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Home My WebLink About16-211� r 1 CITY OF IOWA CITY 410 Last Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. 142 — �L I I (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 le 2. Address (REQUIRED) 191a Hannah To C-+, To�jA C 01:j , =,g 63G90 3. Contact Information (REQUIRED) Email: er�CYle�on (6570P VA�g -COfvlCell Phone: 3f"5 -81 IS (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) Marc es AXI 5. Prior experience in transportation of passengers: I y V Qads 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _ *5 Type of offense What happened to the charge? (Circle one) Where When Tower C,*V 4 N Convicted Dismissed Deferred SuspendedPlead Guil .- - 1Othem Have you been arrested / charged with any traffic offenses in the last five years? n Type of offense What happened to the charge? (Circle one) Where W hen � Convicted Dismissed Deferred Suspended Plead Guilty Other r, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? / o Type of offense Where 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 herebythat I have issued to me by the Iowa Department of Transportation a valid Driver's license number Zcertir 1(09 issued on 39 a expiring on (oIS I-7 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ',C ' 11&6y-,_ Date Ct a-' ) �o STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by r, L tl CA Soy, on 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 b / 5 l 2o(/ Signature of Police 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. Signa0re of City Clerk or desIgne6, Office Use Only Approved application DCI report State certified driving record Website update Date Clerk/TAXIDRNBADGEAPP 92014amende ,DOC 07/2016 Aug. 24. 2016 12:25PM o8/10/2016 00:27 FAX Div of Criminal Investigation No.1433 P. 4/6 4 DCI IOWA 0005 STATE OF IOWA `�"1tt� "' Criminal History Record Check :. Request Form To: Iowa DIvlsloo ofCrIMInal lnvratiaadan Support Operations Barents, V Floor 215 a 7" SUW Da Maines, Iowa 60319 esls�resus6 (515) 7754080 FeIC DO AccountNumber. —Fc- ' From+0.1I7w5 I Akt Skavc.,s Qr• .. •. . —too.", A':.Sa3Y o . Phone: ,(31.4) 338- aqW' 3l4 5SI-829 Last Name coda First Name Middle Name torr Date o(B1rth m alto) Gender (mwdawn) 9�et:.iQal SecurityW amber f0 5 ., Feale OMale ❑m " 1f — I QD i, ( I J ✓ IoG waPoer IgJomtalian: Without a Alvied waiver from the ■abled of the request, a eotapiete erimla■1 Wtory rmrd may not be refutable, per Code of Iowa, Chapter 697.7, For c Iim ,fig criminal history record inform■Non; ■sallawed by law, dway■ gliflin Is waiver, alpisfure from stirsubject of 06 request, ' rrabor Rei8gSt. l lirwbygln pwmlalun rorda sbovesepupdn■ a loW to wndoq an low, c6mlW hhwry mord heck whh dui DlvhlonarComlorl- In.aaytim(DCO. Any erimindh4wydrww IAI m rmlib dbw0.,FlmwbemhosedudlGwodbylaw. WalreP ftfiafwre:^ ' f�lyQIV�,�''✓�� Iowa Criminal History Record Check Results (Del awody). �� 1 Add— � a sxprch of the provided Raine end date of birth revealed: -- ❑ No Iowa Criminal History Record found with DU Iowa Criminal History Retard attached, )JCI At J 1 �� 5 L 73 r.' • I)Cl 7 laltlal5 � , D...:...1 T:_. 4... ID 9014 0.1'JW It. 11140 Aug.24. 2016 12:25PM Div of Criminal Investigation No. 1433 P. 5/6 IOWA CRIMINAL HISTORY DCI 00518350 MISDEMEANOR CONVICTION$ ONLY PAGE 1 OF 2 DATE PRINTED - 2016/08/24 DCI:00518350 NAME: NELSON,RRIC VERNON DOB SEX RAC HGT WGT EYE HAIR SKN POE 19760605 M W 602 250 ELU SRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19960229 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/SCHEDULE 1/MUSRROOMS TRK#: 018655602 CHARGE NO- 03 IA STATUTE IA124-401-1D POSSESSIONW/INTENT DELIVER MARIJUANA TRK#: 018655803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE SCHEUDLE I/ MUSHROOMS COURT CASE ID: PECR40720 TRK#: 018655801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960626 COURT COSTS 19960628 PROBATION 2Y 19960620 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT -NO- 02 IA STATUTE: IA124-401(1)(D: POSSESSION/ W/INTENT TO DELIVER/ MARIJUANA COURT CASE ID; FECRO40720 TRK#: 016655802 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960626 02 ARRESTED 20070422 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESS COHTROLV3D SUBSTANCE TRK#; IAOOIAO02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 PECR079267 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA001AO03 Aug.24. 2016 12:25PM Div of Criminal Investigation SENTENCE JAXL 2D ACI 00518350 PAGE 2 OF 2 DISP EPF DAT 20070919 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIVXCATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. 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 No. 1433 P. 6/6 C, 44 DOT SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOWBdOti gOV Office of Driver: Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 18OD-532-1121 I Fax: 515-239-1837 www:iowadaLgov Certified Abstract of Driving Record Inquiry Date: 9/23/2016 DL/ID #: 464KK6798 (IA) CDL Permit Class: None Customer #: 2301096 Class: D CDL Permit Issue None ,"`RRIIIER,--= Iowa Department of Transportation Date: Name: Nelson, Eric Vernon Audit #: 6011555 CDL Permit None Expiration Date: Address: 1912 HANNAH JO CT Issue Date: 05/29/2012 CDL Permit None Endorsements: Expiration Date: 06/05/2017 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522403080 Endorsements: 3 ID Status: None Mailing 1912 HANNAH JO CT Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522403080 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 6/5/1976 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Nelson, Eric Vernon DL/ID: 464KK6798 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: 6: """•:��% �t •IOWA 9/23/2016 ? zp_ of% -P p 9p'••••••'•$ Services Office of Driver ,"`RRIIIER,--= Iowa Department of Transportation Name: Nelson, Eric Vernon DL/ID: 464KK6798