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Home My WebLink About16-106IDENTIFICATION NO. / U,lbo l 1 (Office Use Only) III X APPLICATION FOR TAXICAB l MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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 (3 19) 356-5040 (319) 356-5497 FAX Middle y /� 1. Name (REQUIRED) / y l (1 \A[Qym p V , 2. Address (REQUIRED) L 10 LodRd sit/ r [ 3. Contact Information (REQUIRED) Email: MOQ C CqbZ E5fiWf(64Tr Cell Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 1 Zho-f zj b. Taxicab Business Name (REQUIRED) MoCcs n_ f 5. Prior experience in transportation of passengers: DC7 h (—Ver "!� r- 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense When 5-05 O O What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? r 6 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilt Other /t / 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? J V O/ Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the-name(s)- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW n You must apply for an individual Department of Criminal Investigation Report (form available upora request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I heregy certify that I have issued to me by the Iowa De rtme of Transportatio, vat Chauffeur's license number O ( S 2) �Q issued on z expiring on 7 L 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 fyont of a Notary Public) Signature of Applicant Date 6 c y) ' � STATE OF IOWA ) COUNTY OF JOHNSON ) (Subscri d and sw rn to before me by } to s`�' a A1AY SWENKA sa S r..vmnission Plumber 78(1095 on this ;;� day of 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license! 4 o6•aL. �o�f. Signature of Pohle Chief 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. Signatu> -Clerk or designee _f Date i� ......ate Office Use Only Approved application r, - DCI report State certified driving record Website update QerP AXIDRIVUADGE PPL92CI4xmended.DOG 03/2015 010WADOT SMARTER 1 SIMPLER i CUSTOMER DRIVEN VUV4t�L'.iCiVt+ {�Ci� i t3V Inquiry Date: 3/9/2016 Customer #: 678915 Name: Vonstein, Mark Wayne Address: 139 HOLIDAY LODGE RD City/State: NORTH LIBERTY, IA Convictions Office of Ottver Services PO Box 9204 i Des Momes, lA 50306-9284 Phone. 515-2449124 1800-532-1121 I Eau: 515-239-1837 www..iowadottlov Certified Abstract of Driving Record DL/ID #: 523179518 Mailing 139 HOLIDAY LODGE RD Address: D Mailing NORTH LIBERTY, IA City/State: 523179518 Date of Birth: 12/7/1972 Sex: M Convictions Office of Ottver Services PO Box 9204 i Des Momes, lA 50306-9284 Phone. 515-2449124 1800-532-1121 I Eau: 515-239-1837 www..iowadottlov Certified Abstract of Driving Record DL/ID #: 013BB2180 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Date: Audit #: 9596504 CDL Permit None Expiration Date: Issue Date: 11/24/2015 CDL Permit None Endorsements: Expiration Date: 12/07/2023 CDL Permit None Restrictions: Endorsements: 3 ID Status: None Restrictions: Corrective Lenses DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation _ County 3UR 08/19/2012 09/18/2012 S92... "Seed .. ... P Iohnson IA Name: Vonstein, Mark Wayne DL/ID: 013BB2180 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: Name: Vonstein, Mark Wayne DL/ID: 013882180 3/9/2016 Office of Driver Services Iowa Department of Transportation e0 leo. b. lulb 1U WIM Uib of Uetminal Investigation ` Fwn..�...y w �uwn any Cl ark vmoo Cf,b SOE0a61f No. 6649 P. 3/5 a 21oa�$07Q '13rZ7 0809 V_004 000 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 0 Floor 2115 L 71a Street Des Moines, Iowa 50319 (515) 725-MG6 (515) 725-6080 Fax I am reouestine an Iowa Criminal Monty Rarnrd m -k nn- DCl Account Number. (�- Cl a a, ` t zz ( (Iro p Nimble) L Frons: Phone.- Pax., hone:P'ax. Last Name ) First (m ) Mid�dlleeNamepcstatwnded) v t �Name Mor VV � Date of$l!i��rth (m+adewD.Y) Gender (mu,datmy) social swurity Number (axaamudeil) I I V 711q 772—t Cale OFt male �O — 3 —( ? Waiver 1"forowlion: without a signed waWer from the subject of the request, a eamplete criminal history record may not be releasable, per Code of Iowa, Chapter692.ZFor commlete criminal history record information, as allowed by law, always obtain a waiver si ature from the sob'eel of the nNuest Waiver Release, I tImeby give pe mbsian far alta aboverequectivg o1Pchl to caudad= lum mimival bbury record d ceb web the bivls;oa 01011ninal ldvestiearian (DC0. AnYaW rel hulwy dale emcerningme Ihat is maimaiaed by the DCI may 6a Kicased m allowed bylaw. R Waiver Signefnre: Iowa Criminal History Record Creech Results As of esZ LT (o a search of the provided name and date of birth rev41e4: cr;.., No Iowa Criminal ffistory Record found with DCJ c� c. i� Iowa CrimiQal History Record attached, DCI # (0 d gg .. DCI ; (v0r5li0) Received Time Feb. 4. 2016 12,15PM No -6640 � dt3Cl utcoaly) C7 .v.� n1b 1V:44M Vin uF GTlminai lnvesiigaiian IOWA CRIMINAL HISTORY Dcl 00609615 FBLONY CONVICTION PAGE 1 O>: 2 DATE PRINTED - 2016/02/00 DCI:00609815 NAME: VONSTOMMARK DOH SER RAC HGT WGT EYE NAIR SK" POS 19721.207 M W $06 210 ERO BRO PAR IA ADDITIONAL IDENTIFIERS SC L LEG CCH RECORD ■** 01 AR'RESTSD 19991110 MENOY: IA0520100 CDRALVILLE PD CHARGE NO- 01 IA STATUTE TA908-4 WILLFUL INOWY TRH#: 035757901 CHARGE NO- 02 IA STATUTE IA700.2(3)-2 ASSAULT - U991331SPLAY OF WHAPON TRK#: 035757902 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.4(2) WILLFUL INJURY - CAUSING BODILY INJURY CHARGE CLASS.- FELONY CONVICTION TRH#: 035757901 RESTITUTION SENTENCE DISP EFF DAT RESIDENTIAL FACILITY 365D 20001222 FINE $750 20001222 SUSPENDED PRISON SY 20001222 PROBATION 3Y 20001222 PRISON SY 20001222 COURT DISPOSITION AGENCY- IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE; IA700.2(3)-2 ASSAULT /USS/DISPLAY OF A WEAPON -1909 COURT CASE ID; 06521 PECRO53425 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 035757902 SENTENCE DISP EFF DAT FINE $500 20001222 SUSPENDED PRISON 2Y 20001222 PROBATION 2Y 20001222 PRISON 2Y 20601222 PROBATION EXTENDED TO 12/22/03 20021222 AN ARRPST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT. THIS RECORD KhTNTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES 15Y 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 NQ. 5649 F. V>