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HomeMy WebLinkAbout18-003IDENTIFICATION NO. _ l 1 — �(Offtce sU e Only) ''WIll � -SO CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 Fast Washington Street Iowa City. Iowa 52240-1826 Failure to Complete the "required" information Will resl//f in denial of the appllcatioli (3 19) 356-5040 13191 356-5497 FAX 1. Name (REQUIRED) I lei tJ Ki 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: .NNt 5 via email) 4a. Driver's License expiration date (REQUIRED b. Taxicab Business Name i REQUIRFD) ) X I 5. Prior experience in transportation of passengers: Phone: '/l Jai Y D 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? ✓; 5 Type of offense Where What happened to the charge? (Circle one) 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? Type of offense Where When --: 1 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the nam*) .1 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 certify thpat I have issued to me by the Iowa �g (,`J J ) p issued on falsely answer any questions in this application, that this a consent to allow agents"or employees of the City of Iowa documents relating to this application, and I fur agree tl limes with all of the(\{�,',ovisions of Title 5, Chaptler Zee Signature of Applicairi 1�/ `� 1 STATE OF IOWA ) COUNTY OF JOHNSON ) epartment of Transportati n valid Driver's license number At i 9expiring on a 2Z I I, I understand that if I cat on may be denied. I gree that in making this application, I y, Iowa, in their discretion, to examine any and all records and it authorization to be a taxicab driver is granted, to comply at all Code. (Needs to be signed In front of a Notary Public) Date 3/1-5 17 ................... ........ ............... .......................... .... *. Subscribed and sworn to before me by 1 e vk n iS 1�- eti- , t on this i ri day of fA_o� r f . 7n r'7 . 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 48D 3- J6 -1-7 Signature of Mlice Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MO THAN O Y ROM THE DATE LISTED BELOW. &L17 Signature of Ciry Clerk or designee I Date Approved application DCI report Stale certified driving record Website update T Office Use Only 0&wrMioaweADG�LM143�o 0712018 r� n 0&wrMioaweADG�LM143�o 0712018 CA001 A DOT SMARTER I SIMPLER I CUSTOMER DRIVEN vvww.iowadot�gov Office of Driver Services PO Box 92041 Des Momes, IA 50 306-9 20 4 Fhone 515-244-9124 1800-532-1121 1 Far. 515-239-1837 www gwadol gov Inquiry Date: 3/15/2017 Customer #: 3588195 Name: Pettit, Dennis Edward Address: 601 KIMBERLITE ST City/State: TIFFIN, IA 523409384 Mailing 601 KIMBERLITE ST Address: Mailing TIFFIN, IA 523409384 City/State: Date of Birth: 9/22/1970 Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 556YY0404 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Date: CJ Audit #: 7895115 CDL Permit None Expiration Date: Issue Date: 03/18/2014 CDL Permit None Endorsements: Expiration Date: 09/22/2018 CDL Permit None Restrictions: Endorsements: 31- ID Status: None Restrictions: NONE OL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG History Information CDL Cert Status: None CDL Med Status: None :nation Date Conviction Date ACD Explanation County JUR 11/22/2015 12/08/2015 S93 Speed Johnson IA Name: Pettit, Dennis Edward DL/ID: 556YY0404 Pursuant to Iowa Code 4321.10, 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: Pettit, Dennis Edward DL/ID: 556YY0404 r.""..... [r'4w 3/15/2017 D. 0. T.: 10. , tf'BIIIwi A Office of Driver Services -1 `,aw...V Iowa Department of Transportation -,D CJ Mat. 9. 1011 1:01YM 07/x7/Ta17 12:427 PAA Div of Criminal Investigation No. 5331 P. 1/5 DCI IOWA INuua STATE OF IOWA Criminal History Record Check Request Form To: Iowa DMdoa of Criminal Investigation Support OperaWou Bureau, l" floor 215 G 7o Street Ilya Metow, laws 50311 (515) 716066 (918)'72 -010 Fag I nm rmuestino an Iowa Criminal Hislom Record Check on: I)Cl Account Numbor:8—� Prom: �arG.S �a.XI II U 54vtraa D'r' oJw /T 5 FYI o no■g: ,( 319) 338- iMq •— Faa:,. 314 SSS- i9 Last Name mmmiiw 1 First Nome anaga Middle Name itrwwowigea Dak��ofBirth in Geadergwu Social Security imixorrirwomy / �I - ZZ -7C) Mak 01remale Number 4 b - 01 - ©zb3 Watper Infonmfbn: Without a alped waiver from the subJect otthe request, 4 complete erimloal abtory record may not be rolessable, par Code of laws. Chapter 411.2. For complete eetmlaal hWary regerd latormsdon, as allowed bylaw, always obrq4a a waiver al sla a from the aubloct~r6quest, Waiver Release lbmbygin PArwi laoeab cRp Wof1leWWwrmIitmI cd 1W pWue chakao"rriv:ienofcnminal Invuklgwim(DCI). Aaywali"hhnry couowninrokeart eabea:wpbflie DCI m1, be du i oW. Waiver Signor F (DCIw aWy) As of -9 ^ L . a search of the provided lame and date of birth revealed: I ❑ No Iowa Criminal History Record found with DCI _ N Iowa Criminal History Record attached, DCI q a. DCi initials rn l "� 77 (08/25/10) — Reevivcd Time Alar 7 70,17 1) AUM Nn F117 f/lar. 9. 