HomeMy WebLinkAbout16-036� r 1
CITY OF IOWA CITY
410 East Washington Slrcct
Iowa City, Iowa 52240.1826
(3 19) 356-5040
(319) 356-5497 FAX
IDENTIFICATION NO. -1 1 - C,� I ip
(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)
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Middle
1. Name(REC)UIRED) -
2. Address (IRF.:0lJIRI::::D) S9 -SS Loa
Last
3. Contact Information (REQLJff,,1 D) Email: f ori e—jess;Ckt) llowa.edu Cell Phone:(319)325- Sbg2
(All written communication sent via email)
4a. Chauffeur's License expiration date ([:1EQUI('Iliia::)) Z H /'ZO 2Z
b. Taxicab Business Name (REQUIRED) _ j3,'9 10 1I a zi rrII
5. Prior experience in transportation of passengers: ^709-2dItJ: riVC Ars Taxi, Cab ancf
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Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? : , f-�`
Type of offense
Where
e1 When
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What happened to the charge? (Circle one)
Convicted DismissedDeferred Suspended Plead Guilty Other
Have you been arrested / charged with any traffic offenses in the last five years? Ye 5 -
Type
Type of offense Where When
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What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
S. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? W>
Type of offense
Where
When
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide;thername(9 "
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE,CERTIF'D V .p
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF Ri
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
171314X3 3-,) issued on �/2a/zai1expiring on y/z4/Zo2-2-. 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 ` -y �. - Date -z I Z 2 /
STATE OF IOWA )
COUNTY OF JOHNSON )
S bs yd and sworn to before me by -T-1..a, r. 11 - -5255 e on this Z `2_. day of
1---�IYribe�.�C, (-4 7-61 LA
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 ate of hauff is li ense V
T12
Signature ofpolice Chi e or designee
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.
) 9`C - 4a'G
Signa of City Clerk or designee
Approved application
DCI report
State certified driving record
Website update
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Office Use Only,
CleikRAXIDRNBADG6 PPL92014amended.DOC 0312015
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CleikRAXIDRNBADG6 PPL92014amended.DOC 0312015
he9. 2016 12:02PM Div of Criminal Investigation No, 7994 P. 1,12
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STATE OF IOWA
a Crfilllln3l HistarY Record Greek
Request Form
'rw Iowa Ulvlslan 0Crindn8l h,vestigation
Support Operations Bureau, 1" Floor
215 P. T" street
Des Moines, Iowa 50319
(515)725-6066
(51.5) 725-6000 Fax
DCIAccountNnmber_ oioo ? -v-:_
` (if applicable)
Frum: Citr�oflowacity
City Cferlc'x OFt7co
410 L. LVashhfgton freer
Yowa City, YA 52240
phone: 319-356.5041_
Fax. 319.356-5497
Last Name (inwdainy)
First Name (nlaadalory) llliddle Name (recommc,ided)
255Q
Tkc, K-aQ g Dean
Date, of Birth(manda,o y)
Gender (n,anaato y) Social Securii� Number (reeommCaaea)
4 5 �zY 1198�i
®Male LIFemale
Wietiver Informatfore Without a signed wailer from the subject orlhe request, a Complete criminal history record nlay not
be releasable, per Cade of Iowa, Chapter 692,2. For coweletQ criminal history record information, as allmred b3,", laI ,a ,s
obtain a waiver signature from the subleet of dhe request
Willl yal' Xte(ea$e: i hereby give permission For the abare requesting official io condacl an lova criminal I,islorynawrd check wish nn Division oferitninal
hrvesltgation (DCI). any criminal history data eoneerning me ma l is meinlained by the DC[maybe released as allowed by law.
Power Signature: k
As of el search of the provided name and data of birth revealed:
El 1\'O Iowa Criminal History Record found with DC]
Iowa -Criminal History Record attached, DCI bR i O ( cp
DCl initials_
DCI -77 (09/25/10)
Received Time Feb. 17, 2016 10:270 No.7751
_
(ULaF�use ony)
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Ea 19. 2016 12:03PM D l v of Criminal Investigation No.7994 F. 2/2
IOWA CRIMINAL HISTORY DCT 00691016
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED -
2016/02/19
DCI:00691016
NAME: JESSE,THOMAS DEAN
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19640524 M W 511 150 BLU ERO FAR IA
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
CCH RECORD +**
01 ARRESTED 20030130
AGENCY: IA0520400 IOWA CITY UNIV SEC PD
CHARGE NO- 01 IA STATUTE IA124-401(5)
POSSESSION OF CONTROLLED SUBSTANCE
TRK#: 100779301
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE: IA124.401(5)
POSSESSION OF A CONTROLLED SUBSTANCE
COURT CASE ID: 06521 SRCR064550
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 100776301
LICENSE REVOKED
SENTENCE DISP EFF DAT
JAIL 2D 20030711
.. ..
FINE $250 20020711
02 ARRESTED 20130612
AGENCY: IA0520500 NORTH LIBERTY PD
CHARGE NO- 01 IA STATUTE IA706.2A(2)(A)
DOMESTIC ABUSE ASSAULT
TRK#: IA00GX701
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE: IA706.2Al2)(A)
DOMESTIC ABUSE ASSAULT
COURT CASE ID: 06521 SMSM094654
a
TRK#: IA000X701
c"
SENTENCE DISP EFF DAT
DEFERRED JUDGEMENT CIVIL PENALTY $100 20130724'
w
PROBATION 6M 20130724_
COMMUNITY SERVICE 25H 20130724
W/I 90 DAYS--"
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I$
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY,
DIVISION OF CRIMINAL INVESTIGATION
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Office of Driver Services
PO Box 9204 ?Iles Moines, Irl 50 306-9 204
Phcxee: '615-244-9124 1 8GG-532-1121 1 Fax 535-239-1337
www•.iowadol.gov
Certified Abstract of Driving Record
Inquiry Date:
2/11/2016
DL/ID #: 713XX3332 (IA)
CDL Permit Class:
None
Customer #:
1404129
Class: D
CDL Permit Issue
None
r°11
Date:
Name:
Jesse, Thomas Dean
Audit #: 8208775
CDL Permit
None
Expiration Date:
"O
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Address:
3835 LOCUST RIDGE RD
Issue Date: 06/27/2014
CDL Permit
None
Endorsements:
Expiration Date: 05/24/2022
CDL Permit
None
Restrictions:
City/State:
NORTH LIBERTY, IA
Endorsements: 3
ID Status:
None
523179518
Mailing
3835 LOCUST RIDGE RD
Restrictions: Corrective Lenses
DL Status:
VAL
Address:
Restriction None
CDL Status:
None
Mailing
NORTH LIBERTY, IA
Supplement:
COL Permit Status:
ELG
City/State:
523179518
Date of Birth:
5/24/1984
CDL Cert Status:
None
Sex:
M
CDL Med Status:
None
History Information
Convictions
Citation Date
Conviction Date
ACD Explanation
�.
Count JulR
12/08/2010
02/23/2011
.592 :Speed (10 mph & under in 35-55 mph zone)
Johnson dA
11/29/2014
01/12/2015
:S92 '.Speed
Johnson IA
11/29/2014
04/10/2015
-592 Speed
- -MO
Name: Jesse, Thomas Dean DL/ID: 713XX3332
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:
2/11/2016
®10;
r°11
,+'tIC
®F
OffServices
BRIYER
Iowa Department tofTransportation
Name: Jesse, Thomas Dean DL/ID: 713XX3332
"O
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