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Home My WebLink About17-105 IDENTIFICATION NO. 1 — 1 0 5 II 1 L 1 (Office Use Only) ,_ ®asst : III APPLICATION FOR TAXICAB I 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 Middle 1. Name(REQUIRED) Ir7'ti Q , �e/f 2. Address (REQUIRED) f' d, /5-Oa I vv-d-. t.A 3. Contact Information (REQUIRED) Email: 65 , s� hr,,, 23(, Cell Phone: �•5' `�3d C �% 2M -.—� (All writ-fen communication sent via email) C 4a. Driver's License expiration date (REQUIRED) 1/z y b.Taxicab Business Name (REQUIRED) Yt.1 -aJ ( 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Ah) 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? Pc" 9.6-3 T e of off nse Where 5p Mu QthM, Co . IIrhen 5 . o(3-) What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other r•s 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? .1 O Type of offense Where 4/414nswami C m 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro�he time( 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 4. •r ` APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa p ment of Transport i n valid Driver's license number .certify 5 )(X S 1 issued on � 7 expiring on � I O! - . I understand that if I falsely answer any questions in this application, that this appl at on may be denied. I a re 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 Date �S I I 1"f-• ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by ► C_ _ rbwx�rton this / I day of 7 INENDY S.MgyE- Notary Public in nd for the State of a -" ,er 9428 My Commi=:ion�Aires ********,1***,****************** - - ************************************************************************************************ 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 Ci of Iowa City(Title 5, Chapter 2, City Code). Expire'on date • Driver's license So2 /11. IIIIA 1 Si. at e of designee f ief or 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 ature of City Clerk,oridesignee Date ********************************************************************************************************************* ********************** d Office Use Only y "" Approved application is "' r� 7.40 � DCI report x,. 1 ` s State certified driving record Website update %' c? Clerk/TAXIDRNBADGEAPPL92014amended.DOC 07/2016 coo, ow T SMARTER I SIMPLER I CUSTOMER DRIVEN WWW.IOWaCJOt.90V Office of Driver Services PO Box 9204 I Des Moines.IA 50306-9204 Phone:515-244-9124 i 800-532-1121 I Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry 8/2/2017 DL/ID#: 428XX5189(IA) CDL Permit Class: None Date: Customer#: 4327574 Class: D CDL Permit Issue None Date: Name: Fowler, Eric Dean Audit#: 6310503 CDL Permit None Expiration Date: Address: 122 1/2 N DEVOE ST Issue Date: 09/18/2012 CDL Permit None Endorsements: Expiration 08/23/2017 CDL Permit None Date: Restrictions: City/State: LONE TREE, IA 527557742 Endorsements: Chauffeur 2 ID Status: None Mailing PO BOX 33 Restrictions: Corrective Lenses, Left DL Status: VAL Address: and Right Outside Mirrors Restriction None CDL Status: None Mailing LONE TREE, IA 527550033 Supplement: CDL Permit Status: ELG City/State: Date of 8/23/1973 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 11/02/2012 11/15/2012 S92 Speed(10 mph&under in 35-55 mph zone) IA Muscatine Name: Fowler, Eric Dean DL/ID:428XX5189(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: �.'''''''.:fao+I 8/2/2017 s*: IOWA ¢ 7,7,6466,j ,% , Office of Driver Services ... oigoalit Iowa Department of Transportation,"-.4 CI c"-‹ 111Name: Fowler, Eric Dean DL/ID:428XX5189 (IA) rn 9^` th. t�`C11 Aug. 8. 2017 9: 33AM Div of Criminal Investigation No. ill i 2 r. L Frorr,¢City of Iowa City Clerk Office 319 36e6497 06/03/2017 op:12 $t1133 P.002/002 , , ) fri l: i° . I� r7,Jce tp� -;Fir STATE OF RJVA fiF .` •-fi\ a/ c � ' His '- 1 K • „ti' :., CY1fiatoryeco)recr . '1 ; , �`G �, 'fi:/ Vv,,,,,,,,,sir',. ; f 1.VC raC1 Account Nur,mber: 1.71”O o — T (ifapplicnble) To: Iowa Division of Criminal Investigation From: City of Iowa City ___ _____ Support Operations Bureau,1"floor City Cleric's Office 215 E.7i1j Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 lows IA 5 City, 2240 _— (515)725-6000 Fax Phone: M9-356-5041 Fax: 319-356-5497 I am re uestin: an Iowa Criminal History Record Check on: Last Name (mandatory) —,_ First Name(mandatory) Middle Name(recommended) -- QWk•-t.„t•- �.-.�4 , Date of Birth(mandatory) Gender(mandatory) Social Security Number(fcconwneode1 —Z j " Male °Female S73`) 3 Li5 J Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable, per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtainYa waiver signature from the subject of the request. l _ � r'Giver–F,ekaseruhcrebygive pennissionfortheabovt-tcycfling offelal'lo-conduot`an'Iowa CHAMP '•• .rd check•willt'dhrDivision'of Criminal-- Investigation(DCI). Any eriminat history data concerning me II. '. . eared by the• I may be : ed as allowed b law, -44‘: <:2 .." -‘ 0.,(lt .... Iowa Criminal History Record Check Results • 1 (DCIuse only) As of I. " 0 ' ( -7 , a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI 3 ■ 0 Iowa Criminal History Record attached, DCI# __ -<tri23. r C:)?, = m DCI initials 'IT,-co DC1-77 (08/25/10) Roro ;vP1 Tima Qua 1 7017 A.l17AM tin 6(11A