The URL can be used to link to this page

Home My WebLink About17-084I P 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 1319) 356-So40 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO., / —7— OE54 (Office Use tmty) APPLICATION FOR TAXICAB I 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 applicatiop 3. Contact Information (REQUIRED) Email:jro4yrr bat./>fs 5a 6? 9 .: / Cell Phone: 30—agO-757 / (AII written communication sent via emai— I') '41' 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers. 6. Have you ever been arrested 1 charged with any misdemeanors and/or felonies in this State or elsewhere? A&f / 1tr wriat nappeneo to me cnarge r tuircie one) Convicted Dismissed Deferred Suspended Plead Guil Other Have you been arrested / charged with any traffic offenses in the last five years? ,Na Type of offense What happened to the charge? (Circle one) Where When 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? As Type of offense Where When 1 - ITIC-FNy 2017 AN 14 Pv -: . 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 I hereby cert'rfy that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 7y 22 ; j3 (. Of issued on 2-;i0-/y[expiring on %- / S - .Z I. 1 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 w��✓ �`z. - Date -! - y- / 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this l `7/ day of T.1 7-01-7. Public jG and f6r the Stat%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). Expiration date of Driver's license Signature of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MO THAN ONE FROM THE DATE LISTED BELOW. 4JR117 Signature of City Clerk or designee 1,D to Office Use Only Approved application DCI report State certified driving record Website update CITYOFIC-CITYCLERK 2017 APR 14 Pm2:11 CWOMoarvsrncrnw1.92014,,, dedooc 07/2016 0 C'J10WA')0T SMARTER 15IMPLER 105TOMER DRIVEN wln/w,iowadoibgov Inquiry Date: Customer 4/11/2017 3190100 Name; Boltz, Robert Adam Address: 13 DATA DR City/State: IOWA CITY, IA Page 1 of 2 Office of Driver Services PO Box 92D41 Des Moines, IA 50306-9294 Phooe:515-2449124 1800-532-11211 Fax: 515-239-1837 www.lewadot.gov Certified Abstract of Driving Record DL/ID #: 345AE5367 (IA) CDL Permit Class: None Class: D Audit #: 7809892 Issue Date: 02/20/2014 Expiration 07/15/2021 Date: Endorsoments: 31. Restrictions: Corrective Lenses Restrictlon None Supplement: History Information CLEAR DRIVING RECORD Name: Boltz, Robert Adam DL/ID- 345AE5367 CDL Permit Issue None Date.- 4111/2017 ate: CDL Permit 522403010 Mailing 13 DATA DR Address: None Halling IOWA CITY, IA City/State: 522403010 Date of 7/15/1958 Birth: EXP Sex: M Page 1 of 2 Office of Driver Services PO Box 92D41 Des Moines, IA 50306-9294 Phooe:515-2449124 1800-532-11211 Fax: 515-239-1837 www.lewadot.gov Certified Abstract of Driving Record DL/ID #: 345AE5367 (IA) CDL Permit Class: None Class: D Audit #: 7809892 Issue Date: 02/20/2014 Expiration 07/15/2021 Date: Endorsoments: 31. Restrictions: Corrective Lenses Restrictlon None Supplement: History Information CLEAR DRIVING RECORD Name: Boltz, Robert Adam DL/ID- 345AE5367 CDL Permit Issue None Date.- 4111/2017 ate: CDL Permit None Expiration Pate: None CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status; EXP DL Status: VAL CDLStstus: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status- None 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: Boltz, Robert Adam DL/ID: 345AE5367 r•'••'•"t:o%"4 4/11/2017 IOWA. c ).O.Tf CJ CITY®FIG-CIYYCt ERIC r Office of Driver Services 2017 APR 14 FM2:11 44,! � Iowa Department of Transportation 4/11/2017 yApr.13. 2U1/,, 4;2/PM,s,o,Uiv of Criminal Investigation Qd/,a,2O17 18:No.6243.a,j. 1,02,0,2 Criminal HistoryRecord Check Request Form r Yi DCl Acoount Number: (ifapplicab c) To: Iowa Division o! Criminal Invostigation brotr: City of Iowa City Support OperarionsBureau, 7s"Floor CE, -11y- 215Ii.71h Street 410 L Washington Street )its hloinesi Iowo 50319 �(S1aJ�Z3-60G6 le',ya-City— M24 (515) 725-6000 Fax _-- Phone: 319356-5041 Fax.