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Home My WebLink About16-115r t 4 �r �lmQ rh CITY OF IOWA CITY 410 Fast Washington Stree! iD" CnY. Iowa 52210-IE2G (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO-_ (unrce Use Oniy) APPLICATION FOR TAXICAB/ MOTORIZED PEDICAS VEHICLE DRIVER (Police Department review must be made between B a.m. to 3 p.m., Monday - Friday) �U I. Name(REQUIRED) SnFirst 8 Idd11e ; Last �oS !+ 2. Address (REQUIRED) by / r°� �e e"I '^ ej 3. Contact Information (REQUIRED) , c It rc Cel Phone:(Hnptten communication sent via email) 4a- Chauffeur's License expiration date (RLO UyIiR-ED] ci7 <4 5 b. Taeicab Business Name (REQUIRED) 'tr ZI 5. Prior xperience in tra/n'sportati n of passengers: 01ni [q 6 � 9 ��lo BEREK pt� kl •F O dy+0 f'�Esf�lCo4� 03 �- �� — 7 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ^C% c -> Tvoe of nffensa E`tSr � CF C riM: ra, i'e r I P, 6e,j When What happened to the charge? (Circle one) onvicted }Dismissed Deferred Suspended Plead G— Other Have You been arrested / charged with any traffic offenses in the last five years? /f +SL' to r2. 1P Jas%s Where v6r4 What happened to the charge? (Circle one) on"viae Dismissed Deferred Suspended Plead Guilty Other B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?$ SI i S En �rAr Type of offense Where When '16(;CIoq l Coe igIc c5 ri For 11 9 Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro c� r ''I O vtd$ciNe rA0ne(s)fi DEPARTMENT OF CRIMINALINVESTIGATION (DCI) REPORT AND STATE C fix DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVM You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07J2015 APPLICAI ION FOR TAXICAB VEHICLE DRIVER Pagc 2 f hereby cedlj-y that I have issued to irie by the Iowa Depprhnent of Transportation valid Chauffeurs license number issued on n fo?r'27/l' expiring on ?S�n'(at• t I understand that if I consent to allow agents or employees of the City of Iowa City, falsely answer any questions in this applicakion documents relating to this application, and I further agree that, if , that this application rnnay be denied. I agree that in making this applicafion, I Iowa, in their discretion, to examine any and all records and authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter2, of the City Code {Needs to be signed in front of a Notary Public) Signature of Applicant_, ' Date lr / r,' 20/i sTATE OF IOWA ) COUNTYOFJOHNSON Subscribed and sworn to before me by 's a n,,,, c \ S Znr o this l S -f" on Cmc day o1 in and for thz State ot?rnva #A#!R+#%iT44}*#kit;*4%kk#*i.k#*N#*k}#k*k#kAA*Skk}y#*ki#%k*k*kk*}tk##k}*k}}kkk+k*444#4***a�*kxk#k*}}**M*Hx>xk#sykk##*4tRkxS Ai}y413ii*}tk##*4M1y#k 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 CiIowa �C,iq�(Title 5, Chapter 2, Cit Code). of/ /eur's license or designee Date AK— AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY F MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. OR NO S 9akkof City Clarkofof designee— Date esignee Dato CIe0Y MDRN I)GGPPDSYf4a 1e d. DOC 03/2015 fes) G Office Use Only c j „cam o Approved application DCI reports-, co C State certified driving record <r u 3 Website update a" o CIe0Y MDRN I)GGPPDSYf4a 1e d. DOC 03/2015 a Inquiry Date: Customer #: Name: DOT SMARTER I SH:PCEF? 1 CUSTOWIFf DRIVT` y wilt v.EQVUc'3d0'C gov Ovice of Driver services PO box 9204 , Des Midi IA 50306-9204 Phone: 515,244-91241800-527.-0121 j Fax: 51 5233-153 7 wwr;. iawado:_gav Certified Abstract of Driving Record 10/1/2015 DL/ID #: 332AE1495 (]A) CDL Permit Class: None 1925346 Class: D Kenner, Samuel Joseph Audit #: 9189893 Address: 308 E BURLINGTON ST Issue Date: 06/23/2015 APT 106 City/State: IOWA CITY, IA 52240 Mailing 308 E BURLINGTON ST Address: APT 106 Mailing IOWA CITY, IA 52240 City/State: None Date of 5/3/1973 Birth: None Sex: M Convictions Expiration 05/03/2022 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation LDL Permit None Endorsements: @/28/2012 CDL Permit None Restrictions: 31 ]UE: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: Fall to Yield to Lmergency Vehicle CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation Erplar iion Occurrence JUR'. 12/12/2011 @/28/2012 _M14 _ Fail to Obey Traffic Sign/Signal County Johnson 31 ]UE: 10/0512012 02/13/2013 M14 Fail to Obey Traffic Sig n/Signal Johnson IA IA 10/25/2012 12/04/2012 N04 Fall to Yield to Lmergency Vehicle Johnson IA 01/25/2015 04/09/2015 M14 Fall to Obey Traffic Sign/Signal Johnson IA Sanctions Type Eilective End ACD Erplar iion Occurrence JUR'. lull Suspended 03/30/2013 _ '06/27/2013 W01 Habitual Violator IA - 'IA Suspended 01/02/2014 _ 01/22/2014 863 Fall to Refile SR22 IA IA Suspended 09/16/2014 .11/24/2014 863 Fail to Refile SR22 IA ]A Name: Kenner, Samuel Joseph DL/ID: 322AL1495 Pursuant to Iowa Code §321.10, 1, 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 1 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, low, this date: 2 Fr�EP, 23, 201h 11:49AM of CK milldl kvV sS i'ahuil �t,, 6122 "J' Cl arDiv K �,,aao ,„=,�enmi GH/2t/2Gts t6 .6/ e27c n+. uG2/Ga2 To: lutsa D(ylstmr ufCritninal )uvestlgarian Support Qperatiou, Korean, I,, Floor 215 $. 