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Home My WebLink About16-023CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. ! i t7 — � 'Z3 (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 F1rst Middle Last 1 Name (REQUIRED) rA\IJ I\At T;7 I r 7L 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: J yn�-,+y 7u lCfii),nekk( ). cc r n Cell Phone: (Ail written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 11-1b ZD b. Taxicab Business Name (REQUIRED)S 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 When MIL 1w,dLyiLLC 7Q What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Ple''ad�' Guilty Other 7 Have you been arrested / charged with any traffic offenses in the last five years?`N U Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other FF 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N (J Tyoe 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(§),_. tv _ DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (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 Chauffeur's license number C-"1SAA i��G I issued on iI-Z1 14 expiring on 1 1 -/6 0020. 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.p[aulsions of Title 5, Chapter 2, of the C'ty Code. (Needs to be signed in front of a Notary Public) SignaturecfApplicant�Date Z 3 STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by vf�n - yA-(� JZJ-e.i on this _ day of V:," !u a (_ 1 -.701 l.o r uMAYEK ~ 7294251 Notary Public in an r the State of to a 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 J"2 Sig ture Police hief 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. moi? a� I'V - 7Utl� Signa of City Clerk or designee Approved application DCI report State certified driving record Website update Date ' �s ; Office Use Only ClerWAXIeRNBAL GEAPPL92014emendetl.GOC 03/2015 State of Iowa Division of Criminal Investigation 215 E. 7rh Street Des Moines, loNva 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Reauest Your name: f Address: I d • G ro F`r 6 L S T- Citv/State/Zi : , LI bEfZ:V SZ31 Phone #: 1 1 --7 Z� Requesting an Iowa criminal history record check on: Fill in all shaded areas. /last Name Apelfido (mmtdatory) First Name Primer teombre (mandatai)l Middle Name Segundo A'omlme fiecommended) PA[9TZL91, DAV 1 � M t LToj Date of girth hechu Nannuento (tnandatory) Gender Genero (mandaton) Social Security Number (recommended) . J - 19 � � J29,11ale ❑ Female 4-P 3 `74 -89 1'I Waiver Si nature Rima` (If the request is on yourself, please sign. If the tcquest is on someone else, write NIA.) \ YY DCI USEONy Results As of I _ Zaj -{ a name and date of birth check revealed: ❑ No record found r , . -0 :-Q r-:, Record attached DCI # 'S 2 S 119 r '- n DCI initials w Receipt Number of requests ( x $15.00 per last name = Total amount $ 1 5, bo Method of payment: �- cash money order check # MasterCard or Visa (Last J digits) Cardholder's name DCI initials - - - -- - - -- -------------------------- Credit Card # Exp. Date DCI -83 (09/09/10; Revised 10/l/10; form reviewed 08/11/14) 0 IOWA CRIMINAL HISTORY DCI 00312314 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2016/01/29 DCI:00312314 NAME: METZLER,DAVE METZLER,DAVID MILTON DOB SEX RAC HGT WGT EYE HAIR SKN POB 19581116 M W 600 150 HAZ SDY MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** O1 ARRESTED 19831126 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321-281 OPER WHILE INTOX TRK#: L25116101 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-281 OMVUI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25116101 SENTENCE FINE $300 PROBATION 6HRS CR,ED-PROS TIL 020885 SUSPENDED 2D CREDIT W/TIME SERVED 02 ARRESTED 19890405 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND TRK#: L25116201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI 2ND CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L25116201 SENTENCE JAIL 10D FINE 03 ARRESTED 19940807 AGENCY: IA0520000 CHARGE NO- 01 OWI 2ND TRK#: 006445901 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 CREDIT 7 HRS/PAY SURCHG $750 JOHNSON CO SO IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE: IA321J-2 DISP EFF DAT 19831126 19831126 19831126 19831126 DISP EFF DAT 19890628 19890628 OWI 2ND COMMITT SEX ABUSE NO INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006445901 SENTENCE JAIL 15D FINE $750 PROBATION lY SUSPENDED 35D SUSPENDED PAY SURCHG 04 ARRESTED 19981125 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA709-4 SEXUAL ABUSE 3RD DEGREE TRK#: 032253001 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 JOHNSON CO DIST COURT IA STATUTE: IA 709-11 ASSLT W/INTENT COMMITT SEX ABUSE NO INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 032253001 RESTITUTION SENTENCE PLEAD GUILTY FINE $500 PROBATION 2Y SUSPENDED 2Y DCI 00312314 PAGE 2 OF 2 DISP EFF DAT 19940928 19940928 19940928 19940928 DISP EFF DAT 19990526 19990526 19990526 19990526 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, DIVISION OF CRIMINAL INVESTIGATION 4:701UVUADOT vwAv iovviadot.gov SMA6FER i `•IMPL'-F I(US T0%1Lp DRI%1FV _I.,,.ti Office of Driver Services PO Box 9204 Des Moines, IA 50306-9204 Phone _515-244-91241800-5332-11211 Fac 515-239-1837 wvm^,lowadot.gov Certified Abstract of Driving Record Inquiry Date: 1/14/2016 li #: 07SAA1861 (IA) CDL Permit Class: None Customer #: 1984143 Class: D CDL Permit Issue None 75/29/2012 06/20/2012 S92 Speed Date: ]A Name: Metzler, David Milton Audit #: 8637174 CDL Permit None Expiration Date: Address; 310 N GEORGE ST Issue Date: 11/21/2014 CDL Permit None Endorsements: Expiration Date: 11/16/2020 CDL Permit None Restrictions: City/State: NORTH LIBERTY, IA Endorsements: 3 ID Status: None 523179671 Mailing 310 N GEORGE ST Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None COL Status: None Mailing NORTH LIBERTY, IA Supplement: COL Permit Status: ELG City/State: 523179671 Date of Birth: 11/16/1958 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR )9/03/2011 09/27/2011 S92 Speed (10 mph & under in 35-55 mph zone) Johnson ]A 75/29/2012 06/20/2012 S92 Speed Johnson ]A 73/31/2013 04/29/2013 N63 Driving Wrong Way on One Way Street Johnson ]A Name: Metzler, David Milton DL/ID: 075AA1861 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: Metzler, David Milton Dli 075AA1861 u Mq �tYClf ®7�i�4i 1/14/2016 = IOWA ).0. T.;' 1=40-407 04emli 4k . r''^^''r Office of Driver Services a8!1=—` Iowa Department of Transportation Name: Metzler, David Milton Dli 075AA1861