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Home My WebLink About14-107410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name Authorization Number f°' ( (Oce Use Only) Ic1I V3 G APPLICATION FOR TAXIIMOTORIZED PEDICAB VEHICLEDRIVER (Police Department review must be made between 8 a.m. to 3 p.., Monday - Friday.) 2. INlailing Address.) c"y_v4 �?! ------ -�^ __---- 3. Telephone: Home__.._________-------_______--__-.-_ 4. lPrior experience In transportation crff passengers:.__ 41-1 -_ _ _ = a a_ . 5. Have you ever been convicted of any misdemeanors and/or felonies in this Slate w elsewhera:? _fyWgf,offense Where: N When Rw /� (� ,pry •- C: �� M�,,. _ _.._.._.._________.._.._.._.._...._.._�!M.A1._.._R.,RSv✓9� 6. Have you been convicted of operath'ng a Mtor vehlcie Ile under the influence of alcohol or drugs in the last five years?—N In 7. Have you been convicted of any traffic offenses in the last five years? 0 When me 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) . 11 �- - •-r � .,- � •_ .� _ it (OVER FOR REQUIRED SIGNATURE AND NOTARY) de&&wd&badg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number m�o.�XY ° 0 2 ""r """� . 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 of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature Applicant °°°°°° Date_ _L ( 1 9 pp t 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 ) S bscnbed and swom to before me by ry S On this day of ----- a .y a ``,N ,lary P b in and for I 'tate of fowa 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). Signature R e C of or designee e`er " 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. Signabr6ofor designee Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update der WiWvbadgaappzoi4.dod 03/2014 May. 1, 2014 1:24PM Div of Crimina:: Investigation X041AW'eu 14 10:32 vel low Cab or lave t -I Ly' .. 1• 1 . `STATROITIOWA nknirlal HistoryRecord Check `Request Form `pees laws Division of Criminal Invoistligistion Support Cperalons Bureau, I's Floor 215 E„7” street J010$Mine 4 In' 50514 (315) 7*6066 (S$ 7204080 Fax I No. 8937 P.1/3 (FAY.)31333027ud e.uu2/0112 DC1 Amount Number: 9967-F ` (GrwppGGeobBo) From Yellow Cab orlawa CG P.Oo Bax 425 Iowa Cltyv IA. 52244 - Phonal Fax: (319) 339-7502 ' teir?ykenl4)aeau®.«�m�,.�®.sera ivalvarBelease:Ibacawygive pamiaa6oef ragee6ovoeequo�tingamuse ta aduss#AIowa or"imiuw$N(etutg� dcheck cashdetCWbIonorCdrca gnus llun(OCI). AnjadenGnmlhisi @Dean G mt®thatha i6fp d6 Use be ea@ ossiWfilioty 1i Waiver wS°ignateurda As ofgg''°gy a® as of provided name d data of birth revealed, G3 No Io Cr nal HiP.9tory'Record found with DC1 Iowa Criminal History Record attached, DCI # 2 7 Ct lnitlalo DCI -77 (08/25/10) Received Time Aor.9R. 9014 3:31PM No.6776 (Del use only) u CO -arC.r :.� r- j u May. 1, 2014 1:24PM Div of Crim,nal Invest(gation IOWA CRIMINAL STORY DCI 00569557 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 TE PRINTED- DCI:00569557 2014/05/01 NAME: ROTZINGER®DAVID ROY DOB SEX RAC MGT WGT EYE HAIR SKN POB 19771111 M W 509 240 SLU SRO PAR IA CCH RECORD *** 01 ARRESTED 19980209 AGENCY: IA0520000 JOHNSON CO so CHANGE NO- 0:1 Y'& STATUTE IA'726A••7 FORGERY TRK#: 016545401 COURT DISPOSITION AGENCY: XA052015J JOHNSON CO DIST COURT COUNT NO- 01 L& STATUTE IA715A-7 FORGERY.` CHARGE CLASRe MISDEMEANOR CONVICTION TRK#k 016545401 SENTENCE DEFERRED JUDGEMENT COURT COSTS PROBATION ZY PRISON BY PRIOR ORDERS CONTINUED REVOKED 02 ARRESTED 20020705 AGENCY: IA0280000 DELAWARE CO $O CHARGE - 01 'IA STATUTE IA321.-561 DRIVE WHILE BARRED TRK#a 059762741 COURT DISPOSITION AGENCYaIA028015J DELAWARE CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED/ HABITUAL OFFENDER CO T•CASB IN: 01.281 AO 005521 CFHARRL SS: MISDEMEANOR CONVICTION TRK#: 059782701 SENTENCE SUSPENDED PRISON 03 ARRESTED 20000.927 AGENCY: YA0520000 JOWSOM CO SO CHARGE NO- OS IA STATUTE IA714.2(1) THEFT/ IST DEGREE TRK#: 101987601 DISP EFF DAT 19900710 19980710 19980710 19900710 20000619 20000619 No.8937 P. 2/3 May. 1, 2014 1 24PM Div of Criminal Investigation AGENCYCOURT DISPOSITION IA052015a JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE rA714.2(3) '. DEGREE COURT CASE IDt 06S21 PECRO77354 CHAW9 CLASS; NON CONVICTION 60 RESTITUTION !; SENTENCE DTSF EFF DAT DEFERRED JUDGEMENT 20001206 FINE ,$675 20081206 PROBATION 2Y 20081200 DISCHARGED FROM 20101207 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECOR13 BUT ONLY BE RELEASED To NON -LAW ENFORCEMENT ,GU 1 IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD X8 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM Olt DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISIONOF CRIMINAL rNVZSTIG4TIOV No. 8937 P. 3/3 Wma Inquiry Date: 5/5/2014 DL/ID #: Name: Rotzinger, David Class: 7684203 Roy VAL Address: 326 CENTER ST Audit #: 11/11/2021 CDL Cert Status: Issue Date: City/State: OXFORD, IA Expiration Date: Corrective Lenses 523229069 None Supplement, ICndonsementm Mailing Address: PO BOX 403 Restrictions: M Date of Birth: Mailing OXFORD, IA Sex: City/State: 523220403 770YY0277 (IA) Customer #: 534866 D ID Status: None 7684203 DL Status: VAL 01/09/2014 CDL Status: None 11/11/2021 CDL Cert Status: None 3 CDL Mad Status® None Corrective Lenses Restriction None Supplement, 11/11/1977 M fault or given o; 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 Office of Driver Services, that this is a tree 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 eny Mgnature and the seal of the: Department W be set upon this document, at Ankeny, Iowa this date: 5/5/2014 wneaw, let ID 'A P• mb4� Office of Driver Services Iowa Department of Transporation