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Home My WebLink About16-092CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. I((2 2, (Office Use Only) i .. APPLICATI011 TAXICAB ! MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must 4e ode between 8 a.m. to 3 p.m., Monday - Friday) First 2. Address (REQUIRED) t / / o$ SSC, 3. Contact Information (REQUIRED) Erri Mt (All writte .60W) Cell Phone: 01�( -5 30 IR imunica ion sent via email) 4a. Chauffeur's License expiration date (REQUIRED) _yyy AA�,`(I O O/Ot �2— � P b. Taxicab Business Name (REQUIRED) t L(—rq.) C— A 6 of j y�, N CtT14 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 What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? /"rrb Type of offense Co, What happened to the charge? (Circle one) When Other When 9- z8 - 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? fjo Type 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 names) f 0 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 h ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number issued on !L�.2 -/4 expiring on ,r S- Z 2 . understand that if I false) answer an �� ig y y questions in this application, that this application may be deni�d`ul jac�P;ee-haat tr1�m�Ring-chis 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 driveris granted, to comply at all times with all of the provisionsfif Title 5, Chapter 2, of the City Code. (Needs to be signed, innff;gnt of a Notary Public) Signature of Applicant G Date STATE OF IOWA ) COUNTY OF JOHNSON ) subscribed and sworn to before me by on this '4 713�n iblic in and for the State of Iowa day of I have reviewed this application, CCI 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).. M ExpiraJdaf hau eur's license r Signatur , 9f Police ChA4 or designee D to 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. Signa u�erk or designee Office Use Only Approved application DCI report State certified driving record Website update Dae / cien< MlDRivenoc�PPL92maa�,e„ded.00c 03/2015 /' Iowa Department of Tra.nuspprtation !' rice d Urnref 8etxicea 0011 40e) KG 532-1121 PQ Box 9244, Des Wines, IA 5D3D6 9204 515-244-9124 ?I a i' _y FJt3rh�a1rr33S/ 1831 R 4.. Certified Abstract of Driving Record,: Inquiry Date: 4/29/2016 DL/ID #: Name: Mullink, Anthony Class: 8036622 Arnold VAL Address: 477 5 SCOTT BLVD Audit #: 05/05/2022 CDL Cert Status: Issue Date: City/State: IOWA CITY, IA Expiration Date: N 522455527 Not Certified NONE Restriction Endorsements: Mailing Address: PO BOX 1223 Restrictions: 5/5/1964 Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522441223 CDL Medical Examiner's Certificate 959AA6410 (IA) Customer #: 2792098 A ID Status: None 8036622 DL Status: VAL 05/02/2014 CDL Status: ELG 05/05/2022 CDL Cert Status: Non -Excepted 319 369-8153 Medical Examiner Type Interstate N CDL Med Status: Not Certified NONE Restriction None Supplement: 5/5/1964 M Certificate Specifics Explanations Medical Examiner First Name Shirley Medical Examiner Middle Name Jane Medical Examiner Last Name POS isil Medical Examiner License Number 29216 Medical Examiner National Registry Number 1542608480 Medical Examiner Jurisdiction IA Medical Examiner Phone 319 369-8153 Medical Examiner Type _ Medical Doctor Medical Certificate Issued Date 06/03/2014 Medical Certificate Expiration Date 06/03/2015 Date Added to CDLIS Driving Record 06/12/2014 CDL Downgrades Type I Effective End ACD Issuing JUR Downgrade 08/02/2015 1 IA History Information Convictions citation Date Conviction Date ACD Ex lanation Count JURt.-�' 06/17/2011 06/28/2011 592 Speed (10 mph & Muscatine IA- under in 35-55 mph zone V• 09/02/2015 09/28/2015 592 Speed (10 mph & Johnson IA `°` under in 35-55 mph t `; zone Name: Mullink, Anthony Arnold DL/ID: 959AA6410 Pursuant to Iowa Code §321.10, 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. 4/29/2016 OWA D. 0. T...: 9* Office of Driver Services Iowa Department of Transporation Name: Mullink, Anthony Arnold DL/ID: 959AA6410 04May._2. 20161�12 18PMr �anDiv of�Crirninal Investigation No, 329 (FAX)3193382,va STATE OF IOWAi'I lteila/ � 1� Request a Toa Iowa Division of Criminal investigation Support Operations Bureau, I" Floor 2I5 Pl.7" Street Des M61hes, Iowa 50319 (515) 725.0066 (515)725-6090 Sox I am requesting an Iowa Criminal HistorvReaord Check on: P. 2 V.002"002 DCI A000unt Number: —9967-F arappllcabia) From: 'Yellow Cab of Iowa City P.O. Boz 428 Iowa City, Lk. 52244 (319) 338.9777 Phone; Foxt (319) 339-7302 Last Name mande() Firat blame (mandato Middle Name (reaemmrnded) u�GrN �o reN aL.� Date of Birth (mandatary) Gondarm.ndelo 'So0ol•L5eeuri Numbbox (rcaommended QS r- (r. (Alale oFemale 4— q� L7 WaNg It( formation: without a signed waiver from the subject of the regpest, a completo griminal history record may not be release bit, per Code of Iowe, Chapter 692,2. For comRIcto criminal hlstory•r000rll Informatlon, as allowed by law, always Waiver Release: t hereby give Delrsllalon for the abave rogaesdag omo(el to oonduel an Iowa criminal hhlorymcog�aah6ck W11h the D(vldeb of Criminal Invullsallon(DCO. My criminal history data ooncemin�/methatlemalnt►Inedbyythh;p//p_ May polalemedae-allowellb)VW. ASH 1/ �JA /// / / _ r Waiver ;town Urlminai rilstory aecoro c;necx Kesu;ts '1:j As of a search of the provided name and date of birih revs h9d: cs No Iowa Criminal History Record found with DCI El Iowa Criminal history Record attached, DCI # DCI initials DC147 (08125/10) Received Time Apr. A 2016 3:08PM No. 3494 (DCI uea only)