2 1) 1 1 2.0&PM Div o1 Criminal Investigation IOWA CRIMINAL HISTORY DCI 00434455 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OR 4 DATE PRINTED - 2017/03/09 DCI:00434455 NAME: PETTIT,DBNNIS EDWARD PETTIT,DENNIS EUGENE DOE SEK RAC HOT WGT EYE HAIR SKN POS 19700922 M N 600 175 HAZ BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE! Y SC ABDOM SC CHEST DISP EFF DAT 19920508 19920508 19920506 DISP EFF DAT 19961121 No. 5331 P. 2/5 N c� �'J v CCH RECORD •*- 01 ARRESTED/TAKEN INTO CUSTODY 19920715 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA321J-2 ONI TRW L41392601 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA121J-2 ONI TRW L41392601 RESTITUTION SENTENCE DEFERRED JUDGEMENT COURT COSTS SA EVAL PROBATION IY 02 ARRESTED/TAKEN INTO CUSTODY 19960729 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708-7(3A2) HARASSMENT IGT / DOMESTIC ABUSE HARASSMENT TRKN: 019233801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-7(2) HARASSMENT 3RD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 019233801 SENTENCE PINE $75 03 ARRESTED/TAARN INTO CUSTODY 19970316 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J-2 DNI 2ND TRK#: 025662101 COURT DISPOSITION AGENCY: lAOS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA32IJ-2 ONI 2ND DISP EFF DAT 19920508 19920508 19920506 DISP EFF DAT 19961121 No. 5331 P. 2/5 N c� �'J v w W Mar. 9. 2017 2:06PM Div of Criminal Investigation DCI 00439155 PACE 2 OF 4 COURT CASE 111: 06521 OWCRO43979 >a CHARGE CLASS: MISDEMEANOR CONVICTION TRKY: 025662101 1 41 SENTENCE DISP EFF DAT JAIL 7D 19970706 FINE $150 19970700 PROBATION lY 19970706 SUSPENDED 53D 19970708 8/27/90 -CONTEMPT -10 DAYS JAIL 04 ARRRSTED/TAKEN INTO CUSTODY 20000912 AGENCY: IA052DDOO JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA216-1 ASLT CAUSING INJURY DOMESTIC ABUSE 2ND TRK#: 100018301 COURT DISPOSITION AGENCY: IA052025J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(3)(B) DOMESTIC ABUSE ASSAULT - 2ND OFFSNSS - AG CHARGE CLASS: MISDEMEANOR CONVICTION TRK#e 100018301 SENTENCE DISP EFF DAT JAIL 1BOD 20010124 FINE $500 20010124 PROBATION 2Y 2DO10124 SUSPENDED 1700 2DO10124 500 of FINE SUSP 05 ARRESTED/TARSN INTO CUSTODY 20010808 AGENCY: IA04110000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321-561 DRIVING WHILE BARRED TRK#: 033753001 COURT DISPOSITION AGENCY: IAD46015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06481 AGCR007517 CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 033753001 SENTENCE DISP EFF DAT JAIL 5D 20020301 5 DYS JL/CRD TM SERVD/F,SC,CC k CT APP ATTY FEE FINE 20020301 No. 5331 P. 3/5 N O >a 1 41 �n —0 J� W - W Mar. 9. 2017 2:081'M Div of Criminal Investigation 06 ARRESTED/TAKEN INTO CUSTODY 20011027 AGENCY: 1AD520000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA321-560 DRIVING NHILN BARRED TRW 300380601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT N0- 01 IA STATUTE: IA321.561 DRTVINO WHILE BARRED HABITUAL OFFENDER 1978 COURT CASE Imo: 06521 PEOR060306 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100350601 SENTENCE JAIL 60D FINE $500 PROBATION lY SUSPENDED 45D 07 ARRESTED/TARRN INTO CUSTODY 20061006 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA706.2A DOMESTIC ABUSE ASSAULT TRK#: 101998501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(A DOMESTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSM066930 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101998501 SENTENCE JAIL 3DD COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA664A.7(4) VIOLATION OF NO CONTACT OR PROTECTIVE ORDER COURT CASE ID: 06521 SMSM066930 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101998502 SENTENCE JAIL 7D OB ARRBSTRD/TAKEN INTO CUSTODY 20090520 AGENCY: IA0520200 IOWA CITY PD CHARGE NO. O1 IA STATUTE IA124.4D1(5) POSSESSION OF A CONTROLLED SUBSTANCE TEEN; 1AG049VOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) OCI 00434455 PAGE 3 OF 4 DISP EFF DAT 20020221 20020221 20020221 20020221 DISP EFF DAT 20061220 DI8P EFF VAT 20080711 No. 5331 F 4 N O J _ 1 � CJ Mar. 9. 2011 2:06PM Div of Criminal Investigation No. 5331 P. 5/5 DCI 00434455 PAGE 4 OF 4 POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO83530 CHARGE CLASS: MISDEMEANOR CONVICTION TRW 1AD049VOI LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 2D 20080820 DL REVOKED 180 DAYS FINE $315 20080620 09 ARRESTED/TAKEN INTO CUSTODY 20080520 A AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA706.7(2) BARASSMENT / IST DBO, - 1909 TRKN: 1A0049WO1 COURT DISPOSITION AGENCY: 1ADS2015J JOHNSON CO DIST COURT COUNT NO. 01 TA STATUTE: IA708.7(2) HARASSMENT / IST DEG. - 1989 COURT CASE ID: 06521 AOCRO82316 CHARGE CLASS, MISDEMEANOR CONVICTION TRKO: 1A0049WO1 SENTENCE DISP EFF DAT FINE $625 20081017 SUSPENDED PRISON 2Y 20081017 PROBATION 2Y 20081017 SUPERVISED PROBATION W/ DCS. PRISON 2Y 20061017 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 BY TOE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. ` DIVISION OF CRIMINAL INVESTIGATION