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HomeMy WebLinkAbout16-231®4st CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240.1826 1319) 356-5040 (319) 3S6-5497 FAX f�-awl IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 6 a.m. to 3 p.m., Monday— Friday) Failure to complete the "required" information will result in denial of the application �. 1. Name (REQUIRED) First —� , Middle Last 2. Address (REQUIRED) 2-2 !-�_ i C S^— 5; -LJ -t- 6 %,61 3. Contact Information (REQUIRED) Email: [ tY�_9 Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) O8,2 57% 2-0 b. Taxicab Business Name (REQUIRED) adz t x r S. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged With any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Ow /, 510�x c_r77 /,� 4 i What happened to the charge? (Circle one) �(s Convicted Dismissed Deferred Suspended eadGuil Othe' 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where t 6n Vjhen pia a_ /VV A-' C What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other y B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense No ry c Where When 9. Have you ever applied to bean 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 a7 3 6 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereby certify that I have iss ed to me by the Iowa Department of Transportation a valid Driver's license number O C. y �L6 6' o issued on c Z m //r 2 expiring on D L�{ . 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 sooffTTitle � 5,, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant C:� Date 01S' • it, /b a. !»ftt»f.iaiffllf4RFlRRHflfihifliiiH44H11ftf»!fl!-111N44»#iYiii»4!!4»f»11flYiitii»i141»e»tflRlff llf»f{ff»a1l41fefl� Rflff!!lrf R:14f1 STATE OF IOWA r COUNTY OF JOHNSON Subscribed and sworn to before me by !+--.o on this I ( day of /L._.. - -- —r. I t., Public ffft#ttt#i#»#L##fltllt»f tlrt###if#tRtt#la4#i#t»t#fi#,if#f»RRtktttHi##»tfifyHRtt#tRiti#4tRt##iMitR41f»tft#4iffk4fit1M1»»flftttt##tM3###t 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 (TIUe 5, Chapter 2, City Code). Expiration date of Driver's license Signature of P lice 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. ig , lure of City Clerk or designee Date l+.t+r»i#i.r# •»4f z«zi.izzzz.11zzizzzz»zv-zziz+w. zz»zzzzlzz:zz:zrzz ufizz»»»zzzlzriz zzz.rzz f zrtiziai##zzzzzzzzrrzz wruyizz zrizz»izzf z z z+lz Office Use Only Approved application DCI report State certified driving record Websfte update oeM1/rAXiDRIVBADGEAPPr82014amended.Doc 07/2016 ,Aug. 9. 2016 1:10PM Div of Criminal Investigation Terry E.19ranstad Governor Kim Reynolds Lt, Governor August 9, 2016 To Whom It May Concern: No.0102 P. 2/3 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 B 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 BAST 7TH STREET • DES MOINES, IOWA 50319-00419516-726-6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service oeiApg. 9. 20164. 1:09PMCeb Div of Criminal Investigation -,No. 0102 STATE OF IOWA Criminal Ilistory Record Check. Request Form To; Iowa Division of Crlmlhnl Investigation Support Operations Burden, 11t Flaor 215 P. 7'4 Street bas Molnee, lows 50319 (515)735.6066 (515) 725.6090 Fax 1 . neNnn „n raw. @rlml..,,l Atnlnry R.v,n�d f:heclr nn! P. 1/3/002 DCYAccount Number: _9,,967-F ' (Ifapplleable) From! Yollow Cab of Iowa City P.O. ,Box 42B Iowa City, U. 82244 (319) 338-9777 Phones Fax: (319)339'7302 Last Name inandato l7jr9t Name mrndele ' Middle Name freoammended)' , r ----- I gG k h 4, Date of Birthtry� maneeto (a�ander mendatn 80CIPJ $00uri Numbor (tacommended) .toy F r '!