HomeMy WebLinkAbout16-203•1 r t
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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED)
3. Contact Information (R
IDENTIFICATION NO.
(Office Use unry)
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 '"retauired"information wfl! result in denial of the apnfication
4a. Chauffeur's License expiration date
b. Taxicab Business Name (REQUIRE(
5. Prior experience in transportation of
email)
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?
Where I When
T
1 r 117s 0 I l a IIx Sim s Itfg93 t`C rzor 1 Foy
What happened to the charge? (Circle one) CoMpbkkV0,)APP
Convicted Dismissed Deferred Suspended Plead Guilty ---Other H2
7. Have you been arrested/ charged with any traffic offenses in the last five years? r->
Type of offense�1
Where clA t6n
2012- COrAX-e
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended lead Gu' Other
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years?
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the Fyne(sr—
N9
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIii.
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE1(IkW
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 he reb rtity th t I h e issued to me by the Iowa Dep rtme t of Transportation a vaJl'd Ch uffeur's license number
4 �i�or Issued on 3 20 1 expng on Ib ZQ, I understand that if 1
falsely answer any questions in this lication, that this app icatlon may be denied. I agree that in making this application, I
consent to allow agents or emplo ees f the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this appl' 'o , urth a ee that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions I ap 2, of a City Code. (Needs to be signed in nt of a Notary Public)
Signature of Applicant Date
4141H4iH4t1MMii1MM4ifi4MH1M444Nti4ikf4fMflfkffklii}N4Mi4Ml4HYRit44M1ittki4lMiiMM4N4444Nt4144M1i44444aNkif if1MIMNi4iM
STATE OF IOWA )
COUNTY OF JOHNSON
S bscribed nd sworn to before me by SCo 1 A Y' I' on this day of
z I c.p r J�
KELLIEK.TUTTLE I LC
AE r ,,,ballon mu ber221st otary Public in and for the State of Iowa
MIHi iiltNRMHtiiH14....Hkii Yi itfttiii1t4H44iiHtlHtYH ii lf4t14itflifiHblilfHltHifillftftf lfttitilFlH
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
l�lr� Q
�N
Signature o e Chief or designee . Date,;,; -
AFTER APPROVAL BY THE CiTY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB mN� arj Fol"
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
r
Signaf6re of City Clerk or deslg a/Date
tMiwfitataMti+HaHHiMiit4iaMMttiHH4HtMittttiHiMiYH»iir4iHtHifNareilttitiH4MMHiffiMN4HftftMMtkai{pytitftHHtttttHtt
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Office Use Only r 1 �-
-
Approved application
DCI report. s S
State certified driving record - r --
Website update 45
C4.WAXIDRNBADGEAPPLO2014 d.d.DOC 032015
-Iowa Department of Transportation
Oltw d CmW eRwas 0011 Free) 800-:32-1121 to
Pt? Box 9204, deS Mom, IA 5121MU04 515-244.5124
PAX: 515.230.10i
Sanctions
Type
Certified Abstract of Driving Record
End
Inquiry Date;
4/18/2016
DL/ID #;
407AF6706(IA)
Customer #:
1533665
Name:
Dorr, Scott Edward
Class:
D
ID Status:
EXP
Address:
1749 PARK RIDGE
Audit A;
8940172
01. Status:
VAL
DR
Child Support
Suspended
Issue Date:
03/20/2015
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration Date:
02/18/2020
CDL 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
05/18/2016
DR
D51
Non -Payment of
Supplement:
IA
Date of Birth:
2/18/1963
Child Su ort
Mailing
CORALVILLE, IA
Sox:
M
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
O5/2712D13
D51
Non -Payment of
IA
IA
Child Support
Suspended
03/26/2014
09/14/2014
D51
Non -Payment of
IA
IA
Child Su ort
Suspended
05/18/2016
INDEFINITE
D51
Non -Payment of
IA
IA
Child Su ort
Name: Dort, Scott Edward DL/ID: 407AF8706
Pursuant to Iowa Code 9321.10, I, Melissa Spiegel, Director of Of0ce 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;
IATdGW 4/18/2016
D. 0. T
Office of Driver Services
Iowa Department of Transporation
Name: Darr, Scott Edward DL/ID; 407AF8706
c,Apr. 12. 2016, 4:15PM, cal:Div of Criminal Investigation {Fax)91933BNo. 1658 P, r1/22/D02
'ril.w4�r Y.�
STATE • •
'1 EOl'd)�x e Record
Request Form
1�4 iy . l fltyl
Tot town Division orCrlminal investigation
Support Operetlons Baraau, In Floor
215 E. 7" Street
Des Me1tlW, tofva 50319
(513) 725.6066
(515)'725.6080 Fix
r�
to
1301 Account Number,, 9967-F
llrepptlon0lo)
Prom Yellow C b fIowa Citv
P,Q. Box 428
Iowa C1ty1 IA. 62244
(319) 33 R-9777
pdonet
Fax, (319) 339.7302
Irl' (03 +I 01rdale oFnl�ate p�3 �o—��
Wa)verlrrformoflon, Without a slgnad waiver from the sublaet of rho r
be relaosable. par Code of lows, Chapter 692,2. For cam le egUelt, w complete griminal history raaord mry not
obtnln d v lvarsi nature IYom fde sub eat Of the re u to Orlminal h,story-record InrormAtlon, As allowed by low, Always
WalasrReldOSdt t hareeyalvepeiminlvn Phr,he etwvv utsn amo 10 d u am Iminel blaaryrvvord ohesk wlfb,ho Dlvislon efCrfmlael
InvndSeIlan(DCq. Myellmind hhlarydamoenum,n6tno st e1n Inc y e t gybe Iwedwalloweabylew,
Waiver Slgnarural
As of, L:� i— �e , a S011I of the provided name and date ofbiith revealed,
No low& Criminal History Record found with 1)CY
Iowa Critninel Fliatoty Record attached, DCII
# S `7
DCI initialAc—
DCI-77 (0&125/l0)
Received Time Apr, 11. 2016 2:26PM No, 2087
v
=
1
v G,
•q I
v
Aar•12. 2016 4:15PM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00456730
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
DCI:00456730 2016/04/12
NAME: DORR•SCOOTBR
DORR:SCOTT EDWARD
SCOOTER
DOS SEX RAC HOT WGT EYE HAIR SKN POE
19530210 M W 600 1S5 BLU BRO MEO - GA
ADDITIONAL YDRNTIFIERS
SC L WRIST
CCH RECORD**
01 ARRESTED 19930320
AGENCY: IA0520200
IOWA CITY PD
CHARGE NO- OS
IA STATUTE IA236.2A
ASSAULT W/INJURY
TRK#: 005909601
COURT DISPOSITION
AGENCY; YA092015J
JOHNSON CO DIST COURT
COUNT NO- 01
IA STATUTE; IA236-2A
PLED TO SIMPLE ASSAULT
CHARGE CLASS; MISDEMEANOR CONVICTION
TRX#: 005959601
SENTENCE
DISP EFF DAT
FINE
$50
19930922
02 ARRESTED 19950210
AGENCY: ZA0520100
CORALVILLH PD
CHARGE NO- 01
IA STATUTE IA321J-2
OWI
TRK#: 014616901
COURT DISPOSITION
AGENCY: IA052015.7
JOHNSON CO DIST COURT
COUNT NO- O1
IA STATUTE: IA321J-2
OHI
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK$: 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
IDRNTIFICATIOH IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF PINGERPRINTS 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. 1656 P. 2/2