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Home My WebLink About16-105w •• rrll®�� CITY OF 101VA CITY 410 East Washington 51reet Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (319) 356.5497 FAX (office Use Only) n 1r5 APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be Inade between S a.m. to 3 p.m., Monday - Friday) First Middle 1. Names Last 2. Address - . 6 0 % � {h S 5A s -z 3 Contact Information Email Z7 i4-Sf l t4 Lf)Ma 'a 11-? Cell Phone 3/9 - 3Li yi5y%� (All written communication sent via email) 4a. Chauffeurs License expiration date i /o % J. Taxicab Business Name -- 5. Prior experience in transportation of passengers: __ _I�C> I✓ t IDS �q k - p p 6. Have you ever been arrested / charged with an sdemeanors an /or felonies in this State or elsewhere? ! C } Tvpe of offense ,-_ _ _ =fir /3vffe- C�r_Me 11�When D�i What happened to the charge? g (Circle one) onvicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested arged with any traffic offenses in the last five years': -e S Type of offense -�.-�- --- - --- - fe A here $pet `s)E'�k i When _- - -- uvc r-fy 14 - c'x�tad s ----------- What -—What happerled to the charge? (Circle one) f -44e n CaA}`1 sA Convicted Dismissed Deferred Suspendedead uilty Other S. Has your driver's license or chauffeur's license been suspended or revoked in the cast five years° /yr0 Ty 1e of offense Where r When `J . 9. Have you ever applied to be an Iowa City � taw driver using a different nyes, If es, please rovice the name(s) ne(s) 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 quest). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) i`>- l v, -'v& xa. I hbercertify that I hpve issued to mei y the Iowa Departm t o � Transpc t k, Gh a+rr�;rr's II ease number f_-�20/_ _ sued cn Z l8 expiring or, 1 I unde s+ nd that if I falsely answer any questions in this application, that this application may be denied. I agrees that in Inaning 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 Of is granted, to comply at all times with ail of Y'lie provision of Title F,, Cha��p�te�r ?_, of t_he Cifij Code. (Needs to be sic ned in front of a Nc ta'y Pod�tic) Signature of , fl :a;,t /�?9C Date T ' 191/6 STATE OF IOWA ) COUNTY OF JOHNSON -ftrbscribed and sworn to before me by ; C� j1CLon this - � � day of Q ��^ 'SEI LIE Y. TUTTLE L C rn,.r ".umber 221819 Y .�, 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), J;�93 Expiration date of Chauffeurs license _ I ID it4 ZOZ Signature of Police Ciller nr designee czlgI -- C?oto AFTER APPROVAL BY THE CITY CLERK YOU ARE. AUTHORIZED T'Ct DRIVF, A TAXIL'AR IN 10VVA U Y f-C)lN NC MORE THAN ONEYEAR FROF41 THE DATE LIMED BELOW, `'rerke 3n Office Use Only Approved application DCI report State certified driving record Website update --..... � /[Y /F�-__.__ kr h] C'7 Iowa Deplartment of Transportation t�+�c� of Urr�x-r�cr'snces PO BUY 9204, Des MOinBS, fA 503De 9204 f tcalf I rce) 9W 532 1121 515244 9124 J'AX 515 239 18"1 Certified Abstract of Driving Record Inquiry Date: 2/18/2016 DL/ID #; 644XX2016 (Iq) Customer #: 758423 Name: Eash, Zachary Dean Class: Address: 607 11TH ST D ID Status: None Audit #: 9791353 OL Status: Issue Date: 02/18/2016 VAL Cit State: CDL Status: None y/ BELLE PLAINE, IA Expiration Date: 10/19/2D24 CDL Cert Status: