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Home My WebLink About17-011� r 1 �III� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 5 2240-1 826 13 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 1 -7-01( (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 Middle Last 2. Address (REQUIRED) /lyn- yu/¢1t St 3. Contact Information (REQUIRED) Email: Cell Phone:3/,91930-6Vr (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) }f?Llod GG u/ oC 1eadA l7 7v 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Yus Type of offense Where When /-% eldh9 Z V.2& -,?o/d ^//'.?C) What happened to the charge? (Circle one) Convicted Dismissed Deferre Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? Type of offense Where t What happened to the charge? (Circle one) Convicted Dismisse Deferred Suspended Plead Guilty Othpf, C_1 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? —i// a Type of offense Where )Z en_ (m d i Try W •t.,.1 "t7 a�i 9 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide th6 name(sJ Ale) — 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 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number �9i�i�/S4S� issued on // 3-xisiexpiring on /2-ar-Zo2G . 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, 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 Tit�5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant-%L� Date 1-24; - Z017 11 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by $v *ine �.. Cs�l�� 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 dat of Driver's license 121t�5 IZL�ZC� Iz Signaturl5bf P lice thief or designee DarN AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICABIOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signa-lw4& City Cle k or designee Date Office Use Only N C- Approved application DCI report :74: State certified driving record C- rn Website update ---r <n. ren i 73 ry ca aerr✓rnxiDMBADGEAPPL92014e�de .Doc 07/2016 Iowa Department of Transportation 0 0lfice d [imam Serftes (Tdi FweD NO -M2-1121 PO Ow 9204, DDB Moines, lA 5MO&9204 515-244,9124 fA)t 615.239.1937 CLEAR DRIVING RECORD Name: Collins, Anthony DL/ID: 288AE5480 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 1 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: 1/16/2017 My ••�..y..•••y. 'ylio•y`A D. 0. L Office of Driver Services Iowa Department of Transporation Name: Collins, Anthony DL/ID: 288AE5480 Certified Abstract of Driving Record Inquiry Date: 1/16/2017 DL/ID #: 288AE5480 (IA) Customer #: 5342369 Name: Collins, Anthony Class: D ID Status: None Address: 1602 YEWELL ST Audit #: 8644200 DL Status: VAL Issue Date: 11/25/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/05/2020 CDL Cert Status: None 522406000 Endorsements: 3 CDL Med Status: None Mailing Address: 1602 YEWELL ST Restrictions: NONE Restriction None Supplement: Date of Birth: 12/5/1972 Mailing IOWA CITY, IA Sex: M City/State: 522406000 History Information CLEAR DRIVING RECORD Name: Collins, Anthony DL/ID: 288AE5480 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 1 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: 1/16/2017 My ••�..y..•••y. 'ylio•y`A D. 0. L Office of Driver Services Iowa Department of Transporation Name: Collins, Anthony DL/ID: 288AE5480 01,Jan.20. 2011311:46AMCabDiv of Criminal Investigation (FAX)3193382'No.1821 STATE IOWA Criminal Historys Request Porm P'..1/2/002 qtr! DCI Account Number. "9967rk" ' - (tropolle.ble) \ Tar IDWa DIvl3lon of Criminal Inve3tlgatloo Froin; YellowCsb ofTowa City Support Operations Bureau, P' Floor P,O, Box A28 215 V. I" Street baa Melne.rlowa $0319 (515) 725-6066 Iowa Cltyr iA 62244 .. _ (515)725.6080 Fax (319)338-9777 Phone) Faxl (319) 339-7302 l em reouestina en Tnw. Crlmled wrarn.., n.__.a n,.__,, __. ' Last Name nrmdu ) Blrat Name m.nduo Middle N me recmnm.odad eV;rw Data of Birth mu,d.te C�ender�ond.�ro '9octal•3ecuri Number ro oenmenda ,�_� ,► IJMaIe ❑Female ,2�� Walvertnformailon: Without a signed waiver from the aub)ect of tho ragpost, a complete grlminal history reaord )pay no be ralmabie, per Code of IOWA, Chapter 692.2, For 00 mo olete erlmthat hlstoryrecoro Information, ad allowed bylaw, alway. obtain A wAlvet signature ]rote the sub ect of the re nest, Wooer Release.l hereby give porini.rlon Ibrure abovo repuotdng omolel to oandual an Iowa erlmtaal hislorymord cheek whir rhe Dlvtllon ofCrlmlrlal Invasrlplton (DCQ. Any erlminnl history date con IOmdnulned by the OCI n,ey berelcued aallowed by hw, Walver Sign at Iowa Criminal History Record Cheep Results As of i��,, a search of the provided name and date of birth revealed. ❑ No Iowa Criminal History Record (bund with DCT Iowa Criminal history Record attached, DCI #,q ! Lt DCI initials—cc. , DC1-77 (08/25/10) Received Time Jan, 16. 2017 2:43PM No. 1580 (DCI u.e only) Jan.20. 2017 11:46AM Div of Criminal Investigation No.1821 P. 2/2 DCI:00916489 NAME: COLLINS,ANTHONY DOB SEX RAC 19721205 M B IOWA CRIMINAL HISTORY DCI 00916489 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2017/01/20 HGT WGT EYE HAIR SKN POB 605 280 BRO BLK ARK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20101130 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#: 1A00AOUO1 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708,2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY IN.IDRY/MENTL ILLNSS(SRMS COURT CASE IO: D6521 SRCRO92689 CHARGE CLASS: NON CONVICTION TRK#: 1A00AOU01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20110330 PROBATION 1Y 20110330 UNSUPERVISED PROBATION TO DCS DISCHARGED FROM 20111110 DEFERRED JUDGEMENT 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 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