing City/State: IOWA CITY, IA Sex: M
522406652
History Information
Convictions
Customer #:
4007420
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert
None
Status:
Iowa Department of Transportation
CDL Med
None
Status:
Restriction
None
Supplement:
Citation DateConviction Date ACD Explanation County JUR
.. ......... ...... _.,__.. ............ _.. _,. ........ ..... __. .... _._.....
02/07/2012 03/14/2012 _ rB64 _ iNo Insurance Card X52 IA
11/17/2012 _ 112/30/2012 S92 Speed X52 IA
Name: Guest, Raymond Isaiah DL/ID: 062BB4559
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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3/1/2013
10 WA
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Office of Driver Services
�... ....
Iowa Department of Transportation
Name: Guest, Raymond Isaiah DL/ID: 062BB4559
3/1/2013
Mar. 7. 2013 4:04PM Div of Criminal Investigation
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