HomeMy WebLinkAbout19-095r
1 l i
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
IDENTIFICATION NO. q- n'I 5'
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday)
Failure to complete the "required" information will result in denial of the application
Last First Middle
3. Contact Information (REQUIRED) Email:
41 Cell Phone:
email)
4a. Driver's License expiration date (REQUIRED) _
b. Taxicab Business Name (REQUIRED) _ y
5. Prior experience in transportation of passengers:
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type
/fofoffense Where When
r {'tti T— r Ow/L L 7Z2`1
QOS..f C�irc�cor 1/ (`I qZ
T.y
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other Pro�bA 1!ic^
7. Have you been arrested / charged with any traffic offenses in the last five years? yes
Type of offense
What happened to the charge? (Circle one)
Where
r
When
Convicted Dismissed Deferred Suspended Plead Guilty Other r -t dd
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ AJ/6
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)
SIGNATURE
04/2018
01
•
Page 2
APPLICATION FOR TAXICAB VEHICLE DRIVER
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).
I hereby certify that I have issued to me by the Iowa De artment of Transportation a valid Driver's license number
of
0.4
A cJ . 5'7&3 issued on O e expiring on 7— Z/ — Z 1 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 provision f T'tte 5, Chapter of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Date It
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by a on this day of
ASHLEY AJAY-PLA1ZNotary Public in anfoKVe tate of
My Commissbn Exp res
iow* ul 14, 2020
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 date of Driver's lice U I Z % 7_e4,3
Sig of Police £Rjief or designee Date
AFTER APPROVAL 13Y THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN`QNE YEAR FROM THE DATE LISTED BELOW.
r,
1
Sipnatu a of City Clerk or desi_ ee i \ Date
Office Use Only
Approved application
DCI report
State certified driving record
Website update
GeM "IDRIV64DGE PL92018em de .MC 04/2018
C1J10WA00T,'
SMARTER I SIMPLER I CUSTOMER DRlvkyh�uwlnl iDw�dfpt gI]�►,;
Ddlrar & Idwntifieawn sarvieas
PO Door 9204 $ Des Wines, IA 5Ci5D6 qZX
Pfip W 5f5.2".24 6 Fax 515,289 IW
Inquiry 11/23/2019
Date:
Customer #: 5937812
Certified Abstract of Driving Record
DL/ID #: 690AI9763 (IA) CDL Permit Class: None
Class: D
Name: Riley, Bobby Joe Audit #: 3286397
Address: 1053 Cross Park Ave Apt Issue Date: 10/12/2018
F
Expiration 07/21/2023
Date:
City/State: Iowa City, IA 522404486 Endorsements: Chauffeur 3
Mailing 1053 Cross Park Ave Apt Restrictions: NONE
Address: F Restriction None
Mailing Iowa City, IA 522404486 Supplement:
City/State:
Date of 7/21/1967
Birth:
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Riley, Bobby Joe DL/ID: 69OA39763 (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 IcSNa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby
certify -that I aW.thec
:rlstodian of the records held by Driver & Identification Services, that this is a true and accurate copy of an
official'. record ttiirentfyj Jn"the custody of said office, and that I have been authorized by the Director of the Iowa Department of
Transportation tq,so ce�fy.
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: t. ..
�
D11C/J23Q/20/129�C
Driver & Identification Services
Iowa Department of Transportation
Name: Riley, Bobby Joe DL/ID: 690AI9763 (IA) ` J
3. 2019:12; 25PMCob DCI IOWA ffA:p319338Z,No. 0354 P. 4/6!006
STATE OF IOWA
Criminal History Record Check
Request Form
SIA
Mail or Fax oompletedfolms tQ:
Yowa DIVISIon of Criminal Investigatiaa
Support Operations Bureau, l^ Floor
215 & 70 Street
roes Moines, Iowa 50319
(515) 7256066
(515) 72$-6080 Fax
l am ♦nm.ocfinn an Toss f`riminwl FTiclnry RPrnrrl f`lhx-k nn'
ACI Account Number: 9967•F
(ifgp8oaele)
Send results to:
Name XeudwrCa6 of Iowa City
Address P.O. Box 428
Iowa 2y, Iowa 52244
Phone 319 339-9777
Fax 319.3594142
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4— No Iowa Criminal History Ro=d found with DCI
c
❑ Iowa Criminal History Record attached, DCI #�
•J r
DCl initials ��� �tsset
DC1.77 (updated 06.262018)
Received Time Nov, 25, 2019 1:07PM No, 9737
(DCi uaa only)
pre IOWA/DPS
y 5 2019
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otifefNAL INVFST
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