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Home My WebLink About17-063CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. l --I — blp 5 (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 3. Contact Information (REQUIRED) Email: (All written communication stint via email) 4a. Driver's License expiration date (REQUIRED) 2 lU% 1-3 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?VPS Type of offense Where When C IuSS 0 Rimy �ohNs,>�, Coub4 3 -too lU iii oOC 6°hhC-70V1 co,' Lc)( -)o What happened to the charge? (Circle one) Convic�te Dismissed Deferred Suspended Plead ((Guilty �� Other Have you been arrested / charged with any traffic offenses in the last five years? /T� 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? Ain Type of offense Where When N 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the f3rne(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE C2 IFI DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEVIEW M You must apply for an individual Department of Criminal investigation Report (form availakW�' 4orWqueo (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I he certify that I have issued to me by the Iowa D partJ��ent of Transportati0� val' Drivers license number (3�.�5?� issued on tl�zh�/lei expiring on L Z J. 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant TM27 yr dj ii/Y) Datekmlelll � STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by llAu ne 1)o on this day of J m Public in alild for the Stale 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 6g' Z /201-1 Signature of Police Chief or designee v/z2/e;7 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 of City Clerk or -d 4k-)((1 Date »»fYllftRfl3<#4'L#tf»fff»ftt�tlf�if�e�'flff-ItYftlffftf»iRtf»»f»f»�ft�Mfl�etf�-/�ff! ^' O Office Use Only a ro 71 :v __4 ao Approved application DCI report State certified driving record Website update aerv(TA)UMAW)GEAPar9201�ded.DOC 072016 �C"') J m s aerv(TA)UMAW)GEAPar9201�ded.DOC 072016 C410WADOT vwvw.iowadotgov SMARTER 1 SIMPLER I CUSTOMER DRIVEN Inquiry 4/19/2017 Date: Customer 678915 Name: Vonstein, Mark Wayne Office of Driver Services PO Box 9204 1 Des Moines, 1A 50306-92174 Phone: 515-244-9124 1 8DD-532-1121 I Fax: 515-239-1837 WWW-l0Wad0l.g0v Certified Abstract of Driving Record DL/ID #: 013BB2180 (IA) CDL Permit Class: None Class: D Audit #: 9596504 Address: 139 HOLIDAY LODGE RD Issue Date: 11/24/2015 Expiration 12/07/2023 City/State: Mailing Address: Mailing City/State: Date of Birth: Sex: Convictions Date: NORTH LIBERTY, IA Endorsements: 3 523179518 CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: 139 HOLIDAY LODGE RD Restrictions: Corrective Lenses DL Status: Restriction None CDL Status: NORTH LIBERTY, IA Supplement: CDL Permit 523179518 Status: 12/7/1972 CDL Cert Status: M History Information None None None None None VAL None ELG None CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 08/19/2012 ;09/18/2012 IS92 iSpeed !Johnson IA Name: Vonstein, Mark Wayne DL/ID: 013BB2180 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: ^� o_ O �� -.a 7a _�rFtllClf�`y41 r 4/19/2017 --q C") �j M '� �,/ ®BIVEi =r Office of Driver eof Services ransportation C� Iowa Department Apr.21• 1011 1I: UI PM Uiv of Criminal Investigation No. P. 1/4 FY.e.... _..• ... Y... ....s CI9Y.• .....�-. .-... Da/16/2017 10:6.. -93e. /DD3 STATE OF IOWA Criminal History Record Ched Request Form a4 DCI Account Number; _`loot -C (if applicable) To: Iowa Division of Criminal Investigation From: Ctty of IOWA Ciiv _ Support Operations Bureau, I" Floor City Clerk's Office 215 B. 71" street 410 E. Washington Street Des Moines, Iowa 50319 — (913)129=60 (5I5)725-6090 Fax Phone: 319-356-5041 Fax: 319-356-5497 I Am renllettine, an Tn%va n.—A r,.—I ..... Last Name (mandatory) _ Ud5 tei First Name mandatory) NjQe Name (recommended) Bate of Birth (mandato r) Gender (mandato Y) SSecuri Number (reeon,mendea) l �/v G Z Elmale ElFemale 11&3-/ 3 -rag S Waiver lnformafion: Without a signed waiver from the subject of the rcquest, A complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For co_ mnlete criminal history record Information, As allowed by late, always obtain a waiver signature from the subject of the request. Waiver Release: I hereby give permission for the above "quelling oRcial m eonduel an Iowa cmninal history record cheek eith the Divition of Combal Investigation (DCI), My aiminl history dale wncerning aw that is mainleintd by the DCI may be telemed see 211OWed by law, Waiver Signature: ��( � Iowa Criminal History Record Check Results of �� ' (� a search of the provided name and date of birth revealed:No Iowa Crilnival History Record found with ACI F(DcJAs r t Iowa Criminal History Record attached, ACI �� ro' _ . m r,3 ACT initials_ uct-f f (ugltvlU) Received Time Apr,19. 2017 10:27AM No.7460 Apr.21. 201/ 12:01YM Div of Griminal Investigation No.664U Y. 2/4 ' IOWA CRIMINAL HISTORY DCI 00609815 FELONY CONVICTION PAGE l OF 2 DATE PRINTED - DCI ;00609815 2017/04/21 NAME: VONSTEIN,HARR DOB SEK RAC HGT WGT EYE HAIR SKN POB 19721207 M W 506 210 BRO BRO FAR IA ADDITIONAL IDENTIFIERS SC L LEG CCH RECORD •** 01 ARRESTED/TAKEN INTO CUSTODY 19991110 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-4 WILLFUL INJURY TRK!(: 035757901 CHARGE NO- 02 IA STATUTE IA702.2(3)-2 ASSAULT - USE/DISPLAY OF WEAPON TRK#: 035757902 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.4(2) WILLFUL INJURY - CAUSING BODILY INJURY CHARGE CLASS: FELONY CONVICTION TRK#: 035157901 RESTITUTION SENTENCE DISE EFF DAT RESIDENTIAL FACILITY 365D 20001222 FINE $750 20001222 SUSPENDED PRISON SY 20001222 PROBATION 3Y 20001222 PRISON 5Y 20001222 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708.2(3)-2 ASSAULT /USE/DISPLAY OF A WEAPON -1999 COURT CASE ID: 06521 FECRO53425 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 035757902 SENTENCE DISP EFF DAT FINE $500 20001222 SUSPENDED PRISON 2Y 20001222 PROBATION 2Y 20001222 PRISON 2Y 20001222 0 PROBATION EXTENDED TO 12/22/03 20021222 p Za AN ARREST WITHOVT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD -4 MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF C-) N IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW 7i � J '<i; ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION TNIS RECORD IS �x BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD O R N 1. L I. L V I I I L• VL I I Y I V I V V I b I I III I (I a 1 1 11 v G 9 l 1 6 a l I V 11 COVERS THE SUBaRCT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION I". VVYV I - J/ Y