HomeMy WebLinkAbout15-291t IDENTIFICATION NO. j—a Z�
1 l 14t (Office Use Only)
�t��MW®
CITY OF IOWA CITY APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
(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
(3 191 356-5040
(3191 356-5497 FAX
,,^t First p Middle Last
1. Name (REQUIRED) 6V I l C NI FEZ C ,AS
2. Address (REQUIRED) 2110 IIIJ O
3. Contact Information (REQUIRED) Email: t t rq/LCell Phone: 1 3 6 -ec '%
(All written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) I Z ^ 2 i — 7-o 2- 0
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers: ::7 \4 c 5 6A.4 -L Cos
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �jG
Type of offense Where When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested I charged with any traffic offenses in the last five years? l -j(,
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 chauffeurs license been suspended or revoked in the last five years? /JQ
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 the name(s)
N C7 c,
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE dtolFIo
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CIa-EF REVIEW �-
You must apply for an individual Department of Criminal Investigation Report (form available upol},reques,4
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ' r\)
C .) 0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certifyhat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
d\3 (bQZ(�,yZ_ issued on A'2D)Sexpiring on t2 -2:-7-Z026. 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant 1 T Date 2 -
STATE
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed pnd sworn to before me by iU , ry,CX-Q_X tsc 0,2.:(on this 9 day of
WENDY S. PAAYEF u �,
,mission Number'=5d2& Notary Publ' in
"„ rnmmissM E,011es 6
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).
_xpiration date of Ch ur's license 2 � O
� LZ tiI�
Signature of olice Chief or signee to
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.
x -j_
Signa re of City Clerk or designee
�a /e /1,5
Date
Clerkfr IDRIVBADGEAPPL92014amendedDOC 03/2015
N
Office Use Only
Approved application
DCI report
State certified driving record
ry
Website update
cr,
Clerkfr IDRIVBADGEAPPL92014amendedDOC 03/2015
0:Z1 DOT
Gffic2 of Dtivet Setvlces
PC, Box :9204 1 Des F�Yoines. IA 50-10 -.. 9'104
Phone: _`i i i 244-9t---'4 I At7Cr-5'2 912I is Fat
www_ oWadot.goy
Inquiry
Date:
Customer
Name:
11/10/2015
3959505
Certified Abstract of Driving Record
DL/ID *: 013BB2642 (IA) CDL Permit Class: None
Class: D
Casella, Michael Peter Jr Audit #: 6831235
Address: 2110 N DUBUQUE ST
City/State: IOWA CITY, 1A
Convictions
Issue Date: 04/03/2013
Expiration 12/27/2015
Date:
Endorsements: 3
COL Permit Issue None
Date:
CDL Permit
522451624
Mailing
2110 N DUBUQUE 5T
Address:
None
Mailing
IOWA CITY, IA
City/State:
522451624
Date of
12/27/1956
Birth:
None
Sex:
M
Convictions
Issue Date: 04/03/2013
Expiration 12/27/2015
Date:
Endorsements: 3
COL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
Restriction None
CDL Permit
None
Endorsements:
CDL Permit
CDL Permit
None
Restrictions:
IA
ID Status:
None
Restrictions: NONE
DL Status:
VAL
Restriction None
CDL Status:
None
Supplement:
CDL Permit
ELG
Speed
Status:
IA
12/09/2010
CDL Cert Status:
None
Speed (10 mph & under in 35-55 mph zone)
CDL Med Status:
None
History Information
CltA'ici 5 Bate
coov;'Ti 5n Plat£
P.CP1
4%ttpEeuna€:an
Cu,U4i::V
lid;
11/01/2009
'.11/30/2009
592
Speed
]ohnson
IA
12/09/2010
01/02/2011
S92
Speed (10 mph & under in 35-55 mph zone)
Cedar
dA
Name: Casella, Michael Peter Jr DL/ID: 013BB2642
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 documen(,,,at Ankeny, Iowa
this date:
CD
c
IOWA`y° 11/10/2015
-t, r
®f BRIYERS`/ Office of Driver Services
I1Nay.10, 20155 1:55PM
«.sew
Div of CrimDCI I6
inal Investigation No. 0611 P. 1/2
.. wJ u2
STATE OF IOWA s'
5: tr
Criminal History Record Check
Request Form r �"
Tol lows lltYlalox orcrimino iarestiptloo
rapport operations Bureau, l" Floor
215 L 7" Street
Des Moines, lova 60719
726.6090 Fax
Q lA-56LL-6 I Std- JOAJ 1 C -M 41`Z.
DCl Aceount Number: 3g
(lrwplkabr=)
Froml I' O Irtrs
IN T�
5k6opv
A SaYi o
ptope; 01R) 30-
Furl,• 319 SSI
r G7-t�—
`2 Male OFemale
ormafion: Without a alped waiver from the eabJect of the requcet, a complete criminal airtory retard r"bY not
R'aloer hFJ
be releasable. par Code or lows, Chapter 691.2` For . eHmbtal hhlory troord isformatbar All allowed by lair, dwaya
Waiver, /telease: r e --by Ow mmlulon rer ON Ab -gallas otaew t o n"c! r* ram Blom ld werK vrb un Dwulm otc mloa
IgVeallrl"e(DCI). Aar crimin�l gkW'YdauoonWn go "III"ehraloed by Y
Waiver ftriafare:
(DCI une eblY)
As of tl_ _0V k� a search of the provided name and date of birth revealed;
Receiveo Time Nov, 9. 2015 10:49AMi No -1646
r•
No Iowa Criminal History Record Pound with DCI
❑
Iowa Criminal History Record attached, DCI N
G
DCI initials -22L_
rj
77 (09125110)
\oma
c�
Receiveo Time Nov, 9. 2015 10:49AMi No -1646