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Home My WebLink About13-038r , CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number 13 — 3A (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) S404a-LRA.'eA c1 First Middle Last 1. Name StePhe., E44A� ✓c 'Iger_K' 2. Mailing Address cl 3 S ei,- /�c 4�.� 1 L F 1,.,,, S 3. Telephone: Home 31`+-53--1`I-?3 Other: 4. Prior experience in transportation of passengers: 32 C'A Z,•v. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? .,Vo Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 5-h- rA�r 1/4/210 3/h/mob 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Vf> 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) N, 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) derkMmidrivbadg 09/2012 I her certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Z'3 Dp �� ti b . 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-- ` (yy =Z� Date 2 2� l� 3 ***#**#*RRf RRM1f1f#fffY#Yk##i#F##f*4*#*R*R**f*f*Rf1RRRRRRRRf*R11RRf1f11ff4ffYf#Y#4ff#4#F#######4YYF##f#FF#f4##H#RH#R###FRR**t*##{#*#Rf*#Rf*Rf STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cribed and sworn to before me by Sia )u o.,(Arw 'e+ On this e15 day of SONDRAE FORT S✓-+i,Gj I, t Commission Number 159791 My Commission Exntrnc Nntary Puhlin in and fnr the State of Inwn 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). 1. Signatu a of Police Chief or designee x-75' 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. Signat re of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update - 5-13 Date de,M .idn ,.a,2010 a 09/2012 Feb.21. 2013 9:00AM Div of Criminal Investigation No.4022 P. 1/1 Feb 71 w ue;9ea reuow Cab or town uny 3193382708 p,Z fa: low,, mvisinu nfC'rbnindl luvei(igation tinpporf Ohenitinns ffarenu. 1" plUor 215 1'- 7' Strew Des Moiuet lmsn Mj I9 VMS) 725-6066 (1[5)725-6080 Fax nm M113C. inu an Inwtl Criminal I lislnn• Rernrd ('i,rnl• ,n - DCI Accouni Number: 99 6-%' F (ifnVrlin+blq . Prom: tr (..Ay� br` XOLa A Ct7y'' p, V. 9UX +7. Yi 'M0,...N C.Ty Phone: 3It 338 - 977 7 Fax: try 315-'772. hasr N:nne rrnoibidn'n I u First Nome (jwnj,,wty) -Name (n.nmmamed) Middle Date (if ltirtit tdunkh.,•) Gentler u�mma.,mn•) Social SecurityNumber�(recommendra) 5-2 z` I ico lid�iale OFemale I�5 7('I-! li'ilive)' lfif rmotion: Without n signed walver from tht subject of fhe request.w complete criminal history rccard inky not be rcledwille. per Calc of lmia, Chapter 692.2. Pur comnlot Criminal hiarory recotvl information, ns allowed bylaw, always nhtwirt n waiver Si¢natm•e from the sub ect of fl(r re uesf. tlrUlllNr K('l('(IFC'IIxrrh}'p:rrp<nuavion tiv I11eR.,vrt9ecelineani96t1 to coMurt M 1m criminvl hi>lury mwrd chock with 01 Divifi•II OrCriminel hneebpunnnit M'1L .t,o• piluinul o,eum aa,a rmar(m'nd mr tkn ,r inuimuined'Y�N DCI may b: Alea/Y/N m 011olwr by IaVe. Waiver Signourre: Iowa Criminal History Record Cheek Results (UClu eonly) As of a`a:`\ 3 . it sent -0i of the provided name and date of birth reyealed: No sown Criminal History Record found with nCl ❑ Iowa Criminal llistogr Rzcord nnuched, DCI tl i — DCI initial DCI -77 (oS/25/10) ME Page 1 of 1 /'` Iowa Department of Transportation ►�t f Office of Driver Services (Toll Free) Wa-632-1121 PO Box 9204, Des Moines, IA 5U3fJfi 924A 515-2-9124 FAX: 515-23939-1837 Certified Abstract of Driving Record Inquiry Date: 2/5/2013 DL/ID #: 236DD0596 (IA) Customer #: 4243013 .......... Name: Stonebraker, Stephen Class: D ID Status: None Franklin Address: 937 SPRING RIDGE DR Audit #: 3959938 DL Status: VAL Issue Date: 12/19/2009 CDL Status: None City/State: IOWA CITY, IA Expiration 05/22/2013 CDL Cert None 522465821 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 937 SPRING RIDGE DR Restrictions: NONE Restriction None Date of Birth: 5/22/1985 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522465821 History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 05/06/2008 _ .+05/09/2008 592 'Speed (10 m"p--h-&- under in 35 55 mph zone) 90 _ IA 02/04/2010 03/15/2030 592 _ Speed 52 IA 03/15/2010 04/12/2010 'S92 Speed 52 IA Name: Stonebraker, Stephen Franklin DL/ID: 236DD0596 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: '.;v%'4 2/5/2013 WA D. 0.1 T.' .......... Office Driver Services UBI --� of ^x81111 � Iowa Department of Transportation Name: Stonebraker, Stephen Franklin DL/ID: 236DD0596 hfp://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 2/5/2013