- 319.356-5497 I mn reauestine an Iowa Criminal Hislory Record Chack on: cast Name (mm,d.4 First Name (mandeton.) Middle Name (ecummendcd 23a 1-�Z �—PoLef-i 04010 a--, Date of Biilbi (mandatong Gender (monda iny) Social Securi Number rceammended Witiver Information: Without a signed wniver from tine subject of the requcst, a eomplelc criminal history record may not be releasable, per Code of Iowa, Chapter 02.2, For complate criminal history record information, as allowed bylaw, always oblain a walversl nature from the subject of tho request. Waiver.Releasa: i ttraby Bivc perminion larnte above rcquesGng afficiai Io ewndual oa lows tthninal h)nory record check ntdl llle Dirhidn atCrimin.l hl.'eslit;etiou(DC). Any e4minol history dntaeaaurning me dail is maintabled by the DCl may benimed as allowed by law, ^ WftiVer' ighq(Ure: �'e Y� 14 Iowa Criminal History, Record Check Results (DCiu,aanly) r., As of �hl�J�l� a search of the provided name and date of billb revealed: (� No Iowa. (-Yiniaal History Record found wills DCI CRes Iowa Criwinal history Record attached, DCI 4 'Tai I :: CnV®F1CF0TVCLE 2617 AFIZ:14 PM2:1 ACI initials-4�— DCI -77 (08/25/10) RtceivtII Time Apr. 10. 2017 4:04PN No, 6807 _. pr. 13• 2017 4,27PM Div of Criminal Investigation DCI:00421715 NAME: SOLTZ,ROBBRT BOLTZ;ROBERT ADAM DOB SEX RAC 19580715 M W • ADDITIONAL IDENTIFIERS TAT L SHLD TAT UL ARM IOWA CRIMINAL HISTORY DCI 00421716 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 20'17/04/13 HGT WGT EYE HAIR SYN POB S10 190 BLV BRO FAR PA CCH RECORD *'4 01 ARRESTED/TAKEN INTO CUSTODY 19910629 AGENCY: IADS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA236-2-2A ASSLT•CAUSE INJ DOMESTIC TRU: L39YB9701 COURT DISPOSITION AGENCY: lAOS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA236.12 ASSAULT CAUSE INJURY CHARGE CLASS; MISDEMEANOR CONVICTION TRK#; L39968701 RESTITUTION SENTENCE JAIL 45D PROBATION lY SUSPENDED 225D BATTERERS AND SUBS ABUSE TRIM NT 02 ARRESTED/TAKEN INTO CUSTODY 19911016 AGENCY: IA05200DO JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-11 VIOL NO CONTACT ORDER TRK#; L39968801 COURT DIBPOBITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA236-11 VIOLATION NO CONTACT ORDER CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988801 SENTENCE JAIL 35D COURT COSTS 5D CREDIT FOR TIME 03 ARRESTED/TAKEN INTO CUSTODY 19911122 AGENCY: 1ADS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 owl IST TRK#i L39900901 DIBP EPP DAT 19911011 1991ID11 19911011 DIBP EFF DAT 19911022 19911022 No, 8243 P. 2 CIiYOFIC— TYCLERK 2017 APR 14 PHT 12 Apr.13. 2017 4:2VM Div of Criminal Investigation COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI -2ND OFF CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988901 SENTENCE JAIL 360D DL EARRED 6Y -PAID SURCHRG FINE $750 04 ARRESTED/TAKEN INTO CUSTODY 19920116 AGENCY: 1ADS20100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA706.2-2 -2-ASSAULT CAUSE INJURY TRK#: L39909002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA700-2-2 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39909001 SENTENCE JAIL 120D 115D CREDIT OS ARRESTED/TAKEN INTO CUSTODY 19920116 A AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 TA STATUTE IA702-18 WILLFUL INJURY TRK#: L39969101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2 ASSAULT WITH INT TO INFLICT SERIOUS INJURY CHARGE CLASS: MISDEMEANOR.CONVICTION TRK#: L39969101 SENTENCE PLEAD GUILTY 115D CREDIT JAIL 390D 06 ARRESTED/TAKEN INTO CUSTODY 19920705 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE TA -321A-32 DRIVE W/REVOKED TRK#: L39969201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-210 DCI 00421716 PAGE 2 OF 3 DISP EFF DAT 19920506 19920508 DISP EFF DAT 19920509 DISP EFF DAT 19920508 19920508 No.8243 P. 3 CITYOFIC—CITYCLERK 2017 RPR 14 PM2:12 ADr.13. 2017 4:26PM Div of Criminal Investigation DRIVING WHILE RVRD CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: L39989201 SENTENCE FINE $50 PAY SURCHRG D7 ARRESTED/TAKEN INTO CUSTODY 19971007 AGENCY: IA0520200 IOWA CITY ED CHARGE NO- D1 IA STATUTE IA124-401 ROSS SCHED I TRK#: 037284301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401(5) POSE CONTR SUBS -SCA I-MARIJ CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037254301 SENTENCE FINS $300 DCI 00421716 PAGE 3 OF 3 DISP EFF DAT 19921007 DISP EFF DAT 19980114 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 8Y THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS EECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION [,�[ No, 8243 P. 4 02017 RPIZ 14 P 2.12