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Home My WebLink About15-296� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO 1 5-J9 1, (Office Use Only) APPLICATION FOR TAXICAB I 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 1. Name (REQUIRED) V LR 2. Address (REQUIRED) 945 Ly 3. Contact Information (REQUIRED) Email: j6eFCocL_ ,00TMl11IL e6n (All written communication sent via 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 6u 5, Prior experience in transportation of passel Last Cell Phone: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? G v Tvpe of offense Where When What happened to the charge? (Circle one) //- -1 �.Convicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? t Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil4 Other Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 40 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prq'xide theriirne(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATLCERTIF.IED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEWS 4 You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Dep rt ent of Transportation vali Chauffeur's license number fC7� 3�s issued on y$ expiring on I understand that if I falsely answer any questions in this application, that this ap is tion may be denied. I 4greeAhat 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 provisionns of Title 5, Chapt 2, Or ttnee�!City Co eeds to be signed in front of a Notary Public) Signature of Applicant ��°9 �"� A& �"/ Date STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by V > OC_ - Q1\ a d) f. on this % C) 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). date of hauff�ur's license 2 Z� �— or designee Dater 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. Signibtare of City Clerk or designee /a /v AS Dat CIeM7AXIGRIV9ADGFA.PPL92014.m.,d.tl.DOC 03/2015 (rt] Office Use Only -` Approved application �' c7 DC]report -- State certified driving record Website update :r Cn ;z CIeM7AXIGRIV9ADGFA.PPL92014.m.,d.tl.DOC 03/2015 C4jWDOT SMARTER ! 51ta1FLE , ! CUSTOMER DRIVEN 1N[n W,IoV1+`adi7t,C�OV office of Driver Services Pa BOX 9204 1 Des Moines, IA 5p306_g204 Phcne, 515244-91124 1 8OG-532-1121 [ 1=•.a , 515-239-1837 Vravi ibwadoi_gov History Information Convictions Citation Date Conviction Date Certified Abstract of Driving Record Explanation Inquiry Date: 12/4/2015 DL/ID #: 712XX9845 IA i ) __.1 'M14 _Fail to Obey Traffic Sign/Signal Customer #: 3038254 Class: --06/24/2015 CDL Permit Class: None _,_.... _.. _ IA C CDL Permit Issue None Name: Marlette, Rick Allen Audit #: 6634389 Date: (_n\DA117Z_ Iowa Department of Transportation Type Effective End CDL Permit Expiration None Address: 900 SPRUCE STREET Issue Date: 01/22/2013 Date: Occurrence JUR _...._.Iq )OR Suspended -_... 0816/2006 1 / COL Permit None --- - _. IA Suspendetl ,11/16/2012 10/26/2006 j01/23/2007 Endorsements: 1Non-Payment of Iowa Fne _. ��q - -_ `"-""- 7 --- `IA Expiration Date: 02/25/2018 COL Permit None City/State: MONTROSE, IA 52639Restrictions: Endorsements: NONE '.DS3 .,� �P ___.._-_�"-- '-`-'—""--� :Non -Payment of Iowa Fine Mailing 2665 TRIPLE CROWN LN UNIT Restrictions: NONE ID Status: VAL Address: 6 Name: Marlette, Rick Allen DL/ID: 712XX9845 DL Status: VAL Mailing IOWA CITY, IA 522407262 Restriction Supplement: None CDL Status: None City/state: CDL Permit Status-. ELG Date of Birth: 2/25/1956 Sex: M CDL Cert Status; None CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation 05/05/2006 - 07/29/2015 08/27 2006 - / __.1 'M14 _Fail to Obey Traffic Sign/Signal County 'Johnson ]OR --06/24/2015 1592 Speed .-=W �.�....._'.._-_.�_._.__ _,_.... _.. _ IA T. """ WY Sanctions 'i F _ S % ,' IV Office of Driver Services (_n\DA117Z_ Iowa Department of Transportation Type Effective End ACD Explanation Suspended 08/11/2006 11/16/2U12 Occurrence JUR _...._.Iq )OR Suspended -_... 0816/2006 1 / A.D53 ;Non -Payment of Iowa Fine ----- -^•'------------.T_-...