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HomeMy WebLinkAbout15-198i CITY OF IOWA CITY 410 East Wash Ington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1 Name (REQUIRED) 2 Address (REQUIRED IDENTIFICATION NO. (Office se 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:�t nr •v�w1- ce-.CellPhone:/3/y)�3(Z All written communicati sent via email) 4a. b. 5. 6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere? 7 TVpe,of offense ��Whe��re When / TA,4-1f+- �ly 2TI-1 J Zat� ✓ `�vFe What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Have you been arrested / charged with any traffic offenses in the last five years? Other T e of offense C Where ,v When z�c � n 5 v L� v 20 13 ✓ ft happened to the charge? (Circle one) d moj S e> Z -O / Convicted Dismissed Deferred Suspended Plead Guilty Other. II 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N 0 Type of offense Where When r�cry 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pi�pvl th"ame( A\ J 'y,` r -j DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STA' DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE You must apply for an individual Department of Criminal Investigation Report (form (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) _ r—) upon request). 0 W., 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I heb c ttify 1lyt I I ave issued to me by the Iowa D artment of Transportation a valid Chauffeur's license number I e issued on ff� d- [¢expiring or� 'o -Z© r`7 . 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 pro /�pns of Title 51 Chapter 2 of the City Code. (Needs to �be signed in front of a Notary Public) Signature ofApplicarit. I iZA1_ Date "6 3ML1 STATE OF IOWA ) COUNTY OF JOHNSON ) ascribed and sworn to before me by �2'� on this day of 11Q.0 r; -r Public in and for the State of Iowa Plumber 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). l Expiration date of Chauffeur's license 12 3 1 Z Dt� �%_ �D3t� Signature of Polide Chief 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. Signatu a of City Clerk or designee � ,1�/-� Dae CledornxiDRmewcea.PPL9zo14amended DOC 0312015 Office Use Only Approved application a ✓-a rn n DCI report ?"� i w - State certified driving record c Website update t s,. M CledornxiDRmewcea.PPL9zo14amended DOC 0312015 State of Iowa Division of Criminal Investigation 215 E. 7" Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Request Your name: Z,&Y e w Address: 2 Ci /State/Zi : ^Xl Phone #: tqj5-1a - 631-7 Requesting; an Iowa criminal history record check on: Pill in all shaded areas. Last Apellido (mandatory) First Name v,,mer Xo nNe (mandatory) Middle Name sem n,10 N.,"hre (reco,»mcnded) �Name Rev,% �J"� " .. v ti ? t k o roL"i Date of Birth Ferha Nacimiento (mandatory) Mender Genera( andatory) Social SeCny rit Number (eccommem&d) 12_ 3C) _I G g1 FyMale El Female �YF - ©g ~7 rep � 0 W alve 1 nature Fi,'rnu (If the request ie onurself, please sign If the request is on �somenne else. write NIA ) 5�9 Rs Its DCIUSE ENE l As of 1 1 a name and date of birth check revealed: - rr ❑ No record found 67 -. r- Record attached 5 -- DCI # �% �a �j 3 -; " w CD c rte DO initials ��--- tel_ r- o Receipt Number of requests I k $15.00 per last name —Total amount $ 1 J . d D Method of payment cash money order check # MasterCard or Visa (Lest 4 digits) Cardholder's name c�a Ei DCI__ initials " t >�, (o� ------------------------------------------------------------------------ --------------------- --------`_: ----t- ----- ------- Credit Card # DCI -83 (09/09/10; Revised 10/1/10; form reviewed 08/11/14) Exp. Date 0 IOWA CRIMINAL HISTORY DCI 00763235 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2015/09/03 DCI:00763235 NAME: DECHARD,JEREMY J REW,JEREMY NICKOLAS DOB SEX RAC HGT WGT EYE HAIR SKN POS 19841230 M W 507 230 BRO BRO XX ADDITIONAL IDENTIFIERS Ul TAT R SHLD cn CCH RECORD *** O1 ARRESTED 20051104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(4) THEFT 4TH DEGREE TRK#: 101698901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(4) THEFT 4TH DEGREE - 1978 COURT CASE ID: 06521 SRCR074228 CHARGE CLASS: NON CONVICTION TRK#: 101698901 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060303 PROBATION lY 20060303 20060903 DISCHARGED FROM 20061011 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 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 SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION N C] ,Y Ul cn 4�4�IUVVADOT S"y144iRTER 15tPAPLE:R I (W>T0WF DRIVEN EN wmvtG}wadl Office of Driver Services PO Box 9204 i Des Monts, EA 503u6 -P204 Phone, 51;-244-9124 j WO -f32-1121 I Fa)': 515-239-1837 w'Av" lovi Certified Abstract of Driving Record Inquiry Date: 9/3/2015 DL/ID #: 775YY4363(IA) Customer #: 1424101 Class: D Name: Rew, Jeremy Nickolas Audit #: 8727168 Address: 2804 MUSCATINE AVE Issue Date: 12/30/2014 Restrictions: IA Expiration Date: 12/30/2019 City/State: IOWA CITY, IA 522402801 Endorsements: 3 Mailing 2804 MUSCATINE AVE Restrictions: NONE Address: 4A Restriction None Mailing IOWA CITY, IA 522402801 Supplement: IA City/State: 06/26/2013 Improper Registration Date of Birth: 12/30/1984 09/27/2014 01/09/2015 Sex: M Johnson IA History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: 7UR CDL Permit Expiration None Date: No Driver's License COL Permit None Endorsements: 01/04/2008 CDL Permit None Restrictions: IA ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date FCD Explarriucin County 7UR 08/16/2007 :09/12/2007 B51 No Driver's License Muscatine IA 12/14/2007 01/04/2008 B51 No Driver's License ..Muscatine IA 03/11/2008 -'04/06/2008 B51 No Driver's License .,Muscatine 'IA 11/30/2012 !12/28/2012 'M14 Fail to Obey Traffic Sign/Signal Johnson 4A 02/08/2013 :03/06/2013 "S92 Speed -Henry IA 05/30/2013 06/26/2013 Improper Registration Johnson IA 09/27/2014 01/09/2015 S92 ;Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Numbe: ]UR 12/25/2011.. -.. 664966 IA Name: Rew, Jeremy Nickolas DL/ID: 775YY4363 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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. r+a d In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Anker Iowa tltlsidate: ...rr 711 W 9 9/3/2015 ;g` IOWA a't Fri A 5=.. Office of Driver lTrransportation IowaDepartme Department C''n