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Home My WebLink About15-008410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Authorization Number I (Office Use Only) Aar( 'k Y/ APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday.) Liflure to mos /efe ti'P "egg¢sfred" eaaforhrag&ion wfl eegult iso denial of P6re gR caCion First Middle I� t 1. Name (REQUIRED) s ;zAkz ��✓ J c 2. Mailing Address (REQUIRED) Q el ,lJ"e 3. Contact Information (REQUIRED) Email: Cell Phone: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or � in the last fi'v'e'"* years? d/e Type of Offense Where When w.... 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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 Deparbnent of Criminal investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 Ibyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number T0 �z 120 . 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 oftheprovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant n =, .,....., Date a 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'scgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) _fl � .. y 0 4 a I fie. 9- On this ) ........ day of S ibedrand sworn to before me _ p �® ry d ,•" t a", n i.r 1 Nota Public for the State of LA til Tq 9 Iowa 1 have reviewed t4application, 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). Sign tun: of Pof " designee w, 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 11-5. 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. Office Use Only Approved application DCI report State certified driving record Website update ClerWrA%IDRVUDGEAPPL92014emwdedDOC 0912014 State ffbr laws Fill in. all shaded areas. anm �.�'�*a�i„m lll�ry,„IIm.a'@,!NYLrC R^'ewmlCf nxu mmauaE rala^:�raemieaa. mm G1m. u,mauNun@nPu on murn,^,w.ro!nau cV,ae. uwrrw NIA Results DCI USE ONLY As ¢ml” = a mmam .c and. date oml''With rhm;a°k revealed: ❑ No record found Record attached DCI # �a:: 1.dl initials Receipt Number mai'o:m:a uaa.rs� � me OaaM na,irm�e �`ol,ad aumuoeu.unt �$ � B x �l.d.lull,l. �' � W ..... Method aai” maa m weft. cagh money order check. # . MasterCard o a 1 1m Y "0<� , — N�� . Cardhnlder's aroa,nae°um. as r^" dam er i- m �a»»ua s a � 'ro ��"i :IOWA CRIMINAL HISTORY DCI 00648384 MISDEMEANOR CONVICTIONS ONLY PAGE I OF 2 DATE PRINTED- DCIzOO648384 2015/01/09 NAME: STOUT,MICHARL LEE STOUT, KE DOB SEX PAC HOT WGT EYE HAIR SKN POP 19860502 M W 600 160 PRO BRO MED TX AD1:.RlTf.0NeU4 IDENTIFIERS SC BACK SC L FOR SC R FT SC R HND TAT LF ARM TAT HE ARM CUM[ RECORD *** 01 ARRESTED 20010709 AGENCY: IA0580000 LOUISA CO SO CHARGE NO— 01 IA STATUTE IA124-4018 FOSS OF CONT SUBS MARIJ TRK#z 038981101 COURT DISPOSITION AGENCY: COUNT NO— 01 IA STATUTE IA 124-401B POSSESSION OF CONTROLLED SUBSTANCE—MARIJUANA CHARGE CLASS- STATUS UNKNOWN TRK#: 038981101 SENTENCE ADJUDICATED DELINQUENT PROBATION 02 ARRESTED 20050712 AGENCY: IA0580200 COLUMBUS JCT PD CHARGE NO— 02 IA STATUTE 11021,1-2 OWI IST OFF TRK#: 061771002 COURT DISPOSITION AGENCY:; IA058015J LOUISA CO DIST COURT COUNT NO— 01 I.A. ST20"UTE IA321Ju 2 (A) OPER VER WE TNT (OWI) / 