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Home My WebLink About17-111 �• IDENTIFICATION NO. 1 7 — I 1 1 r 1, I 1 (Office Use Only) EEG 4IIIArs , •anliiritigoappri il APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First lddle Last 1. Name (REQUIRED) C\ a� e(\ ,� ' � 2. Address (REQUIRED) 3 a\ c) �* S\ C k l % 1 3. Contact Information (REQUIRED) Email: c' OS\Si114`46 II Phone: _f A 1• (Air written cornm tion sent via mail) 4a. Driver's License expiration date (REQUIRED) f b.Taxicab Business Name(REQUIRED) \JeN\c'w C_O‘\i) 5. Prior experience in transportation of passengers: (I '�c cx TS 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 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? \(e, Type of offense Where When 3 ___Fk ‘t .cV0-kl‘Q)c- K('S#k Vc)"\f\ \t)C&if 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? M\.\ Type of offense Where . erC '.y 611 a, .rir C77-[ t rim Zig 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please +e tib narrte) T.%) 4��JJ tit 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 herd..Mhp.t I have issued to me by the Iowa D-•- ent of Transpo ion valid Driver's license number v\Lk issued on 1 -xpiring on . I understand that if I falsely answer any questions in this application, that this appli -tio ay be denied. I agree t a in making this application, I consent to allow agents or employees of the City of Iowa City, lo a, 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 t!t��1ii,�,= Date 5Z\' \1 41111 STATE OF IOWA COUNTY OF JOHNSON ) ,�n Subscribed and sworn to before me by —411 c- ��. , •V loin `' on this '( day of I VIENEW s MYNotary Public innd for the State of I a Commission Number 729428 Mp Conrnl�� tpNn **tk*************** ****A A AAA*********************************************************r******************* 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 PirW245 Signature of Police Chief or desig ee 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. (�/'� g— ` —/1 ig ture of City Cler r designee Date c3' w V ****r**************r*+*++r++**+:+*****:********r**++********x+**+rr+r+r*++****+*+r*++*******r**rr++rr+**** • *r*%*********++*****r+++**r*r IP 310: abri Office Use Only t?""C 41111"16 a Approved application DCI report :V State certified driving record Website update tat CIerWTAXIDRIVBADGEAPPL92014amended.DOC 07/2016 , /047,0, IOWA DOT vv SMARTER I SIMPLER I CUSTOMER DRIVENW'1OWadot.gov Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www_iowadot.9ov Certified Abstract of Driving Record Inquiry Date: 8/18/2017 DL/ID #: 047BB8014 (IA) CDL Permit Class: None Customer#: 4472095 Class: C CDL Permit Issue None Date: Name: Montgomery, Ryan Dean Audit #: 1610296 CDL Permit None Expiration Date: Address: 3121 6TH ST SW APT 4 Issue Date: 02/14/2017 CDL Permit None Endorsements: Expiration Date: 08/12/2018 CDL Permit None Restrictions: City/State: CEDAR RAPIDS, IA Endorsements: NONE ID Status: None 524044094 Mailing 3121 6TH ST SW APT 4 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing CEDAR RAPIDS, IA Supplement: CDL Permit Status: ELG City/State: 524044094 Date of Birth: 8/12/1990 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 06/09/2016 07/07/2016 Improper Registration IA Black Hawk Name: Montgomery, Ryan Dean DL/ID: 047BB8014 (IA) 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: Pk* OW 'iEHICif��,`hi 7dr. AA,.,,....,••'4 it 8/18/2017 g *: : * ii7,1446.4dOell,47)PP " rig°. ifiin rcg .,ex' .��_�\/ Office of Driver Services _ qt`F ORIVEt Iowa Department of Transportation cp 13 N till Name: Montgomery, Ryan Dean DL/ID: 047BB8014 (IA) PrAug, 23. 2011„10: 26AMC1e,Div of Criminal Investigation 08„8,201 12:4.N.0. 8884,ya,,P.r 12/1,2 D2 I `' rr4c 1 STATE OF IOWA .(6\(%,°,'.1.„..).4,, b y a { { �g• ,, \. Criminal History Record Cf-neck `t?-:t ;ii‘?",:...-;•t, .. ;�1t . : ?:ecfo(',stFobs �,,t•`_' , .A_;4'. ')i f7.g nartic•. DCI Account Number: 4-Icat2' _, r' (if yi)pticable) To: Iowa Division of Criminal Investigation From; City of love City Support Operations Bureau, 1”Flnor City Clerk's Office 215 F.7'"Street _410 E.Washingtotr Street _ Des Moines,Iowa 30319 -' (51;9 725-6t1 - Iowa City, IA 52240 (515)725-6080 Fax Phone: 319-356-5041 Fax: 319-356-5497 - — 1 am requesting an Iowa Criminal History Record Check on: _ Last Name (mandatory) First Name(mandatory) Middle Name(recommended) Date of Birthmandatory) Gender(mandatory) Social Security Number (recommended) %•A 1c'\R0Male ❑Female ) ^- i. 0 Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releocablo,per Code of Iowa,Chopter 692.1,For compioto eritr-9r-c:9letory roeord•Inforrno;dort—,oa-allowid-bytaw;Mwaya - • - '----- obtain a waiver signature from the subject of the request. Waiver Release:I hereby give permission for the above requestine official to conduct an Iowa criminal history record cheek with the Division of Criminal Investigation(DCI), Any criminal history data concejting me tl�ef's maintaine I may be released os allowed by law, Waiver Signature: la& �� \ O,L ,1 - -_- N4Fa Iowa Criminal �9Calstor . Record Check Results , C1 ') lt..a. 2 -2317 As of L, a search of the provided name and date of birth revealed: :'‹ 3 rn > No Iowa Criminal History Record found with IDCI Y'' I 0 Iowa Criminal History Record a ached, DCI# • DCI initial DCI-77(08/25/I0) Received Time Aug, 18. 2017 12:21PM No. 5147