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Home My WebLink About17-146IDENTIFICATION NO. l 1 (Office Use Only) '.ED APPLICATION FOR TAXICAB / MOTORIZED PEglpA@ ,EHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between -8 a.rr44�Ft�`IIII p.m., Monday- Friday) 410 East Washington Street ,, Iowa City. Iowa 522401826 Failure to complete the "reouired" information will� aV iklnial of the application (3 19) 356-5040 UVVC ' luwa (3 19) 356-5497 FAX First Middle Last 1. Name (REQUIRED) (Le Y{^ PaSWUSS1k?rt 2. Address (REQUIRED) _ 7 �l OleAFa 3. Contact Information (REQUIRED) Email: )"atS%J �� $ mKr'1, G07 Cell Phone: 3 M -325-34C0 (Ah written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /2 — (i-- 20 2 2 b. Taxicab Business Name (REQUIRED) N -'- T - 5 V1211 AZ✓ L�4 5. Prior experience in transportation of passengers: ac ! Iea rs res Q,,.Q .g4 w*" 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? h G 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? N C Type of offense Where When N lJ 0 What happened to the charge? (Circle one) N3 I.. Convicted Dismissed Deferred Suspended Plead Guilty' C'Ottw 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? - ki Type of offense Where WheA'' j 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 ILED I hereby certify that I have issued to me by the Iowa .Department of Transportation a WOMi%ft license number 4-?OWWfs~�� issued on /0-zQ—(5expiring on l2 -(R-2022 1 understand that if I falsely answer any questions in this application, that this application may be denied. I agree th@itq rUkiig this application, consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to e��rigjppylWOall 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 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by c r Mi S r>u�Se Lon this Zkd� day of K. IN 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). date Dr' license zi f rl L Z 2 f Poli hief or desicnee 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. 44 Z/G Sig re of City Clerk or designee TDate N C� ff»ffHflHflfffffff11X1»lfflffHfHHff111fHffiffrrHf.flrlfflNMfr»ff»rH»1H11If MfIfr111f1f11fH�f ,�H1HH1� —T1 Office Use Only .In v w Approved application M 4 DCI report ry State certified driving record�- Website update Cle RAXIMVBADGEA 92014emrbe0 o 0712016 4' Iowa Department of Transportation (Mrce LN UDv(,r xrnccs 11dl I rw,,) (M 532 1121 NU ND• 9204. Ues Manes. ;A 503Db 9234 515 144 I11124 FAX 515 239 1831 CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 430W W8556 Pursuant to Iowa Code 4321.10, 1, 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 1 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: F,t �'•4• 11/28/2016 QFC IOWA `t C21o1 ��.. D. 0. T.�'�' M BRIY41 = Office of Driver Services Iowa Department of Transpora[ion Name: Rasmussen, Perry Allan DL/ID: 430WW8558 Certified Abstract of Driving Record Inquiry Date: 11/28/2016 DL/ID #: 430WW8558 (IA) Customer #: 1306832 Name: Rasmussen, Perry Class: D ID Status: None Allan Address: 414 Pleasant St Audit #: 8571396 DL Status: VAL Issue Date: 10/29/2014 CDL Status: None City/State: Iowa City, IA 52245 Expiration Date: 12/18/2022 CDL Gert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 414 Pleasant St Restrictions: NONE Restriction None Supplement: Date of Birth: 12/18/1960 Mailing Iowa City, IA 52245 Sex: M City/State: History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 430W W8556 Pursuant to Iowa Code 4321.10, 1, 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 1 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: F,t �'•4• 11/28/2016 QFC IOWA `t C21o1 ��.. D. 0. T.�'�' M BRIY41 = Office of Driver Services Iowa Department of Transpora[ion Name: Rasmussen, Perry Allan DL/ID: 430WW8558 bw �-F.,...... �..r -� •o,.��,..,ay Ci c•. vuu.s a�. 1v2a �201p ttOo .9�9 p.00II/002 STATE OF IOWA Criminal history Record Check i Request )Form To: lo,.a Division cfCrimillol lnvcsllgation Support Operations Durtau, V Fluor 215 H. 70 Street Des Moines, Iowa 50319 _. (515) 725-6066 _. .. (515) 72S-6080 Fax I am re0usefina an Trios Crindnal H:e,...., U.—A M-1. DO Account Number: Qp�Z (i(applioablc) From: City orlowa City _ City Clerk's Office_ --- 410 E. Washington Street _.. 10 CIPIy. _!&.4-W. Phone; 319-356-5041 Fac: 319-3563497c _ OP 1 Last Name mandatory) I First Name manes Miid�dle Name 4bl RCALF MUS—h Perry fl ��ah 10(;, ity.Clcrk Date of Bu th (mandatory)Gender (mandatory) Social Seemi • Number fre it g_r'o IJMaIc ❑Female �f85-90�G�f7� iWailler Injormaftou: Without s signed waiver from the subject of rhe request, a complete criminal history record may pot be releasable,ptr Code of lows, Chepter 692.2. Fm complete criminal history record Information, as allowed by law, always obtain a waiver signature from the sub eat of the request, Waiver Release: I hereby sive paniission for the above 114vefims; afloat t to r onduu an town criminal history reead check an ilia Division of Crin*111 Inveallalilan (DCI. /my alminal MMM dash ebmeamlhs me that is by Ilia DCI may be released as allowed by law. Imain��taf1in��ed Waiver Signature: cit is , Iowa Criminal History Record Check Results As of d / 3 011 I b , a search of the provided name and date of birth revealed: L No Iowa Crimutal History Record fotutd with DCI ❑ Iowa Criminal His(ory Record attached, DCI # DCI initials,G jam_ vol -77 (utu25110) Received Time Nov -28, 2016 9:42AM No.8640 reel use mdy)