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Home My WebLink About16-136I I5 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application 1. Name (REQUIRED) Ke 2. Address (REQUIRED) 2 9 Dy 'LI: 3. Contact Information (REQUIRED) Email: Middle Rd, 4e✓,A S;,AvdZ 1t e written communication 4a. Driver's License expiration date (REQUIRED) S/ if/ /-I b. Taxicab Business Name (REQUIRED) _ Cch .f Tic Last 'J, "— Cell Phone: 319- f911" 711?V sent via email) 5. Prior experience in transportation of passengers: I I yaws d",• `a +,V, :rnwa Cray 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When row1 614 2do2 oat 4'aSSe-is '05 � C;% > 1,?4'% What happened to the charge? (Circle one) Convicted Dismissed eferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? go Type of offense What happened to the charge? (Circle one) Where When 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? NO - Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a When name? If yes, please proyide the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF ROVIEW," 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 certf that I have issued to me by the Iowa Department of Transportati9n a valid Driver's license number MM �Lj99 issued ont ilexpiring on /ff/ 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 f Title 5, Chapt r 2, of he City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date Z f 6 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by KeldtA, 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 or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license_. 6Q%1 -9 0_� Signature of Police Chief or designee I%_2/� 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. Signature of City Clerk or designee Office Use Only /17® �/� Date Approved application t DCI report State certified driving record Website update Clery AXIDRIVBADGEAPPL92014amelded DOC 0712016 ,.�ju 1. 25. 20 16, 10� 42AM,, o,,,D I v of Criminal Investigation 07/19/2010 ljajo01773. 2 r- 2 32100 STATE OF IOWA I � 111 Grin, inal 1-fistory Rel urd Check Request }Form To: low$, Division of Criminal Invesagotlon Support Operations Bureau, I" Floor 21 s E. 711, Street Des Noines, Iowa $0319 (515)725-6066 (515)725.6000 Fax I. all, reauestina an Iowa Criminal History Rear rd Check nn - DCI Account Nfulnber- LfaC7 Z_ (if applicable) From, Citv-of Iowa Cij y M City Cleric's 4lfice 410 E. Washington Street Iowa CIIty, IA 52240 Phone: 319.356-5041_ Fax; 319-356-5497 Last Name 0nat) dAtDry) First Name (mandatory) Middle Nagle [me rnn ended) SA�c 2z jie� Date of t?irth (mandatory) [Yen der (mandemp) � Social Security Number Occununcnded) 6�11�lq�? 4Male QFemale —z 25 Waiper InforP atiom Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Cotte of Iowa, Chapter 692.2, For complete criminal history 1 ecord information, as allowed by law, always obtain a tvalver sl nOram the Orathe subject of the request, Waiver Release: 1 hereby give pcynlissi on for the nbove requesting Date in to Conduct an Iowa criminal history record ehcCh With the Division ofcrinflilM hwesligation (I)CI). Any criminal history data concerning n1n that is maintained by the DO may be r0cosed as allowed by tau•, Ct Iowa Criminal Histary Record Check Results (DO 1.5C 0111)') As of. %�e�� / , a search of The provided name and dale of birth reveakd ut Q No Iowa GimU. Ilistorl Record found with DCI t; L Iowa Criminal His(ory Record attached, ])CI 9 l&o lq 3 u± r�> DClinilials4e-i nrLl�g rnananrn Received Time Jul. 19. 2016 11 07AM No.9820 Ju1.252036 10:420 Div of Criminal investigati0o P. 3 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00604412 NAME: SCHUELTZ,KEVIN EUGENE SCHUETZ,KEVIN SCHUETZ,KEVIN EUGENE DOB SEX RAC HCI 19770611 M W 602 ADDITIONAL IDENTIFIERS DCI 00604412 PAGE 1 OF 2 DATE PRINTED - 2016/07/25 WGT EYE HAIR SKN BOB 230 BRO BRO LOT IA CCH RECORD Wrr 01 ARRESTED 19990023 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA, STATUTE IA124-401-5 POSE CONT SUSS I TRK#{: 046841901 COURT DISPOSITION AGENCY- IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124,401(5) POSSESS SCH I CONTROLLED SUBSTANCE -MARIJUANA COURT CA5E ID: SRCRO52673 CHARGE CLASS; NON CONVICTION TRK#: 046041901 SENTENCE LISP EFF DAT DEFERRED JUDGEMENT 19991201 COURT COSTS 19991201 PROBATION 1Y 19991201 DISCHARGED FROM 20000912 DEFERRED JUDGEMENT 02 ARRESTED 20011016 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321,T-2 OWI TRK#: 100369301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IAS21J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCRO60201 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100369301 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT -. '„ , JAIL 2D 20011124 FINE $1000 2001.1129 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. Ju1,25. 2016 10'!42AM D l v of C r l m i n a I [n v e s t i g a t i o n TN,TVE A68ENCE 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 t c, 0177 F. 4 Page 1 of 2 � 10"NIADOT SMARTER I SIMPLER i CUSTOMER DRIVEN www. iOV adot.gov Office of Driver Services PO Box 92041 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax 515-239-1837 Www .iawadaLgov History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident bate Case Number IUR 03/01/2013 '.728336 IA Name: Schuetz, Kevin Eugene DL/ID: 753MM0999 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,.xt Ankeny, Iowa this date: Certified Abstract of Driving Record Inquiry 7/27/2016 DL/ID #: 753MM0999 (IA) CDL Permit Class: None Date: Office of Driver Services - 1'"0 Customer 5033602 Class: D CDL Permit Issue None #: Date: Name: Schuetz, Kevin Eugene Audit #: 6134497 CDL Permit None Expiration Date: Address: 2904 HEINZ RD Issue Date: 07/13/2012 CDL Permit None Endorsements: Expiration 06/11/2017 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522408122 Mailing 2904 HEINZ RD Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522408122 Status: Date of 6/11/1977 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident bate Case Number IUR 03/01/2013 '.728336 IA Name: Schuetz, Kevin Eugene DL/ID: 753MM0999 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,.xt Ankeny, Iowa this date: e r. p„ih, olo�.ENICIf 7/27/2016 `. ' Office of Driver Services - 1'"0 Iowa Department of Transportation 7/27/2016