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Home My WebLink About15-016t a,®III® RUN CITY OF IOWA CITY 410 East Washington Street Iowa City. lora 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) Authorization Number___;; (Office use Only)TM~ APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) fue6aasx ,tqc�t®arlsAa &g(wtq'"t eat f(" cyfaasf(�srw X69( a°p <taler�µaaeasPwl of flop IL Lea Lom U 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ty e of often ere a Ire e w, Y.° r`d9 6. Have i�Cted of a ri a motor vehicle while un er the infl le of alcohol or ru s h e la five years? � � ��. CT,lJ!Vel ,. Tyne of Offense Where -® When® 7. Have you been convicted of any traffic offenses in the last five years? -ALt4) MM 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Q Type of offense 9. Have you ever applied to Where When City taxi driver using a different name? If yes, please provide DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE'CEf2Tii.ED -°' DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW",---, You must apply for an individual Department of Criminal Investigation Report (form available upprp regal°". (OVER FOR REQUIRED SIGNATURE AND NOTARY)" 09/2014 I her b rti tha I ha a is ed8o ape y the Iowa Department of Transportation a valid Ghaurteur's license number T7 . / . 1 understand that if I falsely answer any questions in this application, that this ap�tion may be denied. I understand thial if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, 1 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) t�; µ Signature of Applican.,. ,l,�ir ' t� a-�"' YOU ARE NOT VALID TO DRIVE_ A TAXI IN IOVIIA 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 sworrnAtoo__before me by '=7Af-Av2)Et L �\A i-oc On this day of 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 residentIof he City of Iowa City (Title 5, Chapter 2, City Code). 4 'Signature of Police Chief or de ignee 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. Signahtre of City Clerk or designee �/ /C�` Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5'/z" (height) and prominently displayed to all passengers. *********#*#********R****#*Rk*Rk#RRRkk*kkkk*k****##*##***#x*hk#***********R***********#****************k******k***************t****#******k*#**# Office Use Only Approved application DCI report State certified driving record Website update Clerk/GVODRNBADGEAPPLM014amwded.DOC 0912014 Jan 16 2015 3'22PM Div of Criminal Investigation No. 8265 P. 1f3 07, ._. __._ 0........... cg, ---- 1� (r'AXy3t8 ®c,o rtuu!/002 Support R0mradina BU nau,1n° Floor 219 L7*$treat On8 *61MOR, Town 5031,0 (5.15) 7304066 (515) 7730°00 lox Protal Yellow Cab of leaw l C& A Box 030 . IIOtYU & 52344 (310) 330-9777 .. P6anea 0axa 30) 333-730.0 k m seirch of the Provided ntane and date oflaaa'tIa x®v0nle>d: 1qm Iowa Cxitlallamt History pejord found vAth DCI rows, Criminal N-Woay Ieeo1°d a11mea1eda DCI 0 DCI aaaz"lanln__. I®77 ( AS11 ) Received Time Jan. 15. 2015 3:05PM No.8901 Jan.16. 2015 3:22PM D v of Criminal Investigation No.8265 P. 2/3 IOWA CRIMINAL HISTORY FELONY CONVICTION DCI 00186.530 PAGE I OF 2 TE PRINTED - 2015/01/16 DCI:00106530 NAME; SBROCE.®S E SHR0CK,STRVUW WARNHR B SE7r. RAC MGT HOT EYE HAIR SKN POE 19460117 M W 500 180 GIN BRO NED IA ADDITIONAL JOHNFIFIERS SC L CNK 01 ARRESTED 19721124 AGENCYv IA0770000 POLK CO SO CHARGE NO- 01 DANGEROUS R.e1OE/P0B.SE S�SB21 OF CONTROLLED SUBSTANCE TRK#a L07373601 COURT DISPOSITION RNCY; XR077015J POLK CO DIST COURT COUNT NO® 01 DANGEROUS DRVGS/ VQpqgSSjoM/CONTXO1,jXV SUBSTANCE CHARGE CLASS, mign2prZANOR CONVICTION TRK#; L07373601 SENTENCE PLEAD GUILTY JAIL 1801) 02 ARRESTED 19740430 AGENCY: IA0070300 WATERLOO PD CHANGS NO- 01 YA STATUTE IA204-401 DAN SROUS DRUGS/PosSESSY /CONTROLLED g/INTENT To DELIVER TRK#: L07373701 COURT DISPOSITION AGENCYK IA007015J B'LN.CK, HAWK CO DIST COURT COUNT NO- 01 POSSESSI /CONTROLLRD SUBSTANCE WYTE INTENT TO DELIVER CHARGE CLASS: FELONY CONVICTION TRK#t L07373701 SENTENCE D:CSP EFF DAT SUSPENDED PRISON sy 1.9751025 PROBATION 19751025 ;w ;ro,ii AGENCY:0 110 f ♦CO $ CHARGE NO- 01 IA STATUTE IR236-12-2 DOMESTIC TRW e COURT DISPOSITION O DIST COURT COUNT NO— 01 Jan.16. 2015 3:22PM Div of Crim nal Investigat+on CHARGE CLASSi MISDEMEAN0R CONVICTION THM L07373001 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF' DAT PROBATION lY 19901212 SUSPENDED 30D 19901212 BATTERERIS EDU PROD 19901212 ENFORCEMENTAN ARREST WITHOUT DlqPOSZTIOU IS NOT AN INDICATION OF OUILTTHIS RECORB MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, EJJFBAC OF IDENTIFICATION X6 A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO SON-LXW R IN THE ABSENCE 1. PXXGXRPRINTS FOR POSITIVE IDENTIFICATION BMED ON INFORMATION^). WE CANNOT CONVIRMDENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL X14VZSTIGATION JV No. 8265 P. 3/3 Inquiry Date: 1/21/2015 Name: Shrock, Steven Warner Address: 4467 490TH ST SE city/Staft: IOWA CITY, IA 522408288 Mailing Addreow 4487 490TH ST SE Mailing City/Staten IOWA CITY, IA 522408286 D OT owado po Iii ox, %m Desi trt infie s, II :MMW-91Z4 Phon SIN-244fl.24jflV'kR'%fa.7e I M.tf � Fwc:515Y,54-183f trlAnt..asrwxlotgav Certified Abstract of Driving Record DL/ID #n 43SAA5012 (IA) Customer An 224854 class: D ID Status: None Audit qn 6581207 DL Status: VAL Issue Date: 01/02/2013 CDL Status: None Expiration Date: 01/17/2018 CDL CartStatus: None Endorsements: 3 CDL Had Statum None strlctions. NONE Restriction None Date at Dlrft 1/17/1946 Supplement: Sem M ' tridents •. Accident IlmlvallverneDt lindicated daeau NOT mean the Ilradividuall was at ftauullt or gilvern a citavtliehi. Acciid relit Date Case Number 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 Offloe or 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: 15 1/21/20 �Qo.,eo ee d xa a io m w Office of Driver Services Iowa Department of Transportation INanmm Shrock, Steven Warner DL/ID: 435AA5012 ,