HomeMy WebLinkAbout15-273IDENTIFICATION NO. 1!5 - v2 -�A
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APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
410 East Washington Street
Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application
(3 19) 356-5040
(3191 356-5497 FAX
FirstMiddle } ast
1 Name (REQUIRED) AfAUQL I,RVIm l�Alt1�Y
2. Address (REQUIRED) III SCoT"r Lqbf iovJN{ CITY IA 522-y5
3. Contact Information (REQUIRED) Email: S- 1c y,oAIAO O j y%cu QcNy,t Cell Phone: 311 -(p2-I--7Z-LZ
(All written communication'bent via email)
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4a. Chauffeur's License expiration date (REQUIRED) � t z V1 /ZCo 20I'
b. Taxicab Business Name (REQUIRED) _ `(C LLO,J CAi'>
5. Prior experience in transportation of passengers: MtutTA2� St-kvTTILL t/AA1 LALk4 LK z M�+7rt5J
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 1 f-5
Type of offense
Where
When
'E3iL/=T Ste" i/� W f4 a s SEP 2009
`7 -H6 -7r 1sT poaA ctT Au zolS
What happened to the charge? (Circle one) 2coq
Convicted Dismissed deferred Suspended
arj
Plead GuiltyOthero,jE.aerJG-
Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense
Where
When
What happened to the 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? No
Type of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provye the 1ne(s)
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE IF
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHt�FIRE VIEW
-1, d ;
You must apply for an individual Department of Criminal Investigation Report (form avaia )e upo -77 eques!);
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) -
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 valid hauff yyd�'s license number
5nmuE� 1 �A I u F-`( issued on 0 2 a 5- expiring on ' h�20 ilnderstand 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 provisions of Title 5, CAaptaii of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applic Date 1112 /15
**hhX**hhk*k*****X**X******XX*RX**t*X#*k*+****kk***X**k***kXR*h*******kk*£**************£**********#s*******************#*k#********#*****£*****
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by '--Na a Iydg Ra on this a, day of
WENDY S. MAYER
M' 729
My Commission S;'.ir�
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 orwelfare of resi-
dents of thyCiiWf Iowa CitLTitle 5, Chapter 2, City Code).
of
or
license 31 Z21 I
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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.
I
Signature of City Clerk or desighee
f Date
Office Use Only
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Approved application
DCI report
State certified driving record C N ��
Website update
ClerWrA IDRNBADGE PPL92014amended.DOC 0312015
Art Ay�/{� y�y
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Office of Driver Services
Piu Box 9204 ; Des Moines, td 50396 4
Ph+xae_ 515-244-91241800.5.32-1121 I Lax. 515239-1837
www.-iowadotgov
Inquiry._ 10/27/2015
Date:
Customer #: 4592204
Name: Rainey, Samuel Irving
Address: 111 S SCOTT BLVD
Certified Abstract of Driving Record
DL/ID V: 220DD4957 (IA) CDL Permit Class: A
Class:
C
Audit It:
9452003
Issue Date:
09/25/2015
LDL Permit Issue 09/25/2015
Date:
CDL Permit
Expiration 08/14/2017
Expiration Date:
Date:
City/State:
IOWA CITY, IA 522453938 Endorsements: NONE
Mailing
111 S SCOTT BLVD Restrictions: Commercial Learner
Address;
Permit
Restrictions:
Restriction None
Mailing
IOWA CITY, IA 522453938 Supplement:
City/State:
VAL
Date of
8/14/1982
Birth:
Sex:
M
T'� ""';
History Information
CLEAR DRIVING RECORD
Name: Rainey,
Samuel Irving DL/ID: 220DD4957
LDL Permit Issue 09/25/2015
