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Home My WebLink About17-053•1 l E • all,r®rm� CITY OF IOWA CITY IDENTIFICATION NO. _ , -7 (Office Use vnry) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday) 410 East Washington Street Iowa city. Iowa 52240-1526 Failure to com tete the_'teguired"information will result in denial of the aaolication (319) 3S6 S040 (319) 356.5497 FAX Irs1 Middle Last 1. Name (REQUIRED) co� -F ,W q (D 7 r i 2. Address (REQUIRED) ( 7LIci 1)4-C D r L 1 le I L4 3. Contactlnformation(REQUIRED) Email- 0PgnTh,0j0rrak91MAI1. Mcenphone: 31°1 T1741 65'12— (All S/2(All en communication sent via email) 4a. Chauffeur's License expiration date (REQUIREDI �I i5 7 0 Z b. Taxicab Business Name (REQUIRED) _Ti� �(.Q J T X) Pt 5. Prior experience in transportation of passengers: 6. He" you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? TI ffen here S.ewr (3�-zo�zco«il ,�) ,� f What happened to the charge? (Circle one) re 6We5T71 VIC COM Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? What happened to the charge? (Circle one) Convicted Dismissed Where Deferred Suspended <6iiG4 ram U445 -2I`-C 1 bpi Other When Other S. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 9. Have you ever applied to be an Iowa City taxi driver using a different name? (U 9 Whe � -r n If yes, please protide the @me(sT — _ T DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFI0 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVKW You must apply for an Individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FORTAXICAB VEHICLE DRIVER Page 2 I hereby se � �Fja��ve Issued to me by the Iowa Dep Z e ` of Transportation a valid Chs�uffeurs license number Q 7 i' f� l k Issued an .5 expiring an 2. I � 2. L/ . I understand that if I falsely answer any questions in this pplication, that this app ication may be denied. I agree that In making this application, l consent to allow agents or emI the City of Iowa City, Iowa, In their discretion, to examine any and all records and documents relating to this apprth a se that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisionsapt 2, of a City Code. (Needs to 6e signed in ont of a Notary Public) Signature of Applicant Data H#NHNNNN##N#HHHiitl/HiH#iwN»Y###iCHNNf»»tHN»»##»#NIM##IIN#/RHHNN/##Hf#/!N#411H/.w./M/#N#//ii1####FH//H STATE OF IOWA ) COUNTY OFJOHNSON, ) 1I 5 bscribed nd mom to before me by SCO (�' r r on this day of 2-0 1 C K! u N/##ININi#»NM»/HMMHIIMMM#NM#IMMNI#i1MMMNINM#N#MM#H#HMi#HN1Mi1N#N#HH W HHUINNM»Ms#I»MHM## 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 ivould be detrimental to the safety, health or welfare of rest - dents of the City of Iowa City (Tale 5, Chapter 2, City Code). Expiration date of Chauffeur's license • !i2-11 Signature V1118 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. �� - "� Signe a of City Clerk 0rdealg e Date fiMiMd111HI#1H#HiiH1iN#iMifIIN#IMMiHHHHHN#NIM#NNtfINNH/1M#MN#kN\NiIMHI1INNNH#N#/��4jHMHMiINHHN b O� Office Use Only Approved application DCI report State certified driving record Website update C1WW# WA1ADGWPL=4MnffaWW0 0312015 = ? ifs C1WW# WA1ADGWPL=4MnffaWW0 0312015 Iowa Department of Transportation Oibce d ilImrservim (Tdl Five) SMA32-1121 4" PO Burt SM, OM MOM, IA 6030&9204 515-2a4•0t24 FA)C 515.239.1831 History Information Sanctions Type Certified Abstract of Driving Record End Inquiry Datee 4/18/2016 DL/ID #r 407AF0706 (IA) Customer #t 1533865 Name. Dom, Scott Edward Class= D ID stahar EXP Addresst 1749 PARK RIDGE Audit Ott 8940172 DL stature