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Home My WebLink About12-011CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home 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? 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?_ ik G 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 driver's license or chauffeur's license been suspended or revoked in the last five years?V, 0 TVDe 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) d.a t.idr,vbadg 09/2010 Ierebypcertify that 5is I have ued to me by the Iowa Department of Transportation a valid Chauffeurs license number fT ,� I ( l' �/ 'te.:7 . 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 imes with all of the provisi of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) /) n��J7 Signature of Date 7 STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworn tol bfore me by V C ��eS 1 r I �t On this day of yl (l ' LO KELLIE K. TUTTLE Notary Public in and for the State of Iowa My 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). Skj'nature'of Police Chief or designee Ay g� "e . -' "'c'✓ Sig Lure of City Clerk or designee /-/IT/z 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. #ft#lfff#!#fflf!!ffllfHtf 11flHflfflf fHf!!lltlff ###HH###++ifffH#fflffHlf lf!!ff H!H!#H##+##HH##pHIHHf#HH#l1HHHHlfHMlHH1H! Office Use Only Approved application DCI report State certified driving record Website update Gedv9 drimadgeapp2010, a 0912010 CIowa Departm4nt of Transportation A - Office of Driver Services (Toll Free) SM -532-1121 PO Box 9204, Des Moines, IA 50306-921]4 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/4/2012 Name: Miller, James Richard Address: 0223 Garfield Avenue City/State: Mechanicsville, IA 52306 DL/ID #: 239CC4258 (IA) Class: D Audit#'. 57209092' Issue Date: 01/04/2012 Expiration 01/17/2014 Date: Endorsements: 1L Mailing Address: 0223 Garfield Avenue Restrictions: Corrective Lenses, Left Mailing City/State: Mechanicsville, IA 52306 and Right Outside Mirrors Date of Birth: 1/17/1931 Sex: M History Information CLEAR DRIVING RECORD Name: Miller, James Richard DL/ID: 239CC4258 Customer #: 1130919 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Officd 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: >,......... 1/4/2012 eoy D. O. T.:ys F�flIYE $ Office�bf Driver Services Iowa Department of Transportation Name: Miller, James Richard DL/ID: 239CC4258 STATE OF IOWA Criminal lbstory Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7`e Street Des Moines, Iowa 50319 (515)725-6066 (515) 725-6080 Fax I am reauesting an Iowa Criminal Histniv Recnrrl Check nn - DCI Account Number: 9861-F ' (d applicable) From: City Clerk's Office City of Cedar Rapids 3851 River Ridge Drive NE Cedar Rapids, IA 52402 Phone: 319-286-5060 Fax: 319-286-5130 ast 1 :.,u"i T+�rs�me,rmandatSa) u lYatne f 5 . , Yh 1 ...,t,., lY�!dle (rnanAaa >7 .•i ...,v `r _....'`i' (Ta X( 15-- S fl 4r 1Ll••_ ili'�„elf �� eY>.(igandafay �'f81e•"t.A 1�_.. J. hl 1. �..c't1k x..�ki F�h18��.. _x �..,I1.J,..,�i\UIII�eT,Et'mandaWfY).:x:5: 7�, iy�a �iT H5 . yd a. Yjr - fac'Tr-w*x- rent ;a'it'K .5" Fi Gf..n.Yk ul tr x 2 • <- '-1�ra �";.; "Ta'F NL- WarvBrTriforrita�iorih�hout�ra CignedfQuaivgrrorti 1)aelsnblect of �lieFegYiest' a GOmplete crlmmal histgfy reggrd�tn3yshipt, b �t , s�. yy`a"P�i k.y if. ri rF>r .sY a vx ia Ilbl�.scele3�ra`b�'��e.,��erhC��e�o�Towa,@ba�ter3692�!=��t,co��n�ete;c�miJn*$1•�sfo kecor�d�mfig7r porisgllq e�by�vq,*altvay��i> -. � atCgaiver�+$i aldre;fromFt%iGl$ub eCC n£thgve he'?�.-5 �"Qf,rk ,y1F �`i= i y 1 � ) f �( t )7-� ti iLY 'l ,J: H i Yy 2. STi 1 i i t�. 11i1 ' �+�Pp 'lT•.l d '� � +f 1 i ✓,.�'x �jl S.N .(- 1 ��'i; -! ik-t \3'.�ipA�)l�l,.ly ti 5a�"F: nyf. Wa yer Be erisea n ysy�ap� nss £o rhs g� Kim g �nat� ona��E R mn a7 �54n yn e8. hd t e of s of con,)r mal `7r r .... 7nVe;'iigafion (D %�Any�Cnlmua]'ihvti�yoi]'data cqn wgfine tda[Is maw-Lvne�by thc^�7XCI- 6erp7eised as allowed by la �'v�'t !'.1 # J �i �>�y ). .� 1 f.T f� .ia✓Y ' 1`.I �t� r5f Y ..�i"p. {�; q 1��'fY�aL .. ,j.s.'7�,�'f �'f}t��t� ,-�.yS.} Bali L e�a� ~1KP�111•'-1 f �`\+.Vi �) �S��C 3��13k f•) 4A 1,,1�,i }Y JJ d�'f.T(��t �},)O! Y- _i �, �d iL�� ).iA l�}J�r� �/K. rlYy� ,�, 11 #I ISL t.i� Record Check As of , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI DCI initials DCI -77 (08/25/10) u (DCI use only) ,dGProcess.asp Page 1 of 1 Criminal History Back round Check Last Name Maiden Name First Name DOB SSN Selection CriterialMiller rames 11931 -January- 17 1480441943 Results Further research is required. Please await DCI's final response for criminal history. Please note: There inay be multi le individuals with similar search criteria, requiring more research. Background Check Complete As Of 1/4/201211:16:26 AM Billing Account 9861-F Cash Deposit Currently at $944.00 Generate PDF https://www.iowaonEne.state.ia.us/SING/SINGSQLProcess.asDx i M nn, I) ,.10. 2012 4:03PM Div of Cri,Tiial Investigation Submitted 2012-01.04 11:16:26.127 IOWA RECORb CHECK REQUEST To: Iowa Division of Criminal Investigation Bureau of Identification 215 E. 7th Street Des Moines , IA 503I9 (515)725.6066 (515)725-6080 (fax) FORM S QUEST (• indicates a required field) LAr requestine an IOWA CRIMINAL HTSTOkI' record check on: No. 9387 P. 1/1 Page 1 of I ACCOUNT NUMBER: 9861-F CITY CLERK - CITY OF From: CEDAR RAPIDS 3851 RIVER RIDGE DRIVE NE CEDAR RAPIDS, IA 52402 Phone 319-296-5060 Fax 319-286-5130 Contact Preference: F MILLER ,TAMES RICHARD Last name* First name* Middle name NO Maiden/Other Last name Volunteer 1/17/1931 M 480441943 Date of Birth* Gender* Social Security number* (DCI use only) RESULTS As of 1110QO12 2:28:43 PM, a name and date of birth check revealed: CCH Record Attached DC1 # No CCH Record Found X DCI initials 4 Waiver on File_yp,9 I hereby give Permission for the above requesting official to conduct an Iowa criminal histogyrecord check with the Division of Criminal Investigation. Any information maintained by the DCI may be released as allowed by lacy. , https://webapps.iowa.,Zov/singadmin/PaxRenuect acnY -..