Date:
CDL Permit
03/22/2016
Expiration Date:
CDL Permit
NONE
Endorsements:
CDL Permit
NONE
Restrictions:
ID Status:
VAL
DL Status:
VAL
CDL Status: VAL
CDL Permit Status: LIC
CDL Cert Status: None
CDL Med Status: None
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:
V4NILff ®��y�
O: 1
10/27/2015
IOWA
so
h
Services
T'� ""';
c7)of
Iowa Department Trransportation
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Name: Rainey, Samuel Irving DL/ID: 220 004957
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Vcl.zy. zvID 9:77k1vi biv 0 �rlminai investigation No9761 P, 1/2
F ro m:Clcy or Iowa city clerk r tticc 319 3686687 10/27,2015 1d;en 1312 p.O02/oo;r
STATE OF IOWA
fir,°irtervinal flistatry Rec®rrd Cheek
Request Y� cirri
DCI AccountNuolber: '41COa -
----tifal/pliTWL) --
To,]owaDivisionofCriminalluvcsPieation From: City oflawaCity _
,01ippol't Opel'atious Bureau, 1" Moor City Clark's Office ------
215 E. Th &beef 410 E. Washington 5trect
Des Moines, Iowa 50319 -
- (515)725-6066 _ wn rum re condo
(515) 725-6000 Fax
Mime: 319.356-5041
Fax: 311-356-5497
Criminal History Rocovd Cbecld on
First frame tmandalory•)
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+) ri'eridel'(mmndalary)•
Q Z 0lale �Felnale
n,aivee [njornlafiolt: Without a signed waiver from the subject of the request, a complete erlininal history record may not
be releasable, per Code of Iowa, Chapter 692.2. For comnlete eritllival his(m-)' record information, aS allowed lly law, always
Ol)tain a lyaivel' SipnataL'e from 1.6e cohfn�a of e6a .<....,.a
H'ItiVar Re/ease, I hereby give prtjw4sio0 for d¢ above requcsiiog official Io condor! an )own criminal hnlofy fecord Check 1vllh rhe Aivi9iol, ofCrinlillal
tnveStigolion (ACI). Fuly criminal history dala Couceming n1e rhat is mainleintd bV uID nCl maybe relcasto as allowed by law.
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Waiver
lolrvaCaimin�lllisfor Itecold�ileck]Results
As of search of the provided name and date of bink revealed;
13 No 1Owa Cirilnillal 13ist'ory Record found with DC1 U..,
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10A'a Criminal History Record attached, DCI #
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Received Time Oc1.27. 9015 2: UPN Mo.(1991
(UC) use only)
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',Jet2y. 2(lih 9:3JAM Div of CrirrilnaI lnvestigatioo No. 9761 P. 2/2
IOWA CRIMINAL HISTORY DCI 00875032
NON CONVICTION PAGE 1 OF 1.
DATE PRINTED-
DCI:00875032 2015/10/29
NAME: RAINEY'SAMUEL IRVING
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19820814 M B 600 185 BRO BLK DRK NC
IDENTIFIERS PHOTO AVAILABLE: Y
COR RECORD *>•
OS ARRESTED 20091226
AGENCY: IA0520100 CORALVILLE PD
CHARGE NO- 01 IA STATUTE IA714,2(4)
THEFT 4TH DEGREE - 1978
_
TRK#: IA008EVOI
COVET DISPOSITION
AGENCY; IA052015J JOHNSON CO DIST COURT
COUNT NO- 02 IA STATUTE: IA714,2(3)
THEFT 3RD DEGREE - 1978
COURT CASE ID: 06521 AGCROB8719
CHARGE CLASS: NON CONVICTION
TRK#: lA008EV02
RESTITUTION
SENTENCE DISP EFF DAT
DEFERRED JUDGEMENT $625 CIVIL PENALTY 20101102
PROBATION 1Y 20101102
UNSUPERVISED PROBATION,
INFORMAL PROBATION REVIEW
06/01/11.
DISCRARGRD FROM 20110913
DEFERRED JUDGEMENT
02 ARRESTED 20150730
AGENCY: IA0520000 JOHNSON CO SO
CHARGE NO- 01 IA STATUTE IA714.2(1)
THEPT 19T DEGREE - 1978
TRK#: 1AOOLA001
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 A92MCIES BY THE DCI,
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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.
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DIVISION OF CRIMINAL INVESTIGATION
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