The URL can be used to link to this page

Home My WebLink About15-238.. I CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52 240-1 82 6 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. / aLb _ (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 5- 3- 3. Contact Information REQUIRED Email: r (REQUIRED) D__idar0l,rt 1�/e�N �_�r ,,,,�ICeIIPhone:/5l q )�q� ya 3'3 (All vVl'ltten communlcatlon sent via email) 42. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 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) Convicted Dismissed Deferred Suspended Plead Guilty Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When Other LIAMM vvi idi i idppenea to ine charge? (Circle one) 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 When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide them me s *� cn DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE�QTIF-D - DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE GRIEF, REMEW You must apply for an individual Department of Criminal Investigation Report form available tj . 9 P ( ,�b�pareglFe (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARYP +Mk F`- ,, 02/2015 G APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Depa ant f Transportation a valid C a eur's license number .!a,1,4 issued on W /6xpiring on 2 l� understand that if I falsely er'any questions in this application, that this application may be denied. I agree tha 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) r 9/ Signature ofApplicant � Date 't�-' STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by forthe on this _ .29 day of 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 Signature of Poli e _5pief'orldesignee 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. -IN I Slgn re of City Clerk or designee Office Use Only a 11-5 Approved application cin ate a Approved application cin DCI report . �a -° State certified driving record '' [\.' Website update ^'`= t" ClerWiAXI DRIVBADGWPL92974amwded D0C 03/2015 41UVVADOT SW,RTU' E;,` a rc , art ;a www.iovvadot.gov Office of Driver Services. PO Box 9204 ; Des Wines, fA 50K6-9204 Ffaone_ 595-244-0124 1 800-E32-1121 i Fax- 545-239-1837 wtr.wJoWadol.gou Inquiry 9/29/2015 Date: Customer 1135116 #: Name: Story, Ernest Arthur Certified Abstract of Driving Record DL/ID #: 580XX9476 (IA) CDL Permit Class: None Class: D Audit #: 6719158 Address: 3507 QUEEN DR SW APT Issue Date: 02/22/2013 8 Expiration 02/27/2018 Date: City/State: CEDAR RAPIDS, IA Endorsements: 3 524043894 Mailing Address: Mailing City/State: Date of Birth: Sex; Convictions CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: 3507 QUEEN DR SW APT Restrictions: Corrective Lenses DL Status: 8 Restriction None CDL Status: CEDAR RAPIDS, ]A Supplement: LDL Permit 524043894 Johnson Status: 2/27/1966 08/28/2012 CDL Cert Status: 11 History Information None None None None None VAL None ELG None CDL Med Status: None Citation date Conviction Date ACD Explanation Count: Itis 02/19/2012 04/17/2012 M42 -. Improper Lane (changing lanes) Johnson ]A 05/13/2012 08/28/2012 M14 Fail to Obey Traffic Sign/Signal Johnson ]A 02/22/2013 :05/30/2013 M14 Fail to Obey Traffic Sign/Signal 'Johnson 7A Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Dale Case Number 3UR 06/25/2013 .747232 IA 12/02/2014 '.831415 IA Name: Story, Ernest Arthur DL/ID: 580XX9476 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department ofr.7Sanspartation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true aERaccurate copy of an official record currently in the custody of said office, and that I have been authorized by the Direct¢c�of the fKlia Department of Transportation to so certify.("? A3 In witness whereof, I have caused my signature and the seal of the Department to be set upon this cumeny, e%at An Iowa this date: --1," M nf' off`......... p . ua�0ep..25. 201Sa11�4AM plv at Crimina1 1 1 v e s t l g a t l 0 h Nu 6965 K 1/2 DCI IOV'� ' STATE OF IOWA Criminal History Record Check Request Form � Tat Iowa Dlablou of Criminal lnestl11alloo Support Operallom Bureau, l" Floor 215 E. 70 street Do Molaes,Iowa $0319 (515) 725-6066 (515) 7x4'66110 -Fac I am rm xtinn an InwA Criminal hien" Record Ch. -lr nn� 1, DO Account Number: 13$3 -F-'L Froml -1 w !lb 5+t'Vcr.s Or-. Toone: DIR) 338— Fa3:,- 319 351 C LamttName maea. ) First Name MlddloName wAyamdedl �.J Daft ofBlrfb mmL6.m Gender rwatnoa Social Sectirity Number rood (}Za I LZ C='. zwe OlVemale Waiver loyfemnation. WIthoot a signed waiver from the 0ublett of the Iaguert, a complete criminal him tory record may sol be releaaable, per Code of Iowa, Chapter 69" For wilgoItto ogma,d hbtory record information, am allowed by law, always obtain a waiver signature fromThesuh fthe r Yat. Walvef /{E7tar8; l hertbl'rSH permfeelon (a the ebovo taqueat¢�g eaicid b tobuu.n Iaw. raimfiml hllary rewA chore .rkA the Dlv�len o(LtiUdnl 1n.aepUm(DC7). Any aiminel hldtoy die.onccrtins me UMI is nmsaw.0ly the OCl mry be mfa.oi u .Moved ly low, Wa1wrKignature: Iowa Criminal History Record Check Results As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI Iowa Criminal History ltocord attached, DCi N -3 DCI initials,_,_ jq Received Time Sep. 24. 2015 10:36AM No. 6645 �'•" I -P.25. 2015 11350 Div of Criminal lnv:stigation No. 6965 P. 2/2 IOWA CRIMINAL HISTORY DCS 00600361 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00600361 2015/09/25 NAME: STORY,ERNEST ARTHUR DOB SEX RAC HOT WGT EYE HAIR SKN PDB 19660227 M W 510 270 BRO BLK MED MN ADDITIONAL IDENTIFIERS SC R EYE TAT LF ARM TAT R CALF TAT RF ARM TAT UL ARM TAT UR ARM CCH RECORD **% 01 ARRESTED 1999062B AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 02 IA STATUTE IA700-2(4) SIMPLE ASSAULT TRK#: 500359102 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 02 IA STATUTE: IA70B-2(4) SIMPLE ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500399302 SENTENCE DISP EFF PAT PLEAD GUILTY 19990924 FINE $50 19990924 COURT COSTS 19990924 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 PUBLXC 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 INOUIRY. DIVISION OF CRIMINAL INVESTIGATION N V .v9 rrl