� i ale ❑female % O1 7 `�'" r „ Waiver information., Without a Blgnod waiver froo� the subject of the regpest, a cotnpigla grlhlinai history record grey not be rateasable, per Code of Iowa, Chapter 691.2. Forgg) aploa criminal hlatory-raeord Information, as allowed by jaw, always obtain it waiver sl naturefrorothesubectoftherc 11b9t, Waiver Re/ease: I busby give pemttsilan for tho Owe roqueetU6 omcitA to conduu en Iowa tslminel hissory rcwrd obaok with the DIvlelon o[Qlmtasl Invesd'allon(DCn. Any odminel himmy dao mneamins miiiiiilme till l nta ed by lbo DCl may be released u dlow0by law, Waivermin Oruro, Xowa Criminal History Record Check Results As of - �(o a search of the provided namo and date of birth revealed: © No lowa Criminal History Record found with DCI Iowa Criminal Hiatory Record attached, DCI 0 5150! �; .: u� s - DCI initials T- 5 N DCT -77 (08!25/10) Received Time Aug. 5. 2016 12:54PM No. 1019 (DCI we only) Aug. 9. 2016 1:10PM Div of Criminal Investigation ADDITIONAL IDENTIPIERS CCH RECORD *** 01 ARRESTED 19960120 AGENCY: IAD970100 SIOUX CITY PD IOWA CRIMINAL HISTORY DCI 00515828 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 AGRNCY1 IA097015J WOODBURY CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 DATE PRINTED - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 023925801 2016/06/09 DCI:00515828 PLEAD GUILTY 19960402 FINE $650 19960402 COURT COSTS NAME: XISGSTEVEN PROBATION lY 19960402 SUSPENDED 6013 19960402 EVALUATION DOB SEX RAC MGT WGT EYE HAIR SKN POB 19510825 M W 511 226 BRO GRY COVERS THE SUBJECT OF YOUR INQUIRY, XX ADDITIONAL IDENTIPIERS CCH RECORD *** 01 ARRESTED 19960120 AGENCY: IAD970100 SIOUX CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRIC# : 023925801 COURT DISPOSITION AGRNCY1 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 6013 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 16 A PUBLIC RECORD AUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT. , 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. 0102 P. 3/3 t , 'AWkV i Dwa c ot. goy ofllce of Drivel services FO Eco:. S:204 Des Vrinas. IA `0308-92L'3 P'h'J^e c15-'_44-0124; At,L'.;j_.11211 P I, ?-I P57 i -dial 40'. History Information CLEAR DRIVING RECORD Name: Kisch, Stephen OL/ID: 606YY7660 Pursuant to Iowa Code §321.10, 1, 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; yEEl61E i /`{rp Certlf led Abstract of Driving Record 7/20/2016 c U Inquiry 7/20/2016 DL/ID tt: 606YY7660 (IA) CDL Permit Class: None Data: IcwaeDepartmentce Transportation Customer V: 3117283 Class: D CDL Permit Issue None Date: Name: Kisch, Stephen Audit 7l: 1123712 CDL Permit None Expiration Date: Address: 2259 C ST SW APT 6 Issue Date: 07/01/2016 CDL Permit None Endorsements: t Expiration 08/25/2024 CDL Permit None Date: Restrictions: City/State: CEDAR RAPIDS, IA Endorsements: 3 ID Status: None 524043030 Mailing 2259 C ST SW APT 6 Restrictions: Corrective Lenses DL status: VAL Address: Restriction None CDL Status: None Mailing CEDAR RAPIDS, IA Supplement: CDL Permit Status: ELG City/State: 524043030 Date of 8/25/1951 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Kisch, Stephen OL/ID: 606YY7660 Pursuant to Iowa Code §321.10, 1, 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; yEEl61E i /`{rp "..••• 4 : IOWA': n1'y 7/20/2016 c U 0. ID. 4�1I%%pol9EflS = of Driver eoflcs IcwaeDepartmentce Transportation Name: Kisch, Stephen DL/ID: 606YY7660