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Home My WebLink About16-135IDENTIFICATION NO. p 1 r 1 (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF I OWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East Washington Slree( Iowa Ciq. lowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) r1ri+L &^ , Pgl r I �1 . Las{ �- �y 2. Address (REQUIRED) 4 U 1 v L p{ f`( '— C, C P, , a�A 5Say h 3. Contact Information (REQUIRED) Email:�a.Y., Ictu-$ „ J a.c l I' r-pChell"iP' cne:3 11 /3 3 ( -- (All writt'enI communication sent via email) -734/ 4a. Driver's License expiration date (REQUIRED)/1 D) ( f Z b. Taxicab Business Name (REQUIRED) l ,f t �( C,0 -ii 6 5. Prior experience in transportation of passengers: �e I l o --PJ l t t.� k° -�+-v r S 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? y it [7 Type of offense Where When V r l y ( U-Cu'o— n5 S• S nA— l { ^�y i 1 a o u S< CSO 0.r 1�C�Ma'eQ S �1 U l What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead, Guilty Other --ter-- Have you been arrested / charged with any traffic offenses in the last five years? N(7 Type of offense What happened to the charge? (Circle one) Where When 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? 0 Type of offense Where Men - r.) 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide th@ ijame(s) j 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certifythat I have issued to me b the Iowa D ment of Trans ortati a valid Driver's license number & `% `j 'V 2, issued on 7/5/ /6 expiring on �3 -- . 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 sof Title 5, Chapter , of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant l/l'--' Date �1 % 6 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by pt�ot - K. L a_T50 ✓, on this day of /S .1, . 2b/In 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 gf tbZna City (Title 5, Chapter 2, City Code). Expiration ddte o ri er' license / I " I /, Q U �z�Ill Signature f P e Chief or designee Dater ' 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 ure of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Cl o-✓ IDRIVMD(3 APPL92014e,neoded.Doc 07/2016 C410WADOT vurrvw.iowadotov SMARTER I SIMPLER I CUSTOMER DRIVER ----..,_ Office of Driver Services PO Box 9204 i Des Moines, tA. 50306-9204 Phone: 515-244-9124 1800-532-11211 Fax_ 515-239-1837 www.iowadol-gov History Information CLEAR DRIVING RECORD Name: Larson, Alan Keith DL/ID: 431XX7942 Pursuant to Iowa Code 5321.10, 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: Certified Abstract of Driving Record Inquiry 7/5/2016 DL/ID #: 431XX7942 (IA) CDL Permit Class: None Date: j i��W" :AIY�=a�� Office of Driver eof Services Iowa Department Transportation Customer 900797 Class: D CDL Permit Issue None #. Date: Name: Larson, Alan Keith Audit #: 8839758 CDL Permit None Expiration Date: Address: 1540 PLUM ST Issue Date: OZ/12/2015 CDL Permit None Endorsements: Expiration 07/13/2016 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522402124 Mailing 1540 PLUM ST Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522402124 Status: Date of 7/13/1954 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Larson, Alan Keith DL/ID: 431XX7942 Pursuant to Iowa Code 5321.10, 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: Q.• 4�r 3� % 7/5/2016 ' IOWA:m,O 0. T. j i��W" :AIY�=a�� Office of Driver eof Services Iowa Department Transportation Name: Larson, Alan Keith DL/ID: 431XX7942 , r,Ju', 7, 2016, WOPM,,ar,6iv of Criminal I n v e s t I g a t l 0 n 07,0512Gie 112No.7819656P. 5/6„oO2 STATE OF IOWA 11 Criminal History Record Check Request Form � DCI Accoum Number: yop�- '” (i] app ieablc) To: Iowa Division of Criminal Investigation Frons, GiY of Iowa City S'apport Operations ilaIto U, I" Floor City Cleric's Office 215 E. 1"' Street -410t. Washington Street_ I)es Mofiles, Iowa 50319 � (615) 725-6080 Fax — -- - Phone: 319-356-5041 Pax: 319-336-5497 I am renuestine an Iowa Criminal History Record Check on: Last R'ame 0„andalory) First Name (nandalony) )q L/4 N1 Middle Nawe (rewmn,a,ded) r� LO Bate of Birth(mandatory) Gender(.nandalory) ecuritjr N uefher(recommended) 7 I 1 g ale ®Female 79 " 7 2-� G/ 0 R'latper Diforntratlofl: Without signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.x, For coo late criminal history record htformation, as aiiowed by larv, always obtaha a waiver si nature from the sub act of the request. ercby give permisal history record check with the Division of Criminal Investigation (DC). Any criminal history 0419 COMM"nm Thal is maimained by the DC`1 m be released as alloerod by law, I%aaiperSigfrnlure:—Gw �� Iowa Criminal History Record Check Results r�(ocluse Only) As of _��% a search of the provided name and date of Milli revealed:: F. Gl Q 1\'o Iowa Criminal I-Tistoh}, Record found with DCI Iowa Criminal History Recoad attached, DCI #67(p -7 o DCI itriiials_--__ Received Time Jul. 5. 2016 11,201V, No 7574 ,Ju',. 1 ` 2016 4,10PM DOI:00567329 NAME; LARSON,ALAN KEITH DOB SEX RAC 19540713 M W ADDITIONAL IDENTIFIERS SC FHD 01 ARRESTED 19990111 Div c1 Criminal I n v e s t l g a t i 0 n IOWA CRIMINAL HISTORY DCI 00567329 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/07/09 HGT WGT EYE HAIR SKIN POB 601 200 BLU SRO FAR IA CCH RECORD *" IVO 1017 I U/U AGENCY; IA0650100 AMES PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE TRKO: 032094601 COURT DISPOSITION AGENCY; IA005015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE; IA124-401(5) POSSESS CONTROLLED SUBSTANCE CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 032094601 SENTENCE DISP EFF DAT £INE $250 19960331 COURT COSTS 19980331 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 DCS. 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