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HomeMy WebLinkAbout16-033..z r = (Off Ce Lise, only) A rrroa��i CITY OF `• �, APPLICATION FOR TAXICAB MOTORIZED PEWCAB VEHICLE DRIVER AWA CATI (Porice Department review muni be made beprreen 3 a.rn. to 3 p.m„ 4utonday— Frid y) W €ast Washington Street Iowa Cily, io,;a S2210-1826 Farr"Pe to complete rhe "rB4u+r'ef1" (3 19) 356-5040 ftltormahort Wrll resuTf ill dPnial n1 fh� a vficatn (319) 356-5497 FAX First Middle Last 1. Name (REOUIRED) ��C� ��% 2 Address (REQUIRED) 607 _3e%'� '�"'g(f. �� �z�q 3 Contact Information (REQUIRED? Email Z� T S/'� ty LTM 7 1<<a^� _Cell Phone All written communica6an sent via email) 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) � r )' - .._. Prior experience in transportation of rasrarc r 6. Have you ever been arrested / charged with ar isderneanors an for felonies in this State or elsewhere? Yf� 1yP- ofaffanse e When — -- .. ti k,1r 1'�--- -- -- (-,'nn !1 T 34 1 /LTO What happened to the charge? (Circle one) onvicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested arged with any traffic offenses in ti)e tast five ; p srs'r' �e s Tyne of offense Spee the charge? (Circle one) VVhera y-4 Convicted Dismissed Deterred Suspendedead uilty Other a Has your driver's license or chauffeur's license been suspended or revoked in the last five ars^ ryrO Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide. the narne(s) - -- -- DEPARTII TENT OF CRIMINAL INVESTiGATIOlN (DCi) REPORT AND STATE GERTiFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIER REVIEW you must apply for an individual Department of Criminal Investigation Report (form available uponJ3equest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) APPLICATION FOR TAXICAB VEHICLE BRIVER Page 2 i herg�Dy certify that [ n.ve issuer, to rye by the Iowa Ciru,�zrn rk. r. rl�nsport,C n ut r:,rauff it litnse number -- --2©� — —_ rss�,usi on Z�IF � erpfr._nq orr 1 12 J2 i and - F rnd ii t if I falsely answer anv ques�tons In this application, ti this app6 ate n he denieti I ra�r� �t`i;mt !i r,�er r #:P� y ,p ier,€iol:; I consent to allow agent s or atlployees cf fi;e C tf of [oua t,ity, ;o v n r, i, ri �rulan, t�, Axa ,line Witty al7d 1, records, ae6 documents relating to this application, and [further agree f at, it 5uthurzstion to be a tamcab driver is granted, to comply at i! times naturte Gf i the ap provision- or Tula 5; Chapter ?. of the City Code (Needs to ;A, si ned in irons ref a Notary Prei3[ic) Dat `7 ' ki*+'tYi'-k+ A.LV Ytn*x4.w rt *kms#.�. Y. 4n[«KRy'N STATE OF 10'vVA ) COUNT -(OF JOHNSON ) p sworn to before me by ZC( kc) �S C� on this � � day of cubed and sw �t _ (� ..�i i �.. C�,.l.: KELLIE V. TUTTLE � r`C, �i.tj.. -_ r tuber 22tsts Notary PutNlc ir. erd for the State o7,f f�vla I have reviewed this application, DCl report, and the State certified driving record of this applicant and have dcterritined that there is no information which would indicate that the issuance would be detrimenta[ to the saf ky, heaiih or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). J l43 �a ci3 Expiration date of Chauffeur's licensemma,ralr(4 Sit,i aiure of o+ c t,tr�f r,,..art�rt� L2lcl�, t��ze AFTER APPROVAL L BY `VRF CITY +..t ERK YOU FPL At.3 f'OPtZFj1 TO JRIVt A T AXiICA IR IOWA CITY FCR Tat) PL1 3 ,F TFIAN 0 N E'i -c!`P i ROVI T -4E OAT% Lr +TEC) SELOW. ;:ir„Ta i G kr {erk n p pa £'kA'kk#%x:'t**k*x**£**££%k*Y!F'kk{kie**iFkt*AA**kkH *#F*h#R;} ivv:'AM✓k*rt'k 1%#'£*##*£. !A£,4#k-;:*iI#*st*v )� r.urtx+Axx' .x+ —.:k.l. 11v:x., +v.* Approved application _ DCI report State certified driving record Website Update h.J C7 ieffbG& Use Only 7 ul- R - -rr t, r CA Iv a epartment of TransportatioLJ'i re(fUrtver's'enices PO BOY 9204. 