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Home My WebLink About16-087IDENTIFICATION NO.- /� ~0197 l 1 (Office Use Only) APPLICATION FOR TAXICAB! MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY 1 (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 (319)356-5040 (319) 356-5497 FAX / Irst MiddleLast 1. Name(REQUIRED) YV1 il) 2. Address (REQUIRED) p� , qC 3 Contact Information (REQUIRED) Email: �r}uvCA7�( yl ��1�{f� e11Phone:a5-3 0-7c7q (All written communication sent via email) 4a. Chauffeurs License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) Ya4x6) 5. Prior experience in transportation of passengers:(}�i > 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 0(->j S7Xt L� , —YY What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended 21�y 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) Convicted Dismissed Deferred Suspended Plead Guilty Other— Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pra'v de'the:7ame(s)-" n Irl - r= 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 herby c rljfy_ that I have issued to me by the Iowa Departm nt of Transportation v id Chauffeur's license number d i 65 issued on ��expiring on (I . I understand that if I falsely answer any questions in this application, that this app icati n 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, an rther agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Tit, Chapter 2, of th ity Code. (Needs to be siged in front of a Notary Public) Signature of Applicant '�J / Date 7Z-6 1,6 STATE OF IOWA ) COUNTYOFJOHNSON ) bscribed and sworn to before me by r l0 rYIQ-kms sc_kc(l ; 6 C9'C (7 this �T'1–day of Notary Public in and for the State of Iowa TUTTLE I have reviewed this application, DCI report, and the State certified driving record of this applicant and have Netdrmined 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 S / l 12,, Y�-. Signature of Police f 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. Signatbre-of City Clerk or designee ate ^J Office Use Only c^ r� Approved application DCI report State certified driving record Website update — Cledd MJDRM6ADGE PPLM14amended.DOC 0312015 C401 4iOWADOT SMARTER E 6€rAPLIF i (USTGM ti t°u � +, c v al ci gov Inquiry 4/21/2016 Date: Customer 2545540 Name: Schoenberger, Roman Tim Address: 2100 S SCOTT BLVD TRLR 40 City/State: IOWA CITY, IA Office of Driver Services. PO Box D204 I Des Mofnes, lA 50306-" 9204 Phone- 515-244-9124 1 SOG-532 1121 1. Fax: 515-239-1837 wwwioswadof:gflv Certified Abstract of Driving Record DL/ID #: 075AA1185 (IA) CDL Permit Class: None Class: D Audit #: 8948857 Issue Date: 03/24/2015 Expiration 05/11/2023 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit 522403032 Mailing 2100 S SCOTT BLVD Address: TRLR 40 Mailing IOWA CITY, IA City/State: 522403032 Date of 5/11/1949 Birth: VAL Sex: M Office of Driver Services. PO Box D204 I Des Mofnes, lA 50306-" 9204 Phone- 515-244-9124 1 SOG-532 1121 1. Fax: 515-239-1837 wwwioswadof:gflv Certified Abstract of Driving Record DL/ID #: 075AA1185 (IA) CDL Permit Class: None Class: D Audit #: 8948857 Issue Date: 03/24/2015 Expiration 05/11/2023 Date: Endorsements: 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: ID Status: VAL Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. A(cident Dare Case Number It1R D9/26/2014 .. 818875 _.._ __... _... -.... IA Sanctions Type Effective End ACD Explanation Occurrence )%JR 3UR Suspended 02/20/2015 03/16/2015 D51 11 Non -Payment of Child Support IA IA Name: Schoenberger, Roman Tim DL/ID: 07SAA1185 Pursuant to Iowa Code g321 10, I, Melissa Spiegel, 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: �O........ Apr 16. 2016 3 : 5 9 P M Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDDMEANOR CONVICTIONS ONLY DCI:00431906 NAME: SCHOENBERGER,ROMAN TIM SCHOENBERGER,TIM DOB SEX RAC HOT WGT EYE HAIR 19490511 M W 601 190 BRO BRO ADDITIONAL IDENTIFIERS SC R THGH CCH RECORD *** 01 ARRESTED 19920105 DCI 00431906 PAGE 1 OF 1 DATE PRINTED - 2016/04/18 SKN POB NY AGENCY: IA0850000 STORY CO SO CHARGE NO- 01 TA STATUTE IA321J-2 OWI TRK#: L41122601 COURT DIOPOSITION AGENCY; IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPLR VER WH TNT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; L41122601 SENTENCE DISP EFF DAT JAIL 2D 19920318 FINE $500 19920318 COURT COSTS 19920318 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 No, 2 10 7 P, 3/3