HomeMy WebLinkAbout15-1739 ,r
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
IDENTIFICATION NO. Z -t5 — % -7
(Office Use 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
Fi
L��rst t
1 Name (REQUIRED) xrl
2. Address (REQUIRED)
13�, W S
3. Contact Information (REQUIRED) Email
4a. Chauffeur's License expiration date (REQUIRED)
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers
S-+: e
7
WD MM Cell Phone: 5 f `I - (v Z 1 - Z OLj Z
via email)
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
What happened to the charge? (Circle one) ^� A4
Convicted Dismissed Deferred Suspended Plead Guilty Other _
7. Have you been arrested / charged with any traffic offenses in the last five years e
Type of offense J� }
Where
When
t o3 Zc►
hdt ha pened to e 41hJge� (Circle on_`�� 5`�'nnC �A wc. (, 4V O 317-6 JZ -01) 3
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 be an Iowa City taxi driver using a different name? If yes, please
L/Cs -- ?>eW%N.M.._ N\l ,L T -)r`11-- -
When
the�Rme(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE�TI4D
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHtEP REVIEW
r'n �
You must apply for an individual Department of Criminal Investigation Report (form avail i'expoRfecIusz.
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
Clp-
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certify that I have issued to me by the Iowa Department of Transportation a vatd Chauffeur's license number
9,L7 D G 30 r issued on ta3 a7 15 expiring on o I understand that if I
falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver is granted, to comply at all
times with all of the prove/gris of Title5, Chapt 2, of the City Cade. (Needs to be signed in front of a Notary Public)
Signature of Applicant /✓ Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by —Z,c laly-, i�LL" AJ -1)r 11i n this 90 day of
,rr WENDY S.
ary MAYER�'�` 1
o .emmfeefnn Numhar 79GA9A Notc In an r the State of low
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 Chauffeur's license _ j /2 1
Signature 7 ief or designee
Date
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.
9f 2�
Signature of City Clerk or designee
Q
D e
Q
Office Use Only
;'
a
Approved application
�;y
o
DCI report
fir -
State certified driving record
�d: y
Website update
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ClerkiTAXIDRIV6 DGEAPPL92014.mended.DOC
03/2015
40041 DOT
SNI r I r nr l €: (US R)'*o r i �. www.iowadot,rgov
Office of Dflver Services
PO BOY 0204: Des Moires,lA 50.306-9244
Phore615-.244-9124 X800-532-1121 i Pax: 515. 239- 1837
www_iowadoi_gov
Certified Abstract of Driving Record
Inquiry Date:
8/5/2015
DL/ID #:
185AD6305(IA)
Customer #:
3727257
Name:
Drilling, Big Benjamin
Class:
D
ID Status:
EXP
02/02/2013
Ezekiel Nash Yeshua
592
.Speed
]ohnsan
IA
Address:
1365 W 34TH ST
Audit #:
8961087
DL Status:
VAL
Issue Date:
03/27/2015
CDL Status:
None
City/State:
DAVENPORT, IA
Expiration
01/02/2019
CDL Cert
None
528065601
Date:
Status:
Endorsements:
2
CDL Med
None
Status:
Mailing Address:
2429 E GEORGE
Restrictions:
Corrective Lenses
Restriction
None
WASHINGTON BLVD
Date of Birth:
1/2/1978
Supplement:
Mailing City/State:
DAVENPORT, IA
Sex:
M
528032143
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
JUR
01/23/2011
03/17/2011
M14
Fail to Obey Traffic Sign/Signal
]ohnscn
IA
02/02/2013
03/26/2013
592
.Speed
]ohnsan
IA
03/12/2013
03/28/2013
M14
.Fail to Obey Traffic Sign/Signal
'lohnson
IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
01/12/2014 779892 1A
Name: Drilling, Big Benjamin Ezekiel Nash Yeshua DL/ID: 185AD6305
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
certify.
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:
VLNIC(f p�'�n
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,,'�f�F
9RIYtR
Office of Driver
eof Services
owaDepartment
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oa/10/7095 13:12 019e P.002/002
STATE' OF IOWA
�1 r11�Ef1�1 M -0011-Y Record Check
Request F(Ir•1t'
To: Iowa Division of q-indnul Ilwestigatlon
9upporl Operations 6urcao, 1'I [>Inor
215 11. 7'a Street
Des Wines, Iowa 50319
(515) 725.6066
(S] 5) 725.6090 Fax
I aln rcueslinL! an
I
W1
1)(:f Accounl )dumber:
(i f applioa6le)
11.Om: _city Offowucity
City Cicrlrsu tlffiec ---------------------
A10 E. Washblg(On street
ton's City, ]A 52240 —__•w_—
Phone: 319-356.5041
Fax: 319.356.5499
Inc
1 1 K 7�L�llfall
e ❑Female
leswear able, per Coe Without a signed waiver from the subject of the request, a completo criminal hlslory record may not
obtain
releasable, per Code Mom, Chapter 692.2. Fol• eon criminal history record information, as allowed by law, ah+'a1's
Ob(ain a waiver sl nature from the sub'ecl of the re uesl• _
ff/lf/PCJ' lQCI!?(1se; 1 hereby give ennission for I �W
hsveeli r' p Ove reyueslin ORmiell condo IhisloY record ehee,l
g non (L)C') Any criminal hislo • data c m' et en lona released
y Y virh the Division of Criminal
9 , me Iher is mai rained Fy m UCI may De «leased as Ellowed bylaw,
1�niverSJgJzrrfur ; �
cl�va�Iirnin�t i�tar RecordCheck Rtaegilts --- ---_-'
(DC) use 0111y)As o!' / a search of the provided name and dale of birth revealed:
® NO Iowa Crituina) History Reco)'d foulyd lvi(J) DCINA
M
U)
Inr re Crinuuul History Record attached, DC)1{ 75 7 9% F;c o
t ` (.i
C _
DO iniliuls.-_ �
llC1-77 (06/25,10)
Received Time Aug, 10. 2015 1;04 PM No. 5017
2.
LU17 iI:7Lnrvi vI U �iiIII inai :n V C a 116aiio11 iv o,[�LJ
IOWA CRIMINAL HISTORY DCI 00751797
NON CONVICTION PAGE 1 OF 1
DATE PRINTED-
2015/OB/11
DCI :00751797
NAME: DRILLING,SENJAMIN NASH
DOB SEH RAC HGT WGT EYE HAIR SKN POB
19700102 M W 602 175 BLU RED IA
ADDITIONAL IDENTIFIERS
CCH RECORD **w
01 ARRESTED 20050604
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA321J-2
OWI
TRK#: 101551901
COURT DISPOSITION
AGENCY: IAD52015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE; IA321J.2(A)
OPER VEH WH INT (DWI) / IST OFFENSE
COURT CASE ID: 06521 OWCRO72714
CHARGE CLASS: NON CONVICTION
TRK#: 101551901
DRUNK DRIVING SCHOOL
SUBSTANCE ABUSE EVALUATION
SENTENCE DISP EFF DAT APPEAL DATE
DEFERRED JUDGEMENT 20060120 20060720
PROBATION 365D 20060120
DISCHARGED FROM 20060731
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 I5 A PUBLIC RECORD 13UT 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