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CITY F IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319)3S6-5040
(319) 356-5497 FAX
Last
1. Name (REQUIRED) _
2. Address (REQUIRED)
3. Contact Information (RI
IDENTIFICATION NO. /97—rR LC
Office Use Only)
APPLICATION FOR TAXICABTM�IQIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday)
,)nlaeFP I?_ PM 1'43
CITY CLEFh
10;",� CITY,1,OVI ,
First Middle
4a. Driver's License expiration date (REQUIRED) 11
b. Taxicab Business Name (REQUIRED) Ve lto " 6.10 4� f- 10�/�
5. Prior experience in transportation of passengers: 1 ylm r ow
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Z>\SorAsI�i Co,,,JC�
Where
When
Zol Z
VtSSe6-. o. o r /V(^(-, Ill" onrat h[r, Vv /77 /
W1e-C1'k ".11n 13' 2111 Cmgrs($
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Fead Guilty
7. Have you been arrested / charged with any traffic offenses in the last five years?
Other
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? A,10
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)
ND
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
04/2018
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RBUT!"
EH
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
2018 SEP 12 PH 1, 43
CIT Y CLERK
I here y cert'rry that I have issued to me by the Iowa Depa pent of Transportation a valid D�I'r`lei WAel�rlAkber
l8 b
A911 I 1 issued on 1 t expiring on 3- Irl- ZS. I understand that if I
falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions ATitle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant h Date ?_/_Z -/CO2
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by .�> f -u " on this / day of
ZOln r ") c.�1 cv LU .r
S. MAYER I Notary Public ir*And for the
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that
there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration i0 license 0z0ofC'
Si ure of Police Chief or designee Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
Sign re of City Clerk esignee Date
}NflN11ff1f}N1ff1f1ffffifHfNlfHffN4HN!}fMlNfNNMNININIfMfNlfifNA!}NNlMfflfNlf!}1Rf}feHlfNlffNlffNlffflfflflff 11111}!!!!
Office Use Only
Approved application
DCI report
State certified driving record
Website update
De�AxiMMW)Grn 9201ee�dWDOC 04/2018
C1
IOWAD4T FILED
SMARTER I SIMPLER I CUSTOMER DRIVEN NWEEEE ENWas 81f6�Ckl �()V
F 0 arS,sbosYio3�96ry-g,iQ8wa3s7
il
Inquiry 9/11/2018
Date:
Customer #: 6639960
Name: Swain, Bret Jamie
Certified Abstract of Driving Record
DL/ID #: 186AN1911 (IA) CDL Permit Class: None
Class: C
Audit #: 2979580
Address:
1840 S Gilbert St Apt 1
Issue Date:
07/11/2018
Expiration
03/14/2025
Date:
City/State:
Iowa City, IA 522404311
Endorsements:
NONE
Mailing
1840 S Gilbert St Apt 1
Restrictions:
Corrective Lenses
Address:
Restriction
None
Mailing
Iowa City, IA 522404311
Supplement:
City/State:
Date of
3/14/1978
Birth:
Sex;
M
History Information
CLEAR DRIVING RECORD
Name: Swain, Bret Jamie DL/ID: 186AN1911 (IA)
CDL Permit Issue
Date:
CDL Permit
Expiration Date:
CDL Permit
Endorsements:
CDL Permit
Restrictions:
ID Status:
DL Status:
CDL Status:
CDL Permit
Status:
CDL Cert Status:
CDL Med Status:
None
None
None
None
None
VAL
None
ELG
None
None
Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby
certify that I am the custodian of the records held by Driver & Identification 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:
JFNI Of ,ggrysq
a' 9/11/2018
O
c
i ooc�MDriver & Identification Services
Iowa Department of Transportation
Name: Swain, Bret Jamie DL/ID: 186AN1911 (IA)
5 2018 4:23PM Div of Criminal Investigation
08/2912018 15:27 Yellow Cab
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No 1478 P. 1/2
(F4Y)319 338 2708 P.0021002
FILED
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Criminat'lTistory Record oqcKERK
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DO Aozount Number: 99:47-)?
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(319)33.8,9171
Fax: C319),330-7301,
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