HomeMy WebLinkAbout16-1811 � i
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
IDENTIFICATION NO. _ / (.O— g f
(Office use umy)
J
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
3. Contact Information (REQUIRED)
4a. Chauffeur's License expiration date
b. Taxicab Business Name (REQUIRE[
5. Prior experience in transportation of
Phone: 3 [ `I r"N Le 512-
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
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?
Type of offense A Where
:l
When
What happened to the charge? (Circle one) (�
Convicted Dismissed Deferred Suspended <ileiG . Other
Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please proGlde the gyne(sr—
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CER?IFIO
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RMW
r.:.
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
0212015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereb certify that I have issued to me by the Iowa De,pp rtme t of Transportation a val'd Ch uffeur's license number
4 �i �i0(D issued an 5 20 1 expiring on 2 1 2.0. 1 understand that if I
falsely answer any questions in this pplication, that this app !cation may be dented. I agree that in making this application,
consent to allow agents or emplo ee� f the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this applic io , ' d urth a ee that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions I apt 2, of a City Code- (Needs to besignedin Iront of a Notary Public)
Signature of Applicant Date / !�
#kkkHi#####i}XXR!###!3M##Hei###ifMii#:liR###�kf#}.Yr##ikiYY#RYR####:RXYkkHf#!-A'!f#i##kiYtRi##i!#t#3R#!i#13X1tLMtX{1t31.YRT#NRill3f iXR##ki!##M#flkle
STATE OF IOWA )
COUNTYOFJOHNSON 1
SNbscrbed pnd sworn to before me by .Sc0A- i0 r r on this � day of
ikAXXXlflif#IXXXXf1XXXf#XX{XXKX{t{ffXR#iiXiXkXXXXi#Xfi#fklki3f3f fAkkiXXXXXXXiliiiflitiitiliXH\X#XAiIfiXMAXfXMtIXXX#XXiixfXRlXXXaXXXXXXHXXXX
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 Chauffeur's license
Signature a Chief or designee Date
v//
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.
��(Cici .Yrs -e��
Signa a of City Clerk or desig e
4,//9 /.q"
Date
t3Mfti3#lXktR34dil33tflJt3H3#fiililMflill#}'ttrl34lftit#llRftflik#k1fkRR33313R#R'.F3#t3333RIriit#3k:MRfiifiiffltti\µfiAA1AA�A AifiXkff3f#ffXRfff
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„T
Office Use Only
Approved application
DCI report t .i
State certified driving record "
Website update ? "'
GeWT/W0nNBADGFAPPL92014amwded.000 03!2015
Iowa Department of Transportation
officeor Day rsery M (Toll Free) 900An-1121
PO Sm 9204, Des Mattes, M 5D30&9204 515mW-B,29
VAX- 515239•101
140
History Information
Sanctions
Type
Certified Abstract of Driving Record
End
Inquiry Date:
4/18/2016
DL/ID #:
407AF8706(IA)
Customer #:
1533865
Name:
Dorr, Scott Edward
Class:
D
ID Status:
EXP
Address:
1749 PARK RIDGE
Audit #:
8940172
DL Status:
VAL
DR
Child Support
Suspended
Issue Date:
03/20/2015
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration Date:
02/18/2020
COL Cert Status:
None
Child Support
522412741
Suspended
03/26/2014
09/14/2014
D51
Non -Payment of
Endorsements:
3
CDL Med Status:
None
Mailing Address:
1749 PARK RIDGE
Restrictions:
Corrective Lenses
Restriction
None
OR
Supplement:
Suspended
05/18/2016
Date of Birth:
2/18/1963
Non -Payment of
IA
Mailing
CORALVILLE, IA
Sox:
M
Child Support
City/State:
522412741
History Information
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence
3UR
3UR
Suspended
05/25/2010
08/16/2010
D51
Non -Payment of
IA
IA
Child Support
Suspended
05/25/2011
05/27/2013
D51
Non -Payment of
IA
IA
Child Support
Suspended
03/26/2014
09/14/2014
D51
Non -Payment of
IA
IA
Child Su rt
Suspended
05/18/2016
INDEFINITE
D51
Non -Payment of
IA
IA
Child Support
Name: Do", Scott Edward DL/ID: 407AF8706
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:
4/18/2016
......yh�
N)
1OW
D. O.
.T
'+ Office of Driver Services
Iowa Department of Transporation
Name: Dorr, Scott Edward DL/ID: 407AFS706
oApr, 12. 2016, 4; 15 PM, cetDiv of Criminal Investigation (FA%)31933S,N0. 1658 P. 1/221D02
..,,.rya.STATE OF IOWA
Criminal HistoryRecord
Request Form
o.,
Tor tows D)vlslon orerlminat invcstleatlon
Support Operatlons Bureau, l" Floor
215 E. 7" Street
Des Melner, Wive 50319
(51S) 725.6066
(515)'725.609D Fax
r
IS 19Co3
W171VRr Itrformatlonr Without a
be rolaas&bla, per Code of low&, Ch
130I Account Number; 9967 F
_996'(-F
� (Irsppllo.ble)
Pfoml _ Yellow Cab of 10
City
P,Q. Box 42R
Iowa C1ty, IA. 62244
(319) 339.9777
Ph&get
Fax, (319) 339-7302
MIVIstle ❑Female 073—&o
I wblver from the subJeet or the regpett, n complrite grlminni history record may not
693.2. Porcom le erlminel hlstotyrocord Informatloa, as allawed by law, always
t of the reouest_
Waiver Rd/dosQl t hereby llve pormhtlon Por,ha
Invdtipilal, (M4). My $11MM51 hloory dam tencamle
Waive.- Sle?1arurd,
binaryraeord Cho* wllb ND Mblon arComlml
allDwaa by uw.
(0cleuonly)
As of �� 12-- t (p a search of the provided name and data ofbirth revoalcd;
❑ No Iowa Criminal History Record found with DCI
Iowa Criminal History Record attached, DCT :10 C.)
�1
DCI initiale
DC1.77 (08125/10) Xj
Received Time Apr, 11. 2016 2:26PM No. 2087
A. . .
Apr.12. 2016 4:15PM Div of Criminal Investigation
IOWA CRIMINAL HISTORY
MISDEMEANOR CONVICTIONS ONLY
DCI:00456730
NAME: DORR,SCOOTER
DORR,SCOTT EDWARD
SCOOTER
DOB SEX RAC HGT WOT EYE
19630218 M W 600 185 BLU
ADDITIONAL, IDENTIFIERS
SC L WRIST
CCH RECORD +**
DCI 00456730
PAGE 1 OF 1
DATE PRINTED -
2016/04/12
HAIR SKN POB
BRO MED - GA
01 ARRESTED 19930328
AGENCY: IA0620200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA236-2A
ASSAULT H/INJURY
TRK#: 005989601
COURT DISPOSITION
AGENCYr IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTEt IA236.2A
PLED TO SIMPLE ASSAULT
CHARGE CLASS; MISDEMEANOR CONVICTION
TRU; 005989601
SENTENCE DISP EFF DAT
FINE $50 19930922
02 ARRESTED 19950210
AGENCY: TA052010D CORALVILLN PD
CHARGE NO- Ol IA STATUTE IA321J-2
OWI
TRK#: 014616901
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE; IA321J-2
OHI
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 014616901
SENTENCE DISP EFF DAT
JAIL 6D 19950217
PAY SURCHG
FINE $500 19950217
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 ACI.
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 YODR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
No. 1658 P. 2/2