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HomeMy WebLinkAbout16-009�� �"'•fit CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. _O -0O C1 (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 3. Contact Information (REQUIRED) Email �,T %�)� )yj� �L r�;411 Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pe qDi�),-a6v5j f. 11- l7 -90i7 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense When What happened to the charge? (Circle one) Convicted Dismissed eferred Suspended Plead G ilty Other 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) D Z,�) 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? �_ I Type of offense Where When 9. Hav�1yo�ver applied to be an Iowa City taxi driver using a different name? If yes, please provide the r,�ame(s) VV o' DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED 9 S` DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CE11EF'REVIEW You must apply for an individual Department of Criminal Investigation Report (form available,'OpcT! reque t)i (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY).' 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here'JbYcertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on Zeapiring on LL 1 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 prov" ions of Title 5, Ch r 2, of the City Cade. (Needs to be signed in front of a Notary Public) Signature of Applica Date 0/— 15�— 2_6 1,6 STATE OF IOWA ) COUNTYOFJOHNSON ) ribed and sworn to before me by on this day of �T ry Public in and for the State of Iowa _=�-;•,lo;.,i.,i l A rnber221819 -n Expires ****X******************************XX*****************************#*X** 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 1 I / f Signatu o `Police 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. Sign4tbwe of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date ClerkUAXIDRIVBADGEAPPL92DiAamentled DOC 03/2015 State of Iowa Division of Criminal Investigation 215 F. 7"' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Request Your name Address: 169 Ci /State/Zi : -,7 Phone # ( 1- z O l Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Apellido(mandatory) First NNlameNonerNombre (mandator•) Middle Name segundoNomhre(lecommended) {�Name Date of Birth FeAa Natamiento (mnndatoty) Gender Gen ew (mandatory) Social Security Number (eemnineuded) I /I5© Male ❑Female W ver SignattiXe F'1r a (if the re uest is on yowselt. Please sign, if the request is on someone else, wine NA) ❑CI USF ON] Sults As of QJN-15 , a name and date of birth check revealed: ` ❑ No record found :y. Record attached DCI # 4 q 1 fT1 C7 (_,`�; 4. � e N) G t.. DCI initials bL/i' (Y) D r y D Receipt J Number of requests x $15.00 per last name = Total amount $ Method of payment: ?41 cash money order check # MasterCard or Visa fl.ast 4 digits) ry Cardholder's name p DCl initials =i ._..------ til--------------------- .-' -ra cWf' Credit Card # Exp. Date 7 - Flu DCI -83 (09/09/ 10; Revised 10/ 1 / 10; form reviewed 08/ 11/ 14) r IOWA CRIMINAL HISTORY DCI 00192705 COURT DISPOSITION PENDING PAGE 1 OF1 STATUS UNKNOWN DATE PRINTED - 2015/12/24 DCI:00192705 NA -ME: ARTHUR,JAMES JOSEPH DOB SEX RAC HOT WGT EYE HAIR SKN POB 19501117 M W 511 190 HAZ BEG MED DC ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19951014 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION SCHEDULE I TRK#: 007761701 COURT DISPOSITION AGENCY: IAD52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: POSSESSION SCHEDULE I / MARIJUANA TRK#: 007761701 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960208 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. 1 DIVISION OF CRIMINAL INVESTIGATION B- .{.. C4iUVVA00T q, :WAV io�.�/�IL:OG. OV "l1011T, � I :.flf di �.:.� I (UST Yl�ti �?�i�Y�€� "�� IIOffce Of Driver services RO Box, g2D4 Des €Yfoenes. IA 5x300-9204 Phune_'515. 244-91241ECO 032-1127 !Fav: 515-239-1837 AWN .yl'sladcLgo" Certified Abstract of Driving Record Inquiry Date: 12/22/2015 DL/ID #: 043SS5374 (IA) CDL Permit Class: None Customer #: 1639571 Class: D CDL Permit Issue None V� Iowa Department of Transportation Date: Name: Arthur, lames Joseph Audit #: 6476952 CDL Permit None Expiration Date: Address: 527 MEADOW ST Issue Date: 11/16/2012 CDL Permit None Endorsements: Expiration Date: 11/17/2017 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522455019 Endorsements: 3 ID Status: Mailing 527 MEADOW ST Restrictions: Corrective Lenses DL Status: None VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522455019 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 11/17/1950 CDL Cert Status: None Sex: M COL Med Status: None History Information CLEAR DRIVING RECORD Name: Arthur, James Joseph DL/ID: 043SS5374 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: Name: Arthur, James Joseph DL/ID: 043SS5374 '....".4V '1 12/22/2015 IOWA *°s D. 0. Tv-ss',p BRIVtPr Office of Driver Services V� Iowa Department of Transportation N L7 m V� J..