7" 5treec Acs "Ohtes, Iowa 50319 (5IS) 725.6066 (515)725-6080 Pax I am re uealin alllOwa Crifltinal ] Pf Birth(,naadelmy) 5 bq On: ra�lie� DCI Account Nuntbrr Li oo .'t` Flo— CILY Of faq'a y City Clerlos Oflfee kI_ E_Washiugtou $treeC 101" City, IA 52240 Pholic 319-356.9041 Fax: 319,356.5497 mlwrale Oremaie r. nsrer,anfOrrytrrfr0lt: Without a sigacd tvaivar frOm tie subject of Phe rtOW, a complete criminal history be releasable, per Code oflotYq, Chapter 692.2. Por col obtaingwairersi natcrllniosl IWO, )'record ihfufrnai eb, 9r eloncd by )a e, allvaysl uretromtbesubectOlthere nest. GY4lt+HP (m)), 81AcrcbyginepermissionfortheeboVcrek�estinaOf Cialloamduejm10�wvipune hitmryrecordcA< :rviththeDirisanofCrirninai lnvesGgnliwt (DCII. My uimbtaihist0q darecon�n> me Ihhl Is s n Itlt by lAe Acl may be rcleasod ay ahowod bylaw, WrrfverSi,9"Mre: Toga CI'minal JF�istor Record Check Results As of c% ' $ / a search of the provided name and dale of birth revealed b No Iowa Cfi,ninal His(O y Record found with bCI Iowa (.1'i11711i3I f-jistory record attached, DCI # DCI initials' DC1.77 (08125/10) Received Tine Seo. 91, 7015 9:51PM No,6499 r- =1 use only) F_ �aU•23iM 11:49AM Div of Cr minal Investigation IOWA CRIMINAL M39TORY MISDEMEANOR CONVICTIONS ONLY DCI:00451531 WANE: RSNNEN,SAMVEL JOE K9NNSN,SAMUEL JOSEPR K91WON,SANUEL JOSEPH DOB SEX RAC HGT 19730503 M W 603 DCI 00451531 PAGE 1 OF 3 DATE PRINTED - 2015/09/2n WGT EYE HAIR SYN PDH 29D GRN DRO FAR TN ADDITIONAL IDENTIFIERS PHOTO AVAILA&LE: Y CCH RECORD ■i+ Cl ARRESTED 19921210 AGENCY: IACS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 ONI TRK#: L43115001 COURT DISPOSITION AGENCY; IAOS2O15J JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE: IA321J,2 OPER VEN NE TNT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L431ISS01 RESTITUTION SENTENCE JAIL 48H FINE $500 02 ARRESTED 19950326 AGENCY: IA0$20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA323A-32 DRIVING UNDER SUSPEND TRK#: 014624201 COURT DISPOSITION AGENCY: IA05201.5J JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE; IA321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 014624201 SENTENCE FINE $250 03 ARRESTED 19950406 AGENCY! IAO520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321A-32 DATVE UNDER SUSPENSION TRK#• 014626201 COURT DISPOSITION AGENCY: IA052015J JOHNSON 00 DIST COURT COUNT NO- 01 IA STATUTE: IA321A-32 DRIVING, UNDER SV$p9NSION CHARGE CLASS: MISDRMEANOR CONVICTION DISP EFF DAT 19930910 19930910 DISP EFF DAT 1995059.9 No. 6722 P, 2/9 3Eg.23. 2015 11:49AM U v of Criminal lnvcsliga:ion TRK#: 014626201 SENTENCE FINE $300 04 ARREDTED 19950524 DCI 00451537. PAGE 2 OF DISP EFF DAT 19950519 AGENCY: IA0160000 CEDAR CO 50 CHARGE NO- 91 IA STATUTE IA321A-32 DRIVING WHXLB LICENSE SUSPENDED TRK#: 012726701 COURT DISFOSITXON AGENCY; IA016015J CEDAR CO DIST COURT COUNT NO- DI IA STATUTE; IA321A-32 DRIVING WHILE LICENSE SUSPENDED CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: 012726701 SENTENCE DISP EFF DAT PLEAD GUILTY 19950811 FINS $350 19950811 05 ARRESTED 19960417 AGENCY: !AC5202DO IOWA CITY PD CHARGE NO- 01 IA STATLrm IA124-401(3) POSSESSION/SCHEDULE I/MARIJUANA TRK#: 024159501 CHARGE NO- 02 IA STATUTE IA121-2 SALE OF FIREWORKS TRK#: D24159502 COURT DISPO91TION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3-2 POSSESSION /CONTROLLED. SUBSTANCE/SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159501 SENTENCE DISP EFF DAT FINE $300 19960906 COURT DISPOSITION AGENCY: TA052015J JOHNSON 00 DIST COURT COUNT NO- 02 IA STATUTE: IA727-2 HALE OP FIRENDRKS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159502 SENTENC E FISP EFF DAT F IIdE $250 19960906 Ro.6722 P. 329 S?G.2;. 2011 11:49AM Div of (rirnina' lnvea'[igation DCI OC451531 PAGE 3 OF 3 No. 6722 F 4/9 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAXNED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATIGN, BUREAU OF IDENTIPTCATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORC£MBNT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORA IS BASED ON INFORMATION FURNI$HND. WE CANNOT CONFIRM OR DENY TSAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION rmi