The URL can be used to link to this page

Home My WebLink About18-007CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 3S6-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. Ifs Z:— (Office Use Only) APPLICATION FOR TAXICAB / 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 application Middle Last 2. Address (REQUIRED) //0, 2 Y, -;'L R& S-4 joukr 11,e 2,9 pp 3. Contact Information (REQUIRED) Email: �Lup fnn/%i9�t4� 9/rkta. eem Cell Phonal 3iGJ�3e-lo/ (All written communication sent via email) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: /o)lrs 6. Have you ever been arrested/ charged With any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 12an,PS71: c l z.r wee a- 412oll0 What happened to the charge? (Circle one) Convicted Dismissed Cpefem Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? .dd Type of offense What happened to the charge? (Circle one) Convicted Dismissed Where When Deferred Suspend Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? YC Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proy3(�e thecname( N �" + a - zr DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT E �TIFIED r DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C}11EF RENEW PTi You must apply for an individual Department of Criminal Investigation Report (form available upon requ�). 0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ry' 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Departent of Transportation a valid Driver's license number /�'G issued on 2d expiring onZa�20 . I understand that ff I falsely answer any questions in this application, that this apolication may be denied. agret 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 Tate 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applic2nf`— Date Z� NNYNNIY WFYYtitfNYtt1t1111NM111111111M1H1f-ff1N1t11f11fff1fi4tYlNRRf#YYtIrYYN11tYNYNYttt}Y1tlflttlfNfY'f1f1NNfIf1111111tf1flltttlft STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by AA 1 0611 on this ZZ day of To 1.. unf., vel it 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 l2 �s IZO2 n _J193 Signature bf Policb Chief or designee o,z?l% 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. Sighature of City Cle < or designee Date NN1rYNNt.l1N1l.NNYYYYIrh'Yff fttf 1NiYYNt.YYYYYNYNYNNtt-1fefNNYNN1N11NNf..NNf-fN1111fY}yRt�rliRlfeNNN1NyYYYNf}YN1tYIN11NYtN Office Use Only N C=_ Approved application CO DCI report DC State certified driving record n� N r Website update N rn .rn a 'v o a&WTAUIDRNBADGenae920148 na0e.o0C W 07/2016 I 01Jan.12, 20181( 9:55AK CebDiv of Criminal Investigation (Fa1()31933e,'N 0. 0698 P.. 1/2,1002 1 r, STATE OF IOWA " Criminal History Record CheckGo B Request Form Toe Iowa Divltlon of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7" Street Det Moiau,Iowa 50319 (818) 7284066 (515)725-6080 Fox DCI Account Number: _9967-F Of tppllabkj From: Yellow Cob of Iowa Cl P.O. Boz 428 Iowa City, IA. 52214 (319) 338-9777 Phone: ika. (319)339-7302 Loot Name Gnendeto First Name (moldoto Middle Name (wornmended) Go � i S OV e i ate'of Birth (mmauoy Ae of a search of the provided name and date of birth revealed; Gender Social Becurltv Number (Mtommeod o /' /9j� /wd'o� ll�Mala ❑Female' l alva) information) Without a slaned vvaiverfrom the subject of the'request, a domplete crlrolnal,hlstary record may not be rtltstable, per Cade of Iowa, Chapter 692,2. For�gleig criminal blstory record Informatlon, as allowed bylaw, always obtain a walvarsl nature prom the suh act of there ueat. WalW Releaye:I hereby alva pelmlulon for the above requeatns omcld td eondusl a fain criminal h[noryrrcord ohdok with tha Division of CrimInal Invetddalon(DCp.'Myen'tnin■lhinorydetdoonumin`methu IMaintained by%beDClMAY bereleased uallowedbyJaw. Waiver Slgnarturs; W AT a%WVJ iW 1 030 ma only) e i Ae of a search of the provided name and date of birth revealed; -' ❑ No Iowa Criminal History Record found with DCI we Criminal Matory Record attached, DCI � , r "� Dinitials CI 171 N q co DCI -77 (09/25/10) Received Time Jan. 11. 2018 10:15AM No -2714 E Jan.12. 2018 9:55AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00916989 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI:00916489 2018/01/12 NAME: COLLINS,ANTHOMY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19721205 M D 605 280 BRO BLK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD +*+ 01 ARRESTED/TAKEN INTO CUSTODY 20101130 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#: 1A00AOU01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE. IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS(SRMS COURT CASE ID: 06521 SRCR092689 CHARGE CLASS: NON CONVICTION TRK#: 1A00AOU01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20110330 PROBATION lY 20110330 UNSUPERVISED PROBATION TO DCS DISCHARGED FROM 20111110 DEFERRED JUDGEMENT 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 THE DC1. 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 No. 0698 P. 2/2 N O C= L_ -r =Grn p. m o; v /lk Iowa Department of Transportation woe Dt Di Serueces (Toll Free) 8lDO-532.1121 Box 9204, Des Mamas, U1 50306-92D4 515.244-9124 FAX-- 515-239,1837 Imp Mailing Address: 1602 YEWELL ST Mailing IOWA CITY, IA City/State: 522406000 Endorsements: Chauffeur 3 Restrictions: NONE Date of Birth: 12/05/1972 Sex: M History Information CLEAR DRIVING RECORD Name: Collins, Anthony DL/ID: 288AE5480 CDL Med Status: None Restriction None Supplement: 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: Collins, Anthony DL/ID: 288AE5480 1/11/2018 I. ' Office of Driver Services Iowa Department of Transporation K O Certified Abstract of Driving Record D c? Inquiry Date: 1/11/2018 DL/ID #: 288AE5480(IA) Customer #: 5342369 Name: Collins, Anthony Class: D ID Status: None Address: 1602 YEWELL ST Audit #: 8644200 DL Status: VAL o Issue Date: 11/25/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/05/2020 CDL Cert Status: None 522406000 Mailing Address: 1602 YEWELL ST Mailing IOWA CITY, IA City/State: 522406000 Endorsements: Chauffeur 3 Restrictions: NONE Date of Birth: 12/05/1972 Sex: M History Information CLEAR DRIVING RECORD Name: Collins, Anthony DL/ID: 288AE5480 CDL Med Status: None Restriction None Supplement: 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: Collins, Anthony DL/ID: 288AE5480 1/11/2018 I. ' Office of Driver Services Iowa Department of Transporation K O m D c? a —i ,... M tYt a o rn