HomeMy WebLinkAbout14-098it 1
1. Larne
Authorization Number
(Office Use Only)
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
2. Mailing�rtdress._-----"�-/=` _ �_✓�___���^� ___
3. "Telephone: I-ome.__ .4_-_ L_w-2-46,_f Other°,
4. Prior expeirlenoa In transportation of passengers:, . "fir Le.4_ t-/ p, T
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? —4f -5-
6.
_4f
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? -" D
Tvoe of Offense VVhere When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? s
am
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
• • •• . r
LtjVZx61zq-91V • 41 zclei
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
°"� 03/2014
I hereby certif. . certify, that II have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
71147�'t . I understand that if I falsely answer any questions in this application, that this
app
lication 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 provisio 1°b`ili#fa 5. Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)ry
Signature of Applicant - 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 !OHNSON i
and swor to before me by m w -- - - s (� On this ' day of
l�
m
5
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).
Signat re ®f ®lice Chief or designee
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.
Signat of City Clerk or designee ate
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 51/2'
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
didavbmg9ap,2014.doo 03/2014
Apr -18, 2014 8:57AP
Npr. lo. LU 14 1:IyrIY
Div of Criminal Investigation
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NO Iowa c Dnal .t istory
Record found �ntzttn i)��
12-
Iowa crinfinal ecord attached, DCA �
Dawtaals.. _.
t6 _7014- 1:11pyi-No.7/56-._____a
Apr. s8, 2014 8:57AM Div of Criminal Investigation Na, 7901 P. 2
KGRA CRIMINAL HISTORY DCI 00558123
MISDEMEANOR CONVICTIONS ONLY PAGE I OF 2
DATE PRINTED -
2014/04/18
DclW0556123
NAME* SKITHdOARY LLA9
DOB SEX RAC HOT NOT RYE HAIR SKU POB
19501019 M w SOB 230 BLU HUY FAR IL
ADDITIQUAL IDENTIFIERS PHOTO ANAILASEE Y
C01 RECORD www
01. ARRESTED 19980815
AGENCY; IAOSBOOOO IOUISA CO SO
CHARGE NO- 02 IA S'1['AT.UrE )1:'.0.1.23 ...46
PUBLIC INTO)t
TRK#. 0:38959802
COURT DISPOSITION
AGENCY: IAOSBOISJ LOUISA CO DIST COURT
COUNT 110- 02 :IA STATUTE rA123-46
CONSUMPTION-PUBIlIxe INTOX
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#� 038959802
SENTENCE DISP FPF DAT
FINE AND COSTS PAY WRONG 19980930
02 ARRESTED 20100517
AGENCY: rA0290000 DES MOINES CO 80
CRUDE NO- 02 IA STW.VUTR IA123, 46(2)-A
CONSUMPTION OF ALCOHOL IN A PUBLIC PLACE 2 COUNTS
TRK#v DA002VW02
CHARGE NO- 03 IA STATUTE 1A719. I (A) -.1
CONSPIRACY - 0001
TRK#: nA002vw63
COURT DISPOSITION
AOxWCy;i IAO29015J DES MOINES co D:11ST COURT
COUNT NO... 01 IA STATUTE IA123 4 6
CONSUMPTION / INTOXICATION - 1976
COURT CASE TD: 08291 SMSM031717
CHARGE CL&88: MISDEMEANOR CONVICTION
TRK#! DA002VW02
SENTENCE DISF EFF DA11['
FINE $65 20110316
COURT DISPOSITION
AGENCY: IA029015J DES MOINES CO DIST COURT
COUNT XO- 02 IA STATUTE IA719.1(1)A
INTERFERENCE W/OFFICIAL ACTS
COURT CASE IDe 08291 SMSM031717
CHARGE CLASSW MISDEMEANOR CONVICTION
TRK#i DA002VN03
SENTENCE DISP EFF DAT
FINE $250 20110316
Apr,18. 2014 8:57AM D,v of Cr urinal Invest gat on
0.'DC1 00558123
PRO13 P. OF 2
AM ARRES'll'i WITHOUT DISPOSITION 19 NOl' AN INDICATION OF OINU.T, THIS Racoym
lWNTYa=D BY THE IOWA, DIVISION OF CRIMINAL XWVFSl['Ic.,XrI(.w, BUREAU OF
IDENTIPICATTOW IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI„
IN THE ABSENCE OF FINGERPRINTS FOR POSITVE IDENTIFICATION THIS RECORD ]Is
BASED ON INFORMATION FURNISHED. WE CANNOT CONVIP14 OR nooV THAT TUB RECORD
COVERS THE SUSMT OF YOUR :ENQUIRY,
DIVISION OF CR'fMXNhX, INVESTIGATION
rimll
No, 7901 P. 3
Iaegnuiiiry Date:
Name:;
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CelrtHff ed Abstract of L riAntg Record
4/16/2014 DL/T.D M 707A38376 (IA)
Smith, Gary Lee Class: D
956 BOSTON WAY APT 2 Audit
issue Date: 04/16/2014
CORALVILLE, IA 522413170 Expiration r
Endorsements: 3
Date of Birth: 10/19/1958
Mailing City/Statw CORALVILLE, IA 522413170 Sax! M
operatling IhIhsIuuta boated'Teat II/'festIFaillure1/Plollat5ons
customer 8i 747183
ID ..Statoau None
011. Statu m VAL
CNII, states,; None
Coil. Ceut.Statuw None
0D11., INe d , to s:: None
Reetrllcidouu None.
auuppiernelntr
Hamm Smith, Gary Lee DL/IM 707AJB376
Pursuant to Iowa 1{ 1 accurate copy or an'Ttric
the custodian Departmentds held by the Office of Driver Servi , that this is a true
f
said office, and that I have been authorl,ed by the Director of the Iowa
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:
office of Driver
Iowa [)apartment of Transportation