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Home My WebLink About14-101410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (319) 356-504 1. Name 2. khailing Authorization Number • c - Department171 « Monday 3. "telephone: Home__ 14L.If Other:._----.----------------------------------------- 4. (Prior experience in transportation of --------------------- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? a `5 Where 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 0 7. Have you been convicted of any traffic offenses in the last five years? N -V Where KM B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ 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) rt « r �jllratl t&I'l*, You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) doidm idnvb®tlg 03!2014 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's Ycense number 6 '�D va F . �"f & 7 . 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 re!ating to this application, and I further agree that, if a license *Code. _ . (Needs to be signed in front is a Nota Public)s with all of the rovisi Signature of Applicant--" ons Title 5, Chapter 2, of the City o e is granted, to comply at a'I time r* 9Date 7 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) - Subscribed and swom to before me by "A `k"s f, �'�o- �' On this day of +n r ~nlgt Public fit; „and for the to of Iowa r ... qua ,.gin �.. X1113 11 -1 uw.;,, \��ro• a,.�✓ate �A in (3 Y° 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). �A� Signature of clic ief or designee � Zs�ir YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signat re of City Clerk or designee ate 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 d9rkt Admbadgeapp2014.d= 03/2044 Apr.18, 2014 8:57AM Div of Criminal Investigation No, 1901 P. 4 ApL. 16. 'LU14 IL:wM city Glerk — city of Iowa 61ty W0.4010 N, I °Poo Iowa Dlv9 ioRofCrE dmalInwestQgaCton Suyrlrarrt Overatdonat:Qlmromm, 1A6.0801• 215 R 7+'a Street Das.Qtrloduas, Iowa 30319 (s.Is) 71s-6066 (3:19)11g...6080 Fax an Iowa Criminal OOY) of Birt o f gy I q' tl DCI AcaountN'umber: ...............( n. 1lcnmYe) Prom;dty a£ Qarya �Rt City MOOS O lice q1� �, �astAQra�dnaa �ta°set T(o e;fity, 1'�, Pia rhonw 3.19.3.66,4041 ..... Paxa 319,1+6-94.97 t hook em aler, Female I . N ��J ... �� ..�s ,C ✓ RafNer,14foa°raaaaf om' W thout a 49maad wMver from tha sobjlect of the request, a coniplote erRemdmaQ history record may not ha rareasable, Poe Code of town, chapter 012, For cur N t orcRmaQrraR 6Q¢tou,g nec®rag dot®n°malloin, as aQQowed Quy Qaea, aQawaya oQatadn a vsanver Slarn®toro.trorua Me subject of (he yeapauos&,-,_-- Waiver Release. 16xesby neve pemwlssleaa &"No ®baVO regmfina w%PdM w asvesEdaa¢rwm QPJC6y. �oaoy �daemaat dnGauecy° deYa sarmcemrGaa Imes abet Y.em7wYntwBurwd IRI r aPdyer°x igrRaaeargq a@dmd by law. Taf � � u "_� 4 a 5aasch of the Irrov1ded�: and date of birth. r e°veofed; No Iowa Criminal history Record found with DMC1 .._ Iowa rrim,inai I$$stmgy 4 erord attached, .D(21 i# Dcl arsidabs,... ect ved Time—Apr. 16.-2014-12:47PMr-IVo, 7754 .................... dew NvisGoa, erCxWaad gtrerQrr dy$ C7r .. i :..} Apr.18. 2014 8:57AM D v of Criminal Invest gat on IOWA CRIMINAL HISTORY DCI 00694606 NzOnemmANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2014/04/18 DCIk00694606 NAME: MOONBSAKUZL DAVID pOH SEX RAC BOT WGT EYE HAIR 9231 POB 19840518 M W 600 260 BRO BRO IA ADI.)XTIONAI, 1DENTIk1BRS CCH RECORD *"�* 01 ARRHOTRO 20030201 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 TA STATUTE IA708-2A ASSAULT CAUSING BODILY INJURY DOMESTIC ABUSE TRK#: 502015901 CHARGE NO- 02 IA, STATUTE :IA708-2A ASSAULT DOMESTIC ABUSE TRK#: 502015902 COURT DISPOSITION AGZNCYP IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA708m2(2) ASSAULT NO INTENT OF INJURY - 1970 COURT CASE ID: 06571 SRCR050284 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 502015901 SENTENCE DISP EFF DAT TIME ,'SERVED 379 20030830 SUSPENDED 0AIL 2D 20030830 JAXL 4D 20030830 PINE $250 20030830 PROBATION lY 20030830 COURT DISPOSITION AGENCY: IA0570159 LINN CO DIST COURT COUNT NO- 02 YA STATUTE IA708,2(5) ASSAULT COURT CASE ID: 06571 SR.CR050284 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 502015902 SENTENCE DISP EFF DAT TIME SERVED 37H 20030830 SUSPENDED JAIL 2D 20030810 JAIL 4D 20030830 PROBATION 1Y 20030830 AN ARREST WITHOUT DISPOSITION NOT AN INDICATION OF GUILT.. THIS ANCOM MAINTA:r.MED NY 'IRR IOWA DIVISION OF CRIMINAL INVESTIGATION, BVRXA0 OF EKFO'RCPMMT AGENCIES BY THE DCI. IN THE ABSENCE OF ..M FOR POSITIVE IDENTIFICATIONORD BASED ON INFORMATIONFURNISHED. CANNOT CONFIRMOR DENY THAT THE RECOIx COVERSOF YOURINQUIRY. 9 No, 7 90 1 P. 5 DOT *,+„r 1. E i r ;°')+( u ° °''.C', M12Fa b 5,,, Inquiry Date: 4/17/2014 DL/ID #: 580WW5113 (IA) Name: Moon, Samuel David Jr Class: D Address: 2110 N TOWNE CT NE APT Audit #s 6464764 5 issue Dalai 11/13/2012 City/State: CEDAR RAPIDS, IA Expiration 05/18/2018 524021952 Date: Endorsements: 3 Nailing Address: 2110 N TOWNE CT NE APT Restrictions: NONE 5 Date of Dirties 5/18/1984 Nailing Clty/Stator CEDAR RAPIDS, IA Sox: M 524021952 QIP' History Information Customer #: 3728851 ID Status None DL Statues VAL CDL Status None CDL Cert Statues None CDL Ned Status: None Restriction None Supplement: 04/30/"'I"1096'A No Irnswunci. Curd 1lr°m ..C. Name: Moon, Samuel David Jr DL/ID: 580WW5113 In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thl< ®p,p_�g•++°y5 •_® 'N 4/17/2014 a Office of Driver Services Iowa Department of Transportation Name: Moon, Samuei David 1r DL/ID: 58OWW5113