-- --- - _. IA Suspendetl ,11/16/2012 10/26/2006 j01/23/2007 :D53 1Non-Payment of Iowa Fne _. ��q - -_ `"-""- 7 --- `IA -_ --- iW01 IHahitual Violator IIA ..... Suspended 01/15/2007 11/16/ 2012 '.DS3 .,� �P ___.._-_�"-- '-`-'—""--� :Non -Payment of Iowa Fine dA �" �-`-""" IA '"" 1A ' Name: Marlette, Rick Allen DL/ID: 712XX9845 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certifythat I am t 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 s that I have been authorized by the Director of the Iowa Department of Transportation to so certify. aid office, a ry In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at AnkY, Io en Athe date: Y. +� C a.T a l,�f,: ..... .�Ip �` :s 12/4/2015 IOWA T. """ 'i F _ S % ,' IV Office of Driver Services (_n\DA117Z_ Iowa Department of Transportation -', Name: Marlette, Rick Allen DL/ID: 712XX9845 UeC.�.S. 2 U I h 10:3hAM Div of Ciminal lnvesfigatlon No. 3336 i"11) rm:IIY Or "W,L:ItY Gl dlH UrYIOC 3l® 361;6497 12/07/2016 14:26 6339 P.002/O02 STATE OF IOWA Crimillal History Record Cheep Request Forin 7'0: Iowa bivlsimt of Criminal Investigation Support Operations $ureas, 1`I fluor 215 E, 7" Street Iycs Moines, Iowa 50319 (515) 725-6066 (515) 725-6090 Fax Criminal MA P LET -IL' /OCK DO Account Number: i-) OCA -Z--,C.--- (If — From: City of Iowa cgy __ City Clerk's Office 410 B. Washington street Iowa qql, IA 52240 Phalle, 319-356-$041 Fax; 31 9-3 5 6-549 7 '- lqa,E-V Male ❑) emale 1 WOiveY77 f0i'YUOIj0rj. Wllhout a signed Waiver(I'M (Iles ubject of the request, a e0mplcte cl'iMInaI history record may not he releasoble, pct Code Of Iowa, Chapter 692.2. For complete criminal history record information, as allolred by lava, waalways obteln a ive r sf nature Eton the sub! Ec[ of fhe rcguasl WpiVCY ,(ieiepSC: I M1cabygive permission for U¢ aboYc regpcsling official to conduct an Iowa criminal historyrecord "'Itch'lviih die Division of Criminal Investigation (DCI). ,any criminal history data cancemiogm Ihntls ainlained by the pCl may b<relcascd as alloaed by law, Waiver signature: ,�^"'�� \. Received Time Dec. 7, 2015 1,15PM No. 3262 Iowa Criminal History Record Check Results As of a search of the }provided name and date of birch revealed: cr y, ® No Iowa Criminal history Record found ixith DCI 4yL lova Criminal History )Zccord at(ached, DO # err; i DC1 initials �W �„�.• _ DCI -77 (08/25/10)------ --�r ' —" 0 Received Time Dec. 7, 2015 1,15PM No. 3262 Dec. tl, 2 U I h 1U,35HM Uiv of Criminal I n v e s t i 9 a t l 0 n IOWA CRIMINAL HISTORY DCI OD375147 MISDE14EANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - DCI ;00375197 2015/12/08 NAME: MARLETTE,RICK ALLEN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19560225 M W 600 180 HAZ BRO MED IA ADDITIONAL IDENTIFIERS SC L LEG TAT LF ARM TAT RF ARM CCH RECORD *** 01 ARRESTED 19600513 AGENCY: TA0900loo OTrumKA PD CHARGE NO- 01 IA STATUTE IA719-1 INTERFERENCE W/OFFICIAL ACTS TRC<4: L341S9701 COURT DISPOSITION -'�•�..i AGENCY- IA090015J WAPELLO CO DIST COURT COUNT NO- 01 IA STATUTE: IA719-1 INTERFERENCE WITH OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: 04159'i01 SENTENCE FINE $50 SURCHARGE COURT COSTS $114 02 ARRESTED 19980320 AGENCY: IA0520200 IOWA CITY PD CHARGE NO. 01 IA STATUTE IA714-2-4 THEFT 4TH (71 CFS TRK{{: 0111993001 COURT DISPOSITION AGENCY: IAC52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA.714-2(4) THEFT 4TH CHARGE CLASS! MISDEMEANOR CONVICTION TROT 017993001 SENTENCE SUSPENDED FINE $250 FINE $2$0 PROBATION SUSPENDED ly 03 ARRESTED 20010407 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 SA STATUTE IA708-1 ASSAULT CAUSING INJURY TRK#: 10020750a COURT DISPOSITION DISP EFF DAT 19660602 19880602 No. 3336 P 4 DISP EFF DAT 19982020 r 19981020 3.9981020 -'�•�..i 0''7' c") �'® 19981020 C3 (71 CFS Ues, AM Div of Criminal Investigation DCI 00375147 PAGE 2 OF 2 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2(2) ASSAULT NO INTENT OF INJURY - 1978 COURT CASE ID: 06521 SRCRO56453 CHARGE CLASS: MISDEMEANOR CONVICTIDN TRK#: 100207501 SENTENCE DISP EFP DAT JAIL 71) 20010808 FINE $250 20010808 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 SY 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 `�.\J Y No. 3336 F. 5 cc �'r