HomeMy WebLinkAbout15-115Ir
CITY OF IOWA CITY
410 East Washington Street
Iona City, lona 52240-1826
(319) 356-5040
(319) 356-5497 FAX
7. Name (REQUIRED)
Authorization Number i
(Office Use Only)
APPLICATION FOR TAXI / MOTORIZED PEDICA13 VEHICLE DRNER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday,)
Failure to comnfete tFre Yaauired" irrfnrmaiton w/11 result fn denial of the application
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2. Mailing Address (REQUIRED) k3
3. Contact Information (REQUIRED) Email: GL`s`; Cell Phone: �S 1 °t X31 - 3' f ra
s eager
A. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 5
Tvoe of offense Wher V1.017
Po e, 5. 04ry�v i 1 v ^� l'r�ivy J /�
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6. Have you been convicted of operating a motor vehicle while under the Influence of alcohol or drugs in the last five
years? NO
TV via of OffenseWhen
7. Have you been convicted of any traffic offenses in the last fire years?
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B. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? 1 �'I o
Type of offense
WF7
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 (DCQ REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an Individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
=01
I hipreby certify that i have issued to me by the Iowa Department of Transportation a valid chauffeurs license number
! $"y -7 °I'4 Z . I understand that if I falsely answer any questions in this application, that this
application maybe denied. I understand that f 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 T'die 5, Chapter 2, of the City Code. yi reeds to ba aigned Ir, front
of a Notary Public)
Signature of Applicant V ��+^•— °t' �1P`" Date (�1
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.
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STATE OF IOWA j
COUNTY OF JOHNSON j
Su0c ribed and swoT_ tD—before me by ) l rpN ca ✓ On this f P} 1 day of
I eeL�Sumrlt ?V
I have reviewed this application, DCI report, and the State certifled 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).
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
t�-is
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and S'/z'
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
CW0A ®amawcEAPeraior�ooc 092014
Jeb, 16. 2015 9:01AM Div of Criminal Investigation
■ r. Fob. 12, 2015 1:00PM City Clerk — City of Iowa City
STATE OF IOWA
Qimlisl> l History Recoird Check
161W R"Uest Form
To: Iowa Mvhdon of CriminalYavettlgatlon
support OperatlonsBureau, rLFloor
315 z 7°' Fhteet
Des Mobter, Iowa 50319
(515)7254066
(515) 725-6080 ]Fan
Tam remaratina en %wA CSimfnal RiaMw Iteem-d Check on:
No, 0337 P. 1/2
No. 5675 P. 2
DCI AccountNiumber: 40c9 =T. _J.
(ifopprt blaj _
From: _ City of Iowa Cill
City C1erk's (?LOee
_410L Woshington fi tmot
Xowa Cita, XA. d324T1
phone 30-356-5041 _
FM 3M35"97
last Name (intftw
First Namo (m,ae tory) _
Middle Nome 6uoumwiam
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Date of Birth ftwmoih
Gender wAdory)
Social Security Number
❑Viunale
H18-12,-361 0
WaiverXr(jorrrtO&M. without a signed wzivw fi-arn the subject of 1he reguesk a complete criminal history record mmy not
be releasable, per Code of Iowa, Chapter MZ
obtain awmlverel t e-mtheaabcetoft e reguest
lWalVeT.RdOa..IbMbygiropaleMonAw1AefiMVOrcgnw6ss:nnrmidmfnadactmIOWArrlmtndbblayruadchedcahbIAenlvkNiofCan"
InVtadgadaa(DC¢ kaywhwlndhblarydnaCana//m}'lt���mOlAeergrminfenedayl�ba7tDCimay6OrcicmedaeHerved6yraw.
(DC711e eah)
Aa of g\ ` I (o � l 5 a search of the provided name and date of birth revealed:
13 No Iowa CiunlualHistory Record foundwithDCI ;
Iowa Criminal History Record attached, DCT
D(xinitialy .,�tt _._
Received Timellib."ll''2015 12:58PM No. 0189
Feb, 16, 2015 9:01AM Div of Cr m:nal Investigation
IOWA CRIMINAL HISTORY DCI. 00567329
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
DCI:00567329 2015/02/16
NAME: LARSON.ALAN KEITH
bola SEX RAC AOT. WOT EYE HAIR S" POB
19540713 M W 601 200 13LO HRO FAR IA
ADDITIONAL IDENTIFIERS
SC FHD
CCH RECORD w*R
O1 A$RESTED 19980111
AQRNCY; IAD050100 AME9 PD
CHARGE NO- of IA STATUTE XA124-401-5
POSSESS CONTROLLED SUBSTANCE
TRK#r 032094601
COURT DISPOSITION
AGENCYc IA085015J STORY CO DIST COURT
COUNT NO- 01 IA STATUTE IA124-401(5)
POSSESS CONTROLLED SUBSTANCE
CHARGE CLASS+ MISDEMEANOR CONVICTION
TRK#: 032094601
SENTENCE DISP EFF DAT
FINE $250 19980331
COURT COSTS 19960331
AN ARREST WITHOUT DXSPOSITION IS NOT AN INDICATION OF QUn T. THIS RECORD
MAINTAINED BY TER IOWA DIVISION OF CRIMINAL XW RSTXQATION, BUREAU OF
=ENTIFICATION IH 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
No. 0337 P. 2/2
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WWW.itrvvedot gov
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Certified Aimtract of Driving Record
Inquiry Date:
2/12/2015
OL/ID #:
4310(7942 (IA)
customer #:
900797
Name:
Lemon, Alen Keith
Clam:
D
ID Status:
None
Address:
1540 PLUM ST
Audit #:
5423120
DL Status:
VAL
Imuo Dater
08/05/2011
CDL Status:
None
City/States
IOWA CITY, IA
Expiration
07/13/2016
CDL Cart
None
522402124
Data:
Statual
Endorsements: 3
CDL Med
None
Status:
Mailing Address:
1540 PLUM ST
Restrictions:
NONE
Restriction
None
Date of Birth:
7/13/1954
Supplement:
Mailing CRy/State:
IOWA CITY, IA
Sex:
M
522402124
History Information
Convictions
Citation Date conviction WAG ACO axpinnatron County Jun
03/25/2011...___ 0410e/2021_ _. X592 L4Peed, _. __. _ _.... bahnsdn..._... IIA ...
03/26/2011 1104/13/2011 IN14 iFall Co Obey Traffic Slgn/Signal Johnson s A
Name: Larson, Alan Keith DL/ID: 431XX7942
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Offfce of Driver Services, Iowa Department of Transportation, do
hereby certify that I am the custodian of the records hell 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 reused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
Name: tars0a, Alan Keith DL/ID: 431)(X7942
2/12/2D15
`
Office of Driver Services
Iowa Department of Transportation
Name: tars0a, Alan Keith DL/ID: 431)(X7942