None 522081517 Endorsements: 3L CDL Med Status: None Mailing Address: 607 11TH ST Restrictions: NONE Restriction None Date of Birth: 10/19/1986 Supplement: Mailing BELLE PLAINE, IA Sex: City/State: 522081517 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, hereby certify that I am Iowa Department of Transportation, do 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, this date: at Ankeny, Iowa IOWA D. 0. T. Name: Eash, Zachary Dean DL/ID: 644XX2016 2/18/2016 t c:T t Office of Driver Services Iowa Department of Transporation CD �rFeb.l6. 2016�12:52fUi�,eYlUiv vi Crimio;l Iovesflgaiion r'.rolrv[:Ity of Iowa Cl,y Clmr 1,f Cll lr,m 314 30PC•40i 02/11/2016 10;0 No. 747 U606F: 1002 0 2 /'I'I / 2C 16 16:12 STATE' OF 10W i Criminal History Record Cheek ' �a�adtnc;.et )k�aDrlls To: lPwp Div[sion of Crinilnr'I Lweutlgatlnn Support opeivians nbroau,1" 171001, 715 C. 716 Street Deg M61M, lave 50319 (511) 9z5-16066 (813) 97,5-6090 NY. 11404 P,002/002 1)C9 AaotioI Numbep:,_xo — piyiplionble) From: Ci of,olvact _ City CIOr1i's O11;c0 � "" ""- A10 L. N'ashln .Iowa Cil IA A2�40 hhwla; 319356_$941__ _ lax: 319�3S6�Sd9). A �ateof8lrths�,alnnleojciAlSecD�iwwkitlbe}}rrliedq`mtnhdl~ Q/ ♦i (tl V6p jRJUf Hf(1t1011 h' WIIIIOat a llpled lYalVCI• Iran) titesllbject of file regl lwt, A COlaplct0 Cr)niaal bistory record mgy J10 be b) e, per Code of Iowa, Cbpp(er 691.2 Tor o. OMY)kte Crll1)tpgl bistory 11COW i iD011AIi0u, as allowed by jaw, atwoys OblpinawoiverslAuaturefrom hes•nbCd!L!vi.e u�t, WR1pCp Release: I hereby give pennluianfor19e abavh r4pol1ny ofildel W eonduet r✓l Lorenfllnbwl 114IMroeardnheeb III dm bivbiau ofhimnlal b+v0;SN1lml (DC7), .1ny triml w IdNory dole eoncedlnly me WIT it maln4ined Ey the DCI mybelegated At alland Ly lAw. Wafi,or S•lgn/rfrtl Received Time Feb. 11, 2016 2'�5?ef0V OQ71V& « UIPhIZ1hf£ 1BeD "` 62��1 t6-i?0-9fOZ Ms of`�_, n scON11 oftba provided nOme and date of birth revonfeit D Aro Iowa Crinuutd H,isuny Record found Wi()) [)Cl t IoWn CI•iluinal liislory Record onilel)ed, f)CY I1 DUfuilials W °j - � _ UCl•77(OS/?SILO)-.,��..__.-..—......—_.�-----...._._-_.'------ ---- _ ----- Received Time Feb. 11, 2016 2'�5?ef0V OQ71V& « UIPhIZ1hf£ 1BeD "` 62��1 t6-i?0-9fOZ fsb.16. 2016 12:52PM Div of Criminal Investigation No 7476 P. 5A DCI:00469133 NA61E: EASH,ZACHARY DEAN DOB SEX RAC 19861019 M W ADDITIONAL IDENTIFIERS D1 ARRESTED 20060127 IOWA CRIMINAL HISTORY CHARGE NO- 01 IA STATUTE IA321J-561 DRIVE WHILE BARRED TRK{: 075930801 DCI 00769133 MISDEMEANOR CONVICTIONS ONLY COUNT NO- 01 IA STATUTE; IA32I.561 DRIVING WHILE BARRED HABITUAL OFFENDER . 1978 PAGE 1 OF 1 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 075930801 DATE PRINTED - DISP EFF DAT SUSPENDED JAIL BD 20060919 2016/02/16 HGT WGT EYE HAIR SKN POB 511 155 BLU BLN GUILT, THIS RECORD IA CCH RECORD waw AGENCY: IA0790000 POW28RIEK CO SO CHARGE NO- 01 IA STATUTE IA321J-561 DRIVE WHILE BARRED TRK{: 075930801 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO- 01 IA STATUTE; IA32I.561 DRIVING WHILE BARRED HABITUAL OFFENDER . 1978 COURT CASE ID: 00791 AGIN011995 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 075930801 SENTENCE DISP EFF DAT SUSPENDED JAIL BD 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 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