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Home My WebLink About12-009Authorization Number ' Z_ 1 ' l 1 (Office Use Only) +. Mlw®ill APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 41 o East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First --.-�� I/ Middle Last 1. Name 1 /1vi a 3yes{Ph l�R� 2. Mailing Address 30 �- ! Co /1,)1- y' t lr T,)o, T z`]__Lf- t 3. Telephone: Home '1I )a 3 R5 3% (- 1 Other. 4. Prior experience in transportation of passengers: &!J ,, j yr. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �? e S Type of offense C/✓ ,l 54. tm d 6. Have you been co years? tij Type of Offense Where —10)1 O,�UQ of operating a motor vehicle while under the influence of alcohol or drugs in the last five Where 7. Have you been convicted of any traffic offenses in the last five years?. Type of offense r II CC ( f� Where - , f "i nl.,, 'I nn l�;; .l;eN/1cMv X l Jl j[/,( cs When When n/If)yf2 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense 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) Gay jddvbad9 0912010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5,Y S" x k. 2 U 5 v . 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 1 % 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Su4enbedl and sworn to before me by Yld ,,� On this �� day of KE_EI�-';_ TU7LE ' - 221 819 Notary Public in and for the State of Iowa 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). Zvi Vgnatur of Police Chief or designee 7244�±4&.l YV . Signalure of City Clerk or designee Date 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. Office Use Only Approved application DCI report State certified driving record Website update deANa d.0 adgeapp2olo ooc - 09/2010 CIowa Department of Transportation AO Office of Driver Services (Tall Free) 500-532-1121 PO Box 9204, Des Manes, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/17/2011 DL/ID #: 555XX2686 (IA) Customer #: 934378 Name: Kral, Thomas Joseph Class: D ID Status: None Address: 306 2ND ST APT 1 Audit #: 5690786 OL Status: VAL Issue Date: 12/17/2011 CDL Status: None City/State: CORALVILLE, IA 522412629 Expiration Date: 05/16/2015 Restriction None Endorsements: 3 Supplement: Mailing Address: 306 2ND ST APT 1 Restrictions: NONE Date of Birth: 5/16/1960 Mailing City/State: CORALVILLE, IA 522412629 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 07/12/2011 07/20/2011 M14 Fall to Obey Traffic Sign/Signal 52 rIA Name: Kral, Thomas Joseph DL/ID: 555XX2686 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: -..:.J/�1p, 12/17/2011' IOWA S> e 1VER $ = Office of Driver Services t,��.� Iowa Department of Transportation Name: Kral, Thomas Joseph DL/ID: 555XX2686 Jan. 10. 2012 9:59AM, Div of Criminal Investigation No. 9237 P. 1/3 Jan 05 1 c i I.oca I euuw Dab o! Iowa any 319-338-2708 p.2 STATE OF IOWA ' Cr-ttninal History Record Cheek mt Request Form To: Iana Divir'ion III CrimiaAl ln`asligatlon hSupplll't 0110110"nX IlUrentl, IA Flenl' 215 e, "", slltlet Des Moines. luwa 511719 (5I i) 725-1,066 (51.5) 725-61)6o 1a1x 1 Anl reuudslinu :ul Iowa Criminnt I iston' Reenrd Check on: DCI Account Number: 9 167 — r 1.W Name ..nmmi:nugq V 07'e gk4bh) From:` -w C,hCI Lr` T"ot,.A i_I.y x t{18 Bale of Mrth Imm,to.m9 pnnnc: �31� 338 - f 7"J 7 Fnx: ❑Fcmolc 1.W Name ..nmmi:nugq V First NA me Middle Name fim mmended) :Tosep rt Bale of Mrth Imm,to.m9 Gender lmunllele,y) Social Socarity Number (,wommmded) b l� ❑Fcmolc 4 g s 60 7 1� V �e If•}liner l!I%nr'171101oll: wilbnnl 11 siBnml troiver rrum rhe subject utthe requot, n complete crimlrul history record maynot be rrh,ju: lu, per ['aIle or Iowa. c'Impler 692.2. Fur ky onlrlu con imd history recurs inrolmAtion. As Allowed byllw. AlwnY2 obhlln a n olver slnouture D,opl rhe sub oel ur the request. lYuirer h'[•!rrl.Cd I Lercbt y!m lwnnn>,ien ii.nhc abe\v rnlne5nng ollleia110Atna�Kl nn lova cnmim! hisrory«e�rd el!ctk clilh Ilr_ Di.uion o!'Crimin�l Im,aitwit-n ilk'11 .,ar cf;mhul lmt.5 A\ 1:.511.51 fnntlT(IfRal r ' I II ImJi1,Wiml by the ITS IY:EIV1IcuWa es liYal by law. Il'niver .Sid qulru•e' .� _,_ Iowa Crinliiial History Record Check Results As of'_ L- �a : a search of the provided name and date of birth revealed: ❑ No lows Criminal I lismry Record found with DCL 1,1Q Town Crimiin:d Ilkioy Record Douched. DCI d� 0Q DCl initials 00 Received Time Jan, 3, 2012 11:46AM No.7974 (PCI uw) only) Jan. 10. 2012 9:59AM Div of Criminal Investigation DEFERRED JUDGEMENT 20040910 PROBATION IY IOWA CRIMINAL HISTORY DCI 00724000 DEFERRED JUDGEMENT MISDEMEANOR CONVICTIONS ONLY PAGE 2 OF 2 AGENCY: IA052015J JOHN80M CO DIST COURT DATE PRINTED - OBSTRUCTION OF EMERGENCY COMMUNICATIONS 2012/01/10 DCI:00724D08 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101172102 NAME: KRAL,THOMAS JOSEPH XRAL,TOM JOSEPH DOB SEPI RAC HGT WGT EYE HAIR SKN POB 19600516 M W 601 2B5 BLU GRY MED IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *++' 01 ARNESTED 20040513 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-2A(2B) ASSAULT CAUSING INJURY DOMESTIC TRK#: 101172101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA70B.2A(2)(B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY COURT CASE ID: 06521 SRCR06B719 CHARGE CLASS: NON CONVICTION TRK#: 101172101 RESTITUTION SENTENCE DSSP EFF DAT DEFERRED JUDGEMENT 20040910 PROBATION IY 20040910 DISCHARGED FROM 20050613 DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHN80M CO DIST COURT COUNT NO- 05 IA STATUTE IA727.5 OBSTRUCTION OF EMERGENCY COMMUNICATIONS COURT CASE ID: 06521 SRCR068719 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101172102 SENTENCE FINE $50 DISP EFF DAT 20040910 02 ARRESTED 20110009 AGENCY: IADC10000 DIVISION OF CRIMINAL INVESTIGATION CHARGE NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1970 TRK#: NKooIPW01 COURT DISPOSITION AGENCY: IAO92015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1910 COURT CASE ID: 00921 SMSM039686 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: NK001FW01 No. 9231 P. 2/3 Jan,10, 2012 9:59AM Div of Criminal Investigation SENTENCE FINE $100 No, 9237 P. 3/3 DC1 00724009 PAGE 2 OF 2 DISP EFP DAT 20110819 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 DCI, IN THE AESENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHBD. WE CANNOT CONFIRM OR bENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION