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Home My WebLink About17-042CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. -7— t { (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 1. Name (REQUIRED) 1 N t3; S i- 2. Address (REQUIRED) n I r is 73:= 12 Ll -T-,- 3. Contact Information (REQUIRED) Email, -.tuft S i, c fl rT % 4 Y,4 e61 6 (All written) communication ent via email) 4a. Driver's License expiration date (REQUIRED) 4l Z Z Ile b. Taxicab Business Name (REQUIRED) /11 Aft Co 5 1rA X 1 5. Prior experience in transportation of passengers: Phone: J17 J5 Y 0 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 7F S _Type of offense Where When <3E �•7TAc -4ji) %t Do i ) 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? I 5 When �--3►IJ What happened to the charge? -- (Circle one) <6o vic l 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? 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 names) IJO 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 1 ave issued to me by the Iowa Department of Transportati n valid Driver's license number ALJ U (0 issued on .3 t t �� expiring on a Z2 I I understand that if I falsely answer any questions in this application, that this applicationy be denied. 11gree that in making this application, I consent to allow agents or employees of the City of Iowa jCity Iowa, in their discretion, to examine any and all records and documents relating to"this application, and I fu agree t t, f authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Tal 5, Chapter o t ty Code. (Needs to be signed in front of a Notary Public) Signature of Applicant �/� Date 3 l5 i STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1 e " VV ; 4, :::�3 eH-, t on this / S day of M -Q -c I 1 . 7n 1 '7 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 6" a8 18 8P Signature oflice Chief or designee 31X.1) 7 Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO M05f THAN O YEA&FROM THE DATE LISTED BELOW. 3�G1� Signature of City Clerk or designee Date Office Use Only I 7 Approved application DCI report State certified driving record Website update 0erk/TM1DRI13ADGEAPPL92014e ded.Doc 07/2016 �•,10WA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN VV1NW'IOWi3[�Ot gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.iowadol-gov Inquiry Date: 3/15/2017 Customer #: 3588195 Name: Pettit, Dennis Edward Address: 601 KIMBERLITE ST City/State: TIFFIN, IA 523409384 Mailing 601 KIMBERLITE ST Address: Mailing TIFFIN, IA 523409384 City/State: Date of Birth: 9/22/1970 Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 556YY0404 (IA) CDL Permit Class: None Class: D CDL Permit Issue None D. 0. T..,.�::i P.�ca'•J Date: Audit #: 7895115 CDL Permit None Expiration Date: Issue Date: 03/18/2014 CDL Permit None Endorsements: Expiration Date: 09/22/2018 CDL Permit None Restrictions: Endorsements: 31 ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation County JUR 11/22/2015 12/08/2015 S93 Speed Johnson IA Name: Pettit, Dennis Edward DL/ID: 556YY0404 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: Name: Pettit, Dennis Edward DL/ID: 556YY0404 �.IIILY- 1 b:.......®/`' 1'�4 3/15/2017 IOWA ' D. 0. T..,.�::i P.�ca'•J 9%'®BIVEw Office of Driver Services �h % Iowa Department of Transportation Mai. Y. 1011 2:0/VM 03io7/ZU17 Iz:49 IAA Uiv of Criminal Investigation No. 5331 P. 1/5 4 DCI IOWA 16IouJ STATE OF IOWA , Criminal History Record Check '_ 1 Request Form To: rows DMdoa of Criminal lavestlgatloo Support Opersttoee Bureau, a Floor 213 E 7* Street Dee Mutant, Iowa 50319 (815)7236066 (618) 7256010 Fat e ...� .......uiwn .w rn.v. Pd.nt...t T -16f.. R.,v,.A f`%I I, nn� DCI Account Number 8- e From: (Mares -FALm owe A 57X;4 o Fioae: ,�314� 339• :9'�. Far:.. Lut Name 1WWr 1 First Nome Middle Nome n!Mn edy EST G 01J N S �olAi Pt,fz,i� Dote of Birth Gender 8oc d Security Number rose q - 1-7 70 Male OFemde - D I - DZb3 WatperAftrns"fix Without a slgaed waiver from the aubleet of the ratiaeeq a complete criminal history record may not be rsiarabre, W Code of Iowa, Chapter 692.2. For oomdeoe criminal binary record laf nautdon, as allowed by law, always obtaig ■ wei+ar sl arae from the nab r oak Webw Release I beroey Sift e.,na.l ra oe ebm oftw w wn& aM f cd d Cho Wen ee oi.:W ofeflyd cow hma,tleaUen(DCI). Agycrimiodbimy wnowninrenlbst w*ainWbydm DC( .. ew. Walvers1knarure: -�^ ""� Iowa Crileninal History Record Check Results As of 3 9 - �► , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI t6Iowa Criminal History Record attached, DCT q L(3 9-4-55 DCI initials�� 77 RPrPivPd Timc Mal 7 7817 17-46PM Nn 6117 PCI wo aWY) a J a Mar. 9, 2011 2:08PM Div of Criminal Investigation