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HomeMy WebLinkAbout15-090_e r t2 No 117W CITY OF IOWA CITY 410 East Washington Street Iowa City. lova 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1- Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. l 5— (Office §e Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application 3. Contact Information (REQUIRED) Email:�t31 —J 6 WR -74 (CW' Cell Phone:3('J ---�30 79 q (All written communication jsent via email) 4a. Chauffeur's License expiration date (REQUIRED) 5 t [ 11 1 207,3 b. Taxicab Business Name (REQUIRED) '-AZ (, C -/-J CA -6f SGA,)A 6,77 Y 5. Prior experience in transportation of passengers:t L) Lie.S � CAO> D UP(J 9- +V --4r 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tvpe of offense Where When C)ca :STVLY tcAiJT`t tqql7 What happened to the charge? (Circle one) onvicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please When i jg�C -,-;:!q l7 wz,lke ra (s)1 `r9 'b r'( DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE9*lFI?f1 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CXIEF REWIEW W You must apply for arc individual Department of Criminal Investigation Report (form available uporir'request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa D part ent of Transportation v id Chauffeur's license number issued on z I expiring on 5� i 2- 1 understand that if I an falsely swer any questions in this application, that this applicP al.ion may be denied. I a ree that in making this application, I consent to allow agents or employees of the f Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, an ��++ er agree that, if authorizati n to be a taxicab driver is granted, to comply at all times with all of the provisions of Title fiapter 2, of the City Co eeds to be s' ned in front of a Notary Public) Signature of Applicant Date ZZ (;E STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and savor to before me by c? V_/1 r> _T. -IJ 4IC2 Q AN �'pii c,�on this i X day of a ►ieY S. ptAYER Notary Public in ar or the State of to My- l.0 I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffe ' 'cense l f 0 2 3 LT121 Signature of P ice Chief or design6Q Elate AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Dale +V O Ct cn Gi r, r AIDRIVDA GCAPPL92094amended.Doc 0312015 W W ry Gi r, r AIDRIVDA GCAPPL92094amended.Doc 0312015 gR1'EP I tJ"5PttF� I CJ iJ1;EF 6FEbEV W1IA IDWadot.fg©V Office of Driver Services PO Boy, 3204 Des Moines IA 50306-9204 Phone: 515-244-912A1 8017-532-1121 1 Fac Sts -235-183" www. iov:adot.go v Certified Abstract of Driving Record Inquiry Date: 4/15/2015 DL/ID #: 075AA1185(IA) Name: Schoenberger, Roman Tim Class: D Address: 2100 S SCOTT BLVD TRLR 40 Audit #: 8948857 Restriction None Issue Date: 03/24/2015 City/State: IOWA CITY, IA 522403032 Expiration Date: 05/11/2023 Endorsements: 3 Mailing Address: 2100 S SCOTT BLVD TRLR 40 Restrictions: NONE Date of Birth: 5/11/1949 Mailing City/State: IOWA CITY, IA 522403032 Sex: M History Information Convictions Customer #: 2545540 ID Status: VAL DL Status: VAL CDL Status: None LDL Cert Status: None CDL Med Status: None Restriction None supplement: t, station [bate Conviction Date ACD Explanation County 3UR 04/17/2010 05/03/2010 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. .,cr c+e R,1 [`?ie Case Number IUR 09/26/2014 818875 IA Sanctions TFpr: Effective End ACU Explanation Occurrence JUR IUR Suspended 02/20/2015 03/16/2015 D51 Non -Payment of Child Support IA IA Name: Schoenberger, Roman Tim DL/ID: 075AA1185 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 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 ce:ti y. 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: ?�......•;'"it 4/15/2015 IOWA*'i D. 0. T..-, 9,<BBIVE® Office of Driver Services v -- Iowa Department of Transportation Name: Schoenberger, Roman Tim DL/ID: 07SAA1185 APr.17, 2015 3'!47PM Div of Criminal Investigation No. 15280 P. 3/6 Fl- illsl.ly m1 —mow —." GI rl,[ v,umm 1.m mbnbwyr 04/16/2016 09:02 *02b ✓.002/002 STATIE (DY IOWA Criminal History Recoyd Check Request Form To: Iowa Division of Criminal Investigalion Support Operations Doreen, 0 Floor 215 E. 71h Street Des Motiles, Iowa 50319 (515)725-6066 (515) 725.6080 Fax I am reauestin2 an Iowa Criminal History Record Check on: DCIAccouniNumber: YOCCX-F7 (Irapplleabie) From: Cily of lowa City City Cleric's Office 410 P, Washington Street Iowa City, IA 52240 Phone: 319-3565041 Fax: 319-356-5497 Last Name (mandatary) First Name (mandatory) Middle Name (rcwnamendad) -qC Ctj th e.'l nA Date of Birth (mandaory) Gender (mandoory) Social Security Number (recommended) q,3 erMale ❑Female 29 ` qO - 9<9qS Waiver Information. Without a signed waiver from the spbJect of the request, a complete criminal history record may not be releasable, per Code of lows, Chapter 692.2. For complete criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the request. Waiver Release: l hereby give pcniiisslen for rbc above requesting offcie ndact an lows in hlstorytizard ebeet vvith the 00ion ofRiminal Investigation (nap. Any criminal history dare mncctning me the is mai ed b e DCI maybe re aotPc y law. Waiver Signature: i rr11 /, Iowa riminal History Record Check Results As of y �1 a search of the provided name and date of birth revealed: th e.'l ni No Iowa Criminal History Record found with DCI ' Iowa Criminal History Record attached, DCI # DCI initials DCT -77 (08/25/10) Received Time Apr, 16, 2015 9:37AM No.5552 ?pr.11. 2015 x:4°Ni Div of Crimlnal Inve.tigatioo IOWA CRIMINAL HISTORY DCI 00431906 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2015/04/17 DCI:00431906 NAME: SCHOENBERGER,ROMAN TIM SCHOENBERGER,TIM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19490511 M W 601 190 BRO BRC NY ADDITIONAL IDENTIFIERS SC R THGH CCH RECORD *** 01 ARRESTED 19920105 AGENCY: IA0850000 STORY CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L41122601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L41122601 SENTENCE DISP EFF DAT JAIL 2D 19920316 FINE $500 19920318 COURT COSTS 19920318 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SU$JECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No, 5280 P. 4/6