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HomeMy WebLinkAbout12-004(3 19) 356-5497 FAX First/� Middle Last 9 1. Name Ffc 2. Mailing Address Z L,t/c '56'W ft r/ 5 zn'olq r _� 3. Telephone: Home .3E2 — 2g2F Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _46de Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? e4l© Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense ,t (9 Where When 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerMa ddv dg 09/2010 /'�- — Authorization Number T r 1 (Office Use Only) ar * ®rte L CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 East Washington Street between 8 a.m. to 3 p.m., Monday – Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX First/� Middle Last 9 1. Name Ffc 2. Mailing Address Z L,t/c '56'W ft r/ 5 zn'olq r _� 3. Telephone: Home .3E2 — 2g2F Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _46de Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? e4l© Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? Type of offense ,t (9 Where When 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerMa ddv dg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number '1 �"' i Z <_ C- i L- / . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree 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 a license 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 i — // — /7 RRR4R�F14ff 1H4H1HlH4YR##RHHHf4444i-Yf 1HHif11#fHHHHIf!!f 1f4f4ffH4Hfff1Hf4411f fflllffflHfftlfll`Hlfl4RRlf4HHH!!H!!!f HIfHHIIf STATE OF IOWA ) COUNTY OF JOHNSON ) scribed and sworn to before me by C0.Lk CDS fie! a On this0� day of I Z -- -- Y. TUTTLE c zi otary Public in and for the State of Iowa #tf#4#HYff*fH***%%*%***#**HtfHf###fff#}1ff1f#Hf#4ffkffHf##fY##Yf##ff4H#4i#fffH##ftfff#f4f##fitf#f4#f#}}!ff###4f#f##4ffff#Hff#fff#lklf%# I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Sfgnatufe of Police Chief or designee ��/e Signat of City Clerk or designee 1-11-12— Date 11/ZDate Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. R44R44HRf41f.f1ffH1Hfl4#FR4R.H.HR44Hf4f.fHHl.4H.H.ff..HH.H..4H.fH.f f!f f f f f f fHHHlffflf f ff if f f fflflllHfffiif4hRRR4H1l4H%H!H Office Use Only Approved application DCI report State certified driving record Website update denAwdarobad�2=o - 09/2010 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1921 PO Box 9204, Des Mmes, 1A 5030B-9204 515-244-9124 FAC: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/4/2012 Name: . Costello, Jack Cochran Address: 280 Wilson Ave Sw City/State: Cedar Rapids, IA 52404 DL/ID #: 809ZZ6961(IA) Class: A Audit #: 3410861 Issue Date: 06/16/2009 Expiration 06/16/2013 Date: Endorsements: NONE Mailing Address: 280 Wilson Ave Sw Restrictions: NONE Date of Birth: 6/16/1941 Mailing City/State: Cedar Rapids, IA 52404 Sex: M History Information Convictions Customer #: 415986 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert None Status: Iowa Department of Transportation CDL Med None Status: Restriction None Supplement: Citation Date Conviction Date ACD Explanation County _ JUR 03/29/2009 .04/06/2009 F04 Seat Belt Violation 52 11A� Name: Costello, Jack Cochran DL/ID: 809ZZ6961 pursuant to Iowa Code §321.10, I, Kim Snook, 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: `•"""•:Vip'4r r 1/4/2012 IOWA :yri G e fD9�YS= Office of Driver Services OHIO— Iowa Department of Transportation Name: Costello, Jack Cochran DL/ID: 809ZZ6961 C 0 Dec. 21. 2011 2:08PM Div of Criminal Investigation No. 4091 P. 1/4 2011=12-96 13:U' Wi —" �f Shwi'U0,WV°';' "'�e'I'11190621094 >> 5113. Tr 5 610$1 ° P 3/3 IN STATIF, OF 101)VA 1 Record •^�'RequestForut '� .41]106' Ta; Iowa Divisinn of C',jr juai IreYNstignllotl 6upporl operatronsBureau, Ir' Irloor Usk. 7" Strret Uxs n2oines, inYnn 50319 (515) M-6066 (15f 8) 725 6080 Fez C04e,i 10 T DCIAccountNumher. qV1ln "'r ll (00prl4ahle) Brant: _.f 1 C moi~ l : Fax; VL� 4(43 G �lG C.!( LY�Mate CI�'rmate 010, ver 111roFthatiow Widtout a 51gaQj Yraivpr Froin the sYlbjeat or ilia ragoest, a connpfete Jill W41 history roeord rune' not be relen.sehle, PN- Cada of lawn, Chapter 692•1.,1.or emnplefa cdniteal history retard ittforinetfau, ns a1foweC Dy tasY', zhvapx l oblinarvnf iarst nature from the spUect of the l'WurgG )eft/VCY 1{CICaSd; Ilmrcbygive pi�rmisaionlor lfu rhoveroaarsting rmkltlfG CUaQnclM lmatriimisal ldrlOry TCoord thal:gjlR ehe Division afC.ipritafll —II t hYwligetl ort (DLI), fiery rriroln�hirlory date conoeraLiEme ewt rl AW010,111Cd Willi DM may W wJp, f4 as allowrJ yj•lAw J WrclverSignrurre: `i JI fQWA Crtmival History Record Check Results '4S of_ a " . a senrd l Of the pfovrded name and dale of hittli xe'veMod; � ❑ [Vo To';va Gimfnal Histoty Is,ecord feuud vvith%CI r I fovea GY;minalE[isiorYRWord attached .i)cr#�--, J Cj b o PCA -17 (08/25/1 (j) v Dec -27. 2011 2:09PM Div of Criminal Investigation 'IOWA CRIMINAL HISTORY DCI 00167360 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2011/12/27 DCI:00167368 NAME: COCHRAN,JACK COSTELLO,SACK DOB SEX RAC HG� WOT EYE HAIR SKN POB 19420613 M W 601 195 HAZ SRO MED OK ADDITIONAL IDENTIFIERS MISS R FOR TAT LF ARM TAT RF ARM CCH RECORD *** No.4091 P. 2/4 Ol ARRESTED 19691004 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 INTOX TRK#: L05412101 COURT DISPOSITION " AGENCY: IA057015J LINK CO DIST COURT COUNT NO— 01 INTOX CHARGE CLASS' MISDEMEANOR CONVICTION TRH#: L05412101 SENTENCE D19P EPP DAT FINE $26 19691010 02 ARRESTED 19820204 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO— 01 ASSAULT TRK#: L05412201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO— 01 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1#05412201 SENTENCE DISP EFF DAT PLEAD GUILTY 19820610 FINE $100 19820610 COURT COSTS 19620610 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT. 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 DCI, IN THE ABSENCE OF FIN09RPRINTS 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 z b Dec. 27. 2011 2:09PM Div of Criminal Investigation Terry E. Branstad Governor Kim Reynolds Lt. Governor December 27, 2011 i' To Whom It May Concern: No.4091 P. 3/4 Larry L. Noble Commissioner The Iowa Division of Criminal Investigation believes COSTELLO , JACK COCHRAN DOB 06/16/41 (submitted) COSTELLO , JACK DOB 06/13/42 (appears on criminal history) are one in the same. If you feel these results are in error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of 8:00 a,m, and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, BECKY Iowa Division of Criminal Investigation lib tA51 OH 41 ttnl •UtbP Profec&n Off r ays