IOWA CRIMINAL NISTORY DCI 00434455 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTRD- 2017/03/09 DCI700434455 NAME: PETTIT,DENNIS EDWARD PETTIT,DRNNIS EUGENE DOB SEK RAC HOT WGT EYE RAIR SKN POB 19100922 M W 500 175 HA2• BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ABDOM SC CHEST DISP EFF DAT 19920506 19920508 19920508 DISP EFF DAT 19961121 No. 5331 P. 2/5 CCH RECORD *** O1 ARRESTED/TAKEN INTO CUSTODY 19920215 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA32IJ-2 OWI TRK#: L41392601 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 ONI TRK#: L41392601 1 RESTITUTION SENTENCE DEFERRED JUDGEMENT COURT COSTS SA EVAL PROBATION IY 02 ARRESTED/TAKEN INTO CUSTODY 19960729 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-7(IA2) HARASSMENT IST / DOMESTIC ABUSE HARASSMENT TRK#: 019233801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA700-7(2) HARASSMENT 3RD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 019233801 SENTENCE FINE $75 03 ARRESTED/TARKN INTO CUSTODY 19970316 AGENCY: IA0S20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA32IJ-2 OWI 2ND TRK#: 025662101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA32IJ-2 OW1 2ND DISP EFF DAT 19920506 19920508 19920508 DISP EFF DAT 19961121 No. 5331 P. 2/5 J =.7 1 e.a Mar. 9. 2017 2:08PM Div of Criminal Investigation No. 5331 P. 3/5 DCI 00434455 PAGE 2 OF 4 COURT CASE ID: 06521 OWCRO43979 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#; 025662101 SENTENCE DISP EFF DAT JAIL 7D 19970708 FINE $750 19970708 PROBATION lY 19970708 SUSPENDED 53D 19970708 8/27/98 -CONTEMPT -10 DAYS JAIL 04 ARREST9D/TAKEN INTO CUSTODY 20000912 AGENCY: IA052DOOO JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-1 ASLT CAUSING INJURY DOMESTIC ABUSE 2ND TRK#: 100018301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: 1A708,2A(3)(9) DOMESTIC ABUSE ASSAULT - 2ND OFFENSE - AG CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100018301 SENTENCE DISP EFP DAT JAIL 180D 20010124 FINE $5OO 20010124 PROBATION 2Y 20010124 SUSPENDED 170D 20010124 500 OF FINE SUSP 05 ARRESTED/TARNN INTO CUSTODY 2DO10806 AGENCY: IAD480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321-561 DRIVING WHILE BARRED TRK#: 033753001 COURT DISPOSITION AGENCY: IAD40015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06481 AGCR007517 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 033753001 SENTENCE DISP EFF DAT JAIL 5D 20020301 5 DYS JL/CRD TM SERVD/F,SC,CC & CT APP ATTY FEE FINE 20020301 Mar. 9. 2011 2 : 0 B P M Div of Criminal Investigation DCI 00434455 PAGE 3 OF 4 06 ARRESTED/TAKEN INTO CUSTODY 20011021 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321-560 DRIVING WHILE BARRED TRK#: 100380601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 PECRO60306 CHARGE CLASS: MISDEMEANOR CONVICTION TRW 100380601 SENTENCE DISP EFF DAT JAIL 60D 20020221 FINE $500 20020221 PROBATION lY 20020221 SUSPENDED 45D 20020221 07 ARRESTED/TAKEN INTO CUSTODY 20061006 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708.2A DONESTIC ABUSE ASSAULT TRK#: 101998501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(A) DONESTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSM066930 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 101998501 SENTENCE DISP EFF DAT JAIL 30D 20061220 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA664A.7(4) VIOLATION OF NO CONTACT OR PROTECTIVE ORDER COURT CASE ID: 06521 SMSM066930 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 301998502 SENTENCE DISP EFF DAT JAIL 7D 20080711 00 ARRESTED/TAKEN INTO CUSTODY 70030528 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- O1 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: IA0049VOI COURT DISPOSITION AGENCY; XA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) No.5331 P. 4/5 Mar. 9. 2017 2:08PM Div of Criminal Investigation DCI 00434455 PAGE 4 OF 4 POSONS9ION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO83530 CHARGE CLASS: MISDEMEANOR CONVICTION TRW IA0049VDI LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 20 20080820 DL REVOKED 180 DAYS FINE $315 20080820 09 ARRESTED/TAKEN INTO CUSTODY 20060526 A AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA708.7(2) HARABSHENT / 1ST DEO. - 1989 TRK#: 1A0049WO1 COURT DISPOSITION AGENCY: IADS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA108.7(2) HARASSMENT / 23T DEG. - 1989 COURT CASE ID: 06521 AGCR002336 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1AD049WO1 SENTENCE DISP EFF DAT FINE $625 20081017 SUSPENDED PRISON 2Y 20081017 PROBATION 2Y 20081017 SUPERVISED PROBATION W/ DCS. PRISON 2Y 20081017 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 No. 5331 P. 5/5