1ST OFF COURT CASE ID: 08581 OWIN009693 CHARGE CLASS: MISDEMEANOR CONVICTION IRK#: 061771001 DRUNK DRIVING SCHOOL SUBSTANCE ASUSE EVALUATY.ON SENTENCE DISP EFF DAT TIME SERVED 2D 20051114 SUSPENDED JAIT.., 28D 20051114 JAIL 30D 20051124 DCI 00646384 PAGE 2 OF 2 FINE $1000 20051114 UNSUPERVISED 24M 200511.1.4 PROBATION AN ARREST WITHOUT. DISPOSITION ]Z NOT AN INDICATION OF GUILTTHIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS 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 I (((( Ir Il�lll IlUll 0T N livula icN Vvi"i 111,10t g SMARTER I SWI..ER I OTSIOMr1ER D11:0VEN 4:�Ilfirc'm. est ID irlivaprr .'Seryk*s PO Box 9204 l Dea Mclnes, @A 50306 WNR Phone: 515-244 9124 1800-532411211 Fax: 5!&2.39-1837 wwwa.iaswadoLgov Ceirtli led Abstract of IDrlving Record Inquiry Date: 2/6/2015 OL/I0: #: 897ZZ7798 (IA) Narne, Stout, Michael Lee Class: A Address: 2143 KOUNTRY LN BE Audit #2 8315629 02!22¢2010 APT 5 Issue ®ate: 08/01/2014 Clity/State: IOWA CITY, IA Expiration 05/02/2015 851 522409331 ®ate: IA 04/12J2010. .._ .. 06/17(2010 Endorsements® NONE Mailing Address: 2143 KOUNTRY LN SE RestrIctionin Corrective Lenses 11/14/2014 APT .5 Date of B rtir: 5/2/1986 MatnnS City/ ter IOWA CITY, IA Soup M .522409331 COL Medical tnluner's Certificate Certificate Specifics Medical Examiner First Name Madlcal Examiner Middle Name Medical Examiner Last Name Medical Examiner License Number Medical Examiner National Registry Numb ler Medical Examiner Jurisdiction Medical Examiner Phone Medical Examiner T2/pe ... . MedicalCertificate_.,Restriction 1 Medical Certificate Issued Date... a. Medical Certificate Expiration Date Date Added to CDLIS Driving Record ,,Tvmm i FCI) MM Explanations Claudia Lynn _. ._.. _'.Corwin 29261 879585'6463 IA (319) 356-3335 Medical Doctor Westing corrective tenses . ,07/02/2014 07/02/2016. 08/01/2014 Citation Date Conviction Date ACD Explanation County'- Jtllt 07/12/2005 X11/14/2005 A20 Operating While Intoxicated iouIsa 'IA 02!22¢2010 03/04/2010 M14 Fall to Obey Traffic Sign/Signal - - Muscatine IA; 02/22/2010 03/04/2010 851 No Driver's License Muscatine IA 04/12J2010. .._ .. 06/17(2010 851 No Driver's Ilcense .._. , Muscatine. _. %N 10/31/2014 11/14/2014 593 Speed 30hnson "IA .. Operating While Intoxicated Test Refusal/Test Failure Violations occl iu irreiiii�,im ACD Explanation .Ti11„11I11it 0'7.,9d.712005 A98 OWI Test Failure ;IIA Aorto Blunts .•• A=11derrit IlVaVONGIconent [ndllca ted does NCrW rnnis airs tbie Ancil rllduamll was at fauugt or giveun a d1tartion. t�maclldent Date Case V' tuilrlrrvllae� IIU„uR tl S1tlY"a,j',�Ao H,2 6/5504_ Irk ... .. .. ..... JU IR, 7261H ..... !11!A .. .... 0131 t'�20 tl,48246 li 1, IIt a 1111cto l to I"Is lype Inffectlive, IEnd ACD In•7xpllainatik m ttceuu111,0una.e :9ulk ..... JU IR, 'ievoked 09r1!5/2005 0.3/I.4/7.006 A98 OWN "II"a^at FaUBuuue _ M �., I1A iuuspa.ufl¢A'ed 08/13p2010 11/1.0y'201.0 MY. IIHaabilhd'alll U9 olataii NA ..... ]A Nalmeea Stout, Michael Lee IDI /SID„ 89774.7798 Pursuant to Iowa Code §921.10, 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: 11612015 Office of Driver Iowa Department po tion