VAL Suspended DR D8/16/2010 D51 Non -Payment of IA IA Issue Dalai 03/20/2015 CDL Robust None City/StaterCORALVILLE, IA Expiration Date: 02/18/2020 CDL Cert Status% None Noo-Payment of 522412741 IA Child Support Endorsements: 3 COL Med Status; None Mailing Address: 1749 PARK RIDGE Restrictions: Corrective Lenses Restriction None DR child support Supplement: Suspended 05/10/2016 Date of Birth: 2/18/1963 Non -Payment of TA Caty/state: ing 52241L274L1E, TA Sox: M Child Support History Information Sanctions Type ENective End ACD Explanation Occurrence 3UR 3UR Suspended 05/25/2010 D8/16/2010 D51 Non -Payment of IA IA Child Support Suspended 05/25/2011 05/27/2013 D51 Noo-Payment of IA IA Child Support Suspended 03/26/2014 09/14/2014 D51 Non -Payment of IA TA child support Suspended 05/10/2016 INDEFINITE D51 Non -Payment of TA IA Child Support Nome: Dcrr, Scott Edward DL/ZD: 407AF6706 Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmentof 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 offldal 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 certlfy. 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: V r.,.�.4 4/[8/2016 .1NON Office of Driver Semlma Iowa Department of Transporallon Name: Dort, Smtt Edward DL/ID: 407AFS705 o+Apr, 12. 2016, 4:15%eetDiv of Criminal Investigation trAXl319330No.1658 P. 11 STATE OF • Ilel.a�!Criminal HistoryRecord Request Form Tot Iowa Dlvbloe ofCtttnlnal Invasaeatlon Support operatlont Bproltu, Ix Flcor 21513.71'' Street Des Melnal,lawn 50319 (633) 725.6066 (615)•776.6000 Fax Feb IS 19(03 Walver"Iformaffow wllhouta De relocrgblo, Por Codo of town. Ch 11CT Account Number; _9961-p Orwil"t From, yellow Cgb Atiowe City Iowo City, IA. 52244 Phonal (319) 338.9777 Faxt (319) 339.7302 [a t wolver from th"ALINUt of tha rewatt,* a complgN griminal htstory record 4th notnot 697.1• For eamnkt&ortminttl hteloryrecorg Information, is allowed by law, Alwoya d arthe "hunt walvarRdldad'dl I bvebytiva pooh tUaa ter ata Iavetdptita (M. Myglmlml hhtary data oeoteam walvar 0 0 a A*wltb No Dlrblon arewo" eeawh of the provided name and date ofbtrth rovealcdi toclapenl4 ❑ No Iowa Crlmlbel History Record found with T)CI Iowa Criminal History Record attached, DCI # '1 %1S 7 3 d DCI 101tldl0 �? C' DCT -77 (0812sn0) 0 0 Received Time Apt, 11. 2016 2:26PM No. 2081 Apr. 12, 2016 4:15PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00456730 MISDEMEANOR CONVICTIONS ONLY me 1 OP 1 DATE PRSNTRD- OCI:00456730 2016/04/12 NAME: DOR11,8COOTSK DORR,SCOTT BHWARD SCOOTER DOR SEX RAC HOT WGT RYR HAIR SKN POR 19630218 N W 600 155 BLU RRO MBD - GA ADDITIONAY, 113ENTIPSERS SC L WRIST CCN RECORD *** 01 ARRESTED 19930320 AOEHCYc IAOS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA236-2A ASSAULT H/INJURY TRK#: 005989601 COURT DISPOSITION AGENCY I110520150T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTEr IA236.2A PLED TO SIMPLE ASSAULT CHARGE CLASS; MISDRMEANOR. CONVICTION TRRN: 005989601 SENTENCE DISP EFF DAT FINE $50 19530922 02 ARRRSTUD 19950210 AGENCY: XAD62D100 CORALVILLB PD CHARGE NO- 01 IA STATUTE IA321J-2 DWS TRK#s 014616901 COURT DISPOSITION AGENCYI IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA321J-2 OHI CHARGE CLASSr MISDEMEANOR CONVICTION TRRBc 014616901 SENTENCE DISP EFF DAT JAiL 6D 19950217 PAY SURCHG FINE $500 19950217 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 POBL'IC W=RD BUT CAN ONLY BR 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 THS SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION kl— No. 1658 P. 2/2