HomeMy WebLinkAbout15-032'r g
Al W1
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa S2240-1826
(319) 3S6-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
Authorization Number /,
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.)
ra/(ra faz corrra sdg(g1&tfteg ear st" ntonna�iart„will resulf,bra denial of the tat' ?/tcf�Adfsra
EM
M
Mailing2. Address
3. Contact Information (REQUIRED) Email: Cell Phone:
.1 Prior pe _ _ in transportation of passengers:.,
If. Have you been convicted of d felonies ” or
ME
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_ NO
Lm of Offense Where 1 When
/na \ A$' C&' 6�__ -A_ .,,...&• tt". °`W be. a...X "." V, =w_�., wog �. u: i-'�., .�-U U _
7. Have you been convicted of any traffic offenses in the last five years?
When
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? T --'j
Tvoe 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)
09/2014
I h reby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
I understand that if I falsely answer any questions in this application, that this
application rrfaybe 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 aigned In front
of a Notary Public)
Signature of Applicant_akw 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.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and savor t ..before me by F ra y% C ca -f ra r�,._ On this z t �� day of
T:;
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).
Signatur of Poli ief or designee
oai�4 -
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
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 6 1/2"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CleTOAXIDZNBADGEAPPL92014amwded.Doc 09/2014
Feb.16. 2015 9:01AM Div of Criminal Investigation No.0337 P. 1/2
Feb. 12, 2015 1:0011 City Clerk — City of Iowa City No. 5625 P. 2
STATE IOWA
Criminal ist ry Record Check
Is Request Form
,.
DCI AccountNwnber:� "
........................................
tac'MuaruRw�)
To.- Iowa Divislon of CrfialualTavestilatlon
i apo Operations oor
71S R, 7M streei
Des Molnow, loym 90319
(515) 125-6066
asr Vax
L.,
From
City CtoWN 00190
tD9!E< aeRnRaoMoanstreet
laawa ety'r....:A A tD
Phone: 3I9.;R„5u64041..
....................................................................................................................._..................._.....................
Arai. :319..356, 497
r2y,,,maie a 41 -�” ,- f o
WalyerWithout o oR trued w4ver n°aro the: object of Me regin,re„o eown pleto rR°Rum final fiftfer^y a°vaord many not
One rdpavabk, per mode ollovvo, CRnapteu° 9912, ,R�ou•,rc ,mm, �fx;;f; a^,w�AkaaRuuaat bVR2oR°y a,^eceuraq tRataru°u o6uoRu�n ra)ket�reaR my Vunaur,N n6a �,y�
WPM ..&'MMe.,IdR�r�May�Aro,tm�ntina�tH�nruuraR�:abon'reaaaucaungDffida aaacondaa;taimsRema dle&awRnRuRRu�IIDA��aBauq¢utrt°vRmro�dmm.W
kn�mx„Il igymuNoe �yJ��'Rya
Any 0111 ul WWI eau vapezjma�arsuimrOPM Ha er>Tolmr.R a auo&waea 6,r km
R1�"ta!Rmarr^��°�t�xatartua^e*, �'s..,aw� �'°� �::.-on..,.n_�y.....�••,•W.�.M
(DCYuse only)
Aa of baa °wn ra oDr�ta aRff t6naR IRxo.ala .aI ruaRsrn.o uaR� alaR:eu of 6alr VR R`a'wcaAla a1:
No Iowa Grindnall' htnry Reco.ii:d found VAth.MY I....
l awla CmrfRRR.inal,•IHf:ataary:Ila.,caa'aI uttacfnO, DC
DCaH:ira'afttaf ...................
Received 7ime1�Feb.*11;•02015 12:58PM No -0189
Feb, 16, 20115 9:01AM Div of Crim nal Investigahon
IOWA CRIMINAL HISTORY DCI, 00567329
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1.
DATE PRINTED...
DCI.,00567339 201.5/02/1.6
NAME LARSON,ALAN XMITH
DOB SEX 'RAC HaT HOT EYE HAIR SxN POB
19540713 M W 601 200 Bi.0 HRO FAR IA
ADDITIONAL IDENTIFIERS
SC Flo
CCH RECOPD ***
O1 ARRESTED 19960111
AGENCY; IAOO50100 AMES PD
CHARGE NO- 01 IA STATUTE IA124-401-5
POSSESS CONTROLLED SUBSTANCE
TRK#€ 031094601
COURT DISPOSITION
AGENCY: IA085015J STORY CO DIST COURT
COUNT NO- 01 IA STATUTE IA124-401(5)
POSSESS CONTROLLED SUBSTANCE
CHARGE CLASSi MISDEMEANOR CONVICTION
TRX#= 032094.601
SENTENCE DISP EFF DAT
FINE $250 19980331
COURT COSTS 19980331
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUZLT, THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL XXVRSTXQATION, BUREAU OF
IDENTIFICATION I9 A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI,
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD,IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
IVa 0337 P. 2/2
>r
DOT
SMARTER 151MPIFF, I PIIS EF DI I, V ` F.nro::_uyl Yl
Office Dfiver Services
.t°I3 Bou X041 Den heir. M 81}%. 6 sDg 64
P'I:aawac 5 9 r-244-9924 � 8&?lG-52f2-'6 "8:1.t (. F a.51, to 15 2399 '1837
. W8dFh1M.,ICIP'dA'u'�",'lAkt.l;l$a4"
RM-
Clty/states
IOWA CITY, IA
522402124
Mailing Adtdra-uss 1540 PLUM ST
eIrtif ed Abstilract of (Driving Itecoird
pill #:
431XX7942 (IA)
Customer #:
900797
Class:
D
ID statue;
None
Audit #:
5423120
DL status:
VAL
.Issue El
08/05/2011
CDL statue.
None
Expiration
07/13/2016
CDL Cert
None
Date:
statue,
Enders ' en: 3
CDL Med
None
Status:
Restrictions:
NONE
Restriction
None
Date of 1iril
7/13/1954
supplements
Sex:
M
History Information
Q'Il1t'althnn Date O'ioln 'rlaAllon Dr," ACED k"qfl1,,.7naVon County Oat:
"n/2fl911 114008/raadv A. ,.......,.,... :"�9) IS11peed ...�. ..... .... ..............11aalhnson .. .I.....,.,
A
03/26/20]11. 04/:1:3/20111. =1M'14 �Iraill G:o0111eyII'rc�saffic,",�,";I1g1[0°tllgnM=:]Iohiilson 11
Name: Larson, Alan Keith DL/ID: 431XX7942
r >y
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:
JO
Office of Driver Semices
Iowa Department of Transportation
IIdl�Ti 441'.FTIi�7ifI:1F11If;Af777A