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Home My WebLink About16-1491 � 1 AMP -no fluff cccccril CITY OF IOWA CITY 410 EasI Wash nbton Street Iowa City, Iowa 5 2240-1 82 6 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 1 �— 1 q r (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 First �. / Middle Last 2. Address (REQUIRED) 22 1r-5, �' , SZ. !3 u0 ' II61 Iw 3. Contact Information (REQUIRED) Email: r �Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 0 �P . ,Z -5- , 2- b. b. Taxicab Business Name (REQUIRED) ye, Lt 5. Prior experience in transportation of passengers: fi 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense e / What happened to the charge? (Circle one) Where 51 u t x C_, 7 When /,;� 4C= Convicted Dismissed Deferred Suspended ead Gu,, Othet' 7. Have you been arrested / charged with any traffic offenses in the last five years?- - Type of offense Where 2- What happened to the charge? (Circle one) 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? Type of offense W here When 9. Have you ever applied to be an 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 You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0712016 3G APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herebyce ify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 6 ry 6 y � "76 6' o issued on 0-/ m 7./foexpiring on 2 D 2!j . I understand that if I falsely answer any questibns 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 55,, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant L� Date Q9 -R, STATE OF IOWA ) "" COUNTY OF JOHNSON ) 5, A Subscribed and sworn to before me by I 1 !S+-- f "� e,� K, Sc L� on this t (N day of . Public idland for 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 Signature of Pdlibe 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. Sigilipture of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Olen AxIDRIVBADGEAPPLM14amendednoc 07/2016 Aug. 9, 2016 1:10PM Div of Criminal Investigation No.0102 P. 2/3 Terry E. 13ranstad Governor Kim Reynolds LL Governor August 9, 2016 To Whom It May Concern: Department of Public Safety Roxann M. Ryan Commissioner The Iowa Division of Criminal Investigation believes the attached record is the same individual as the subject of your request. If you feel that these results are In error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, Iowa Division of Criminal Investigation DIVISION OF CRIMINAL INVESTIGATION • 215 EAST 7TH STREET • DES MOINES IOWA 50319.6041 •515.7256010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service oe/Aug. 9, 20164, 1:09 PM Cab DIV Of Cr Ifni n a I Investigation (FA%)3193382;N 0. 0 10 2 STATE OF IOWA Criminal History Record )1 Requesta To; Iowa Division of Crlmlhal Investigation Support Operations Buraau, V Moor 3151;. 7'h Street Dos Moines, lowo 50319 (515)725.6066 (515)725.6080 Fax T am renriectinv en Tnwa Crlminnl Mintnm Rnrnrd Check nn - P'. 1/3/002 DCT Account Number: _9967-F (if applleeble) Fromt Yellow Cob of Iowa City _ P.O. Box 428 Iowa City, M. 52244 (319) 338-9777 Phones Fax: (319) 339-7302 Last Name mandala Vlrgt Name mendalory ' Diddle Dame (rewmmandsd) `C / �a'� ez- k 1, a,, r� Date of Birth (mandatory) Gender (mandolo 'Sociril. Security Number (recommended) Male ❑Fomale 5 6 t S r 7 3 Waiver Information: Without am Ign od waiver frog the subject of the regpcst, a compigle orlminal history record may not be releasable, per Code of lows, Chapter 692.2. For somnl0la criminal history•rcoord Information, as allowed by law, always obtain a walvor sl nature from the sub act ePthe re ullbct. Waiver Release; I hereby give permladon for the above roquoaling offmial to conduu an Iowa tdminel hlrtory record shook with the Divlaion orCtlminal InYeAgatlon (DCD. My orimintl hhmry data eonceming me that t milntn}ted by the DCI may be released ae allowed bylaw, Waiver Signature, (DCI use only) As of a-9-1 J a search of the provided name and date of birth rovealed: No Iowa Criminal History Record found with DCI 1, f Iowa Criminal History Record attached, DCI # i v DCI initials Uw r: :Fry N DCI -77 (08125/10) Received Time Aug. 5. 2016 12:54PM No. 1019 Aug. 9. 2016 1, 10 PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19960120 IOWA CRIMINAL HISTORY AGENCY: IA0970100 SIOUX CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 DCI 00515828 MISDEMEANOR CONVICTIONS ONLY COURT DISPOSITION AGENCY: IA097015J WOODBURY CO DIST COURT PAGE 1 OF 1 OPER VEH WH INT OWI DATE PRINTED - TRK#: 023925801 2016/06/09 OCI:00515826 PLEAD GUILTY 19960402 FINE $650 NAME: KIg STEVEN COURT COSTS 19960402 PROBATION lY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19510825 M W 511 226 BRO GRY XX ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19960120 AGENCY: IA0970100 SIOUX CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#: 023925801 COURT DISPOSITION AGENCY: IA097015J WOODBURY CO DIST COURT COUNT NO- 01 IA STATUTE; IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 023925801 SENTENCE DISP EFF DAT PLEAD GUILTY 19960402 FINE $650 19960402 COURT COSTS 19960402 PROBATION lY 19960402 SUSPENDED 60D 19960402 EVALUATION 19960402 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 DCT. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD 13 BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION } No. 0102 P. 3/3 'JiulfvADOT ,. .'_I;, I „`• t ilia _'', 10V 1 FI `.t :_ ^U rb,.e DI'liver 4;-p vlrr FV E -_,"4 D PA cie.-es 1 =L�.. Ph'2 "-_44 AY+,: JSRGGr-r! dap. Inquiry 7/20/2016 Date: Customer #: 3117283 Name: kisch, Stephen Address: 2259 C ST SV! APT 6 City/State: CEDAR RAPIDS, IA Name: Kisch, Stephen DL/ID: 606"77660 Certified Abstract of Driving Record DL/ID #: 606YY7660 NA) Class: D Audit #: 1123712 Issue Date: 07/01/2016 Expiration 08/25/2024 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD CDL Permit Class: None CDL Permit Issue None Date: CDL Permit 524043030 Mailing 2259 C ST SW APT 6 Address: None Mailing CEDAR RAPIDS, IA City/State: 524043030 Date of 8/25/1951 Birth: Sex: M Name: Kisch, Stephen DL/ID: 606"77660 Certified Abstract of Driving Record DL/ID #: 606YY7660 NA) Class: D Audit #: 1123712 Issue Date: 07/01/2016 Expiration 08/25/2024 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CLEAR DRIVING RECORD CDL Permit Class: None CDL Permit Issue None Date: CDL Permit Nun, Expiration Date: ��iLidaal CDL Permit None Endorsements: Office of Driver Services Iowa Department of Transportation CDL Permit None Restrictions: ID Status: None DL Status: VAL COL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Cade @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 �O'0. ""•"• ;v/S� yr 7/20/2016 IOWA ' �' U: :fly ��iLidaal rr F'-•...... � rr �CQr 4�r�ORl94ft,r Office of Driver Services Iowa Department of Transportation Name: Kisch, Stephen DL/ID: 606YY7660