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Home My WebLink About16-2641 r �III� N CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. / L-1 - Z- ( O7 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PE11 . .yEHICLE DRIVER (Police Department review must be made between -8-a. t p.m., Monday — Friday) 3. Contact Information (REQUIRED) Email: )^a,,- 21(0 mai(, Goy, Cell Phone: 3(4-32 - 3gC0 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /a — 2 2 b. Taxicab Business Name (REQUIRED) l a rzos %a x! II .L 5. Prior experience in transportation of passengers: �s 2Cirl iy-r rl Y1d -ia x i r a� sh uVWs--r 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? P) D Tvoe of offense Where When 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? fZ D Type of offense Where When 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? h0 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 'ILE ID I hereby certify that I have issued to me by the Iowa Department of Transportation a VA-0033i%ft license number 426 WWR'S.SfR' issued on/ expiring on (2-(4-202 1 understand that if I falsely answer any questions in this application, that this application may be denied. I agree thQiily rUWrig this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to e> ogjpfylWOall 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 ApplicantDate STATE OF IOWA ) COUNTY OF JOHNSON ) subscribed and sworn to before me by f e'r rLnL �' r `�S� ` on this Z day of t 1„J KELLIE K. FRUEHLIN �--� ' � _-�-�' k ` _t-- Commission Number 22181 otary Public in and for t e State of Iowa 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). date !D license 14, pZ or designee biz19 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. Sig re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update //G Date aerVTAXIDRIVBADGEAPPL92014a.ded.DOC 0712016 Iowa Department of Transportation {Yhc"01 ilrrrf zServiLe3 i9dl F reel 532 1121 f'U 60, 9204, €des Mafli:s. aA 503069204 615-244 9,124 1• AW 5t5 239 4&037 CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 43OWW8558 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: IOWA =, D. 0. T. Name: Rasmussen, Perry Allan DL/ID: 430WW8558 11/28/2016 'eD QFC '2101 Office of Driver Services Iowa Department of Transporation Certified Abstract of Driving Record Inquiry Date: 11/28/2016 DL/ID #: 430WWO558 (IA) Customer #: 1306832 Name: Rasmussen, Perry Class: D ID Status: None Allan Address: 414 Pleasant St Audit #: 8571396 DL Status: VAL Issue Date: 10/29/2014 CDL Status: None City/State: Iowa City, IA 52245 Expiration Date: 12/18/2022 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 414 Pleasant St Restrictions: NONE Restriction None Supplement: Date of Birth: 12/18/1960 Mailing Iowa City, IA 52245 Sex: M City/State: History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 43OWW8558 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: IOWA =, D. 0. T. Name: Rasmussen, Perry Allan DL/ID: 430WW8558 11/28/2016 'eD QFC '2101 Office of Driver Services Iowa Department of Transporation i eta, ivu ". VJVL I. I/I —F............y ....y Cl cin �, ,, ,tee a,c u....... 11/Me/201e 11:0, e1747 P.002/Oo2 STA'T'E OF IOWA Criminal History Record Check Request Forlm To: 101aa UNISlen OfCtimmol Investigation 5uppol•t ()perations ftureao, I" Fluor 215 E. 7" Street Des Moines, Iowa 50319 (515) 725-6060 Fax 1 alll renueslinn an f0\YA 10 ,,A rl,.s, DCI Account Number: 4pn-L--_ (i(applicablc) —� From: Citv of Iowa City City clerk's office ._–_--^-- _L101'. Washington Street —. _IOWA City, LAJzj240 -- Phone: 319.356.5041 _ Fax: _i"5-35( -•5497 _ _ LAst Name (mandatory) First Name (mandatory) Middle Name (ncomii,ta as tAusseh PPl^ry ��An Ianraity.Ci�'�k Date of Birth (n,a„ealop9 Gender (mnndamry) Social Sec qk Number lie e' a ended) 'a.—�g—�'� LrJlVlalc ❑1~`emale �'�J�'-90'�'�?� WaiVer Aformati011: Without a signed waiver from the subject of the request, s canplete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. Por eom late critoIna I history record information, as allowed by law, always obtain a waiver signature from the sub'ect of the request, Waiver Relaw-e: I hereby give permission for the above requesting official to conduce an Iowa criminal hismq record chcCA with the Division of Criminal Ynvcsligation (UCY).y�Any criminal bismrydeta coneerning me that is by the UCt maybe released as allowed by Imv. lmaintained Iowa Criminal Histor Record Check Results cot use only) As of -__% E P3 OL a search of the provided name and date of bitch resealed: r.`• L7 No Iowa Criminal History Record fotutd with DCI ❑ Iowa Criminal Hislury Record attached, DCI # DCI initials,(.__ DCI -77 (08/25/10) Received Time Nov. 20. 2016 9:42AM No -6640