1 Ii ojnLs, IA W3156 92174 41DI1 h fec) 8W 532 1121 51S 244 9124 }-AX..515239 Mir Convictions Name: Eash, Zachary Dean DL/ID: 644XX2016 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: 1r� IOWA 0 T. Xr li Name: Eash, Zachary Dean DL/ID: 644XX2016 2/18/2016 Certified Abstract of Driving Record Inquiry Date: Name: 2/18/2016 Di #: 644XX2016 (IA) Customer #: Eash, Zachary Dean Class: D 758423 Address: 607 11TH ST Audit #; 9791353 ID Status: None C:i Issue Date: 02/18/2016 DL Status; CDL Status: VAL City/State: BELLE PLAINS, IA 522081517 Expiration Date: 10/19/2024 CDL Cert Status: None None Mailing Address: 607 11TH ST Endorsements: 3L CDL Med Status: None Restrictions; NONE Restriction None Date of Birth: 10/19/1986 Supplement: Mailing City/State: BELLE PLAINS, IA 522081517 Sex: M History Information Convictions Name: Eash, Zachary Dean DL/ID: 644XX2016 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: 1r� IOWA 0 T. Xr li Name: Eash, Zachary Dean DL/ID: 644XX2016 2/18/2016 Office of Driver Services Iowa Department of Transporation CD c= Ci F C:i Office of Driver Services Iowa Department of Transporation CD rFeb.16• 2016„, 12: 52FVol errDiv of Criroina,I lnvestigatloh 4 1-rOIn:Ca ly of lowq Olty Glorlr owpl 319 3Dfi&A07 o it'o 741b,O6F,..4' 6/oar 02/11/2010 1d;12 i Criminal History Record Check Re1i1 e-0 Fortin To: Iowa D(V(Shlh of (,'rinilnal layntigatlnn Support bpel•a(lonn 1lbreorl, l"floor ars C, 'll^ Street Des Moines, Iowa 50319 (51s) 9Es-d066 (519) 77,5-0080 i%x EA:� H 10/1q/1 18u MA ZAt, k(AK,`( /And R,(102/tbe2 D(`I gccunut 1Qusnber: �-hoc �i G_ _ (ifyrplionUlLJ From: City c(erlt's orMa 4101. A'asbhr ton htrebi WNW, CRY] IA 2240 Ylhono; 930.356.5041__ Fax: lllM 4e 11"eknole °-Di5A/V rralvul' lltjulwlariofsr wphoata signed waiver rrenl (heenbject cruet repwt, o eompiceb crhnlanl bistory iacord mxy not be releasablel per Cade urlown, Chapter 693.2, rar co let cl'ilninal history recol-d hirwn.41101j, as n(la,vad by law, always nalala z ran Ler A ... lo.... n.._ n.. —.u__r Waiver RelBose; I Anyrby Ove pennImIdn for roe above rogaefling efdciel lU "16"1 wl lolvn Orllnllml hidary "Cordgarg rvilh U1,DiVl,lan or[/imnlol brrtHignllon (DCI• ally rrhnb'd lugory drle eoncrdlnlg Pit 'hot k nlxlnbined by rhe DCI MAL• helehalrb ar afloned by lxrv, Tfi'aludr Bi rrn4u e; L j) a -L, Vi�r�— As of _ a senrell of the provided 1101ne and date ofbir0i ieve4di 1\rD lows ('fintinal 1-Iis(w'y Record found with I)Cl "" r '• ' 'r:c: luwn CruuinDl bistory Record DnirClted, DCT N � �1�3__. �»-f_ Del Initials, _ 0° DO -77 (08/25/10) -- - — ReceivedTimeFeb, II. 2016 2;5%P�,'y.� V3 « t,201VZhEE ASO 6VE4 11-20-902 feb162016 12:52PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00769133 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/02/16 DCI:00769133 NAME: BASH,ZACHARY DEAN DOB SEX RAC HGT WGT EYE HAIR SKN POE 19061019 M W 511 155 BLU SLN IA ADDITIONAL IDENTIFIERS CCH RECORD a+w 01 ARRESTEb 20060127 G'. AGENCY: IA0790000 POWESHIEK CO SO CHARGE NO- 01 IA STATUTE IA321J-561 n-� DRIVE WHILS BARRED TRK#: 075930801 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 08791 AGIN011995 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 07$930001 SENTENCE DISP EFF PAT SUSPENDED JAIL 8D 20060919 JAIL 10D 20060919 SUSPENDED FINE $500 20060919 UNSUPERVISED lY 20060919 PROBATION AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATXON, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. 10 THE ABSENCE OF FINGERPRINTS FDA 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 No7476 P, 5/6 G'. n-