HomeMy WebLinkAbout12-0161 r
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240- 1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing Address
3. Telephone: Home
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of
Authorization Number /a —/4�,
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Other C11
S
felonies in this State or elsewhere?
When
6. Have you been onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ku
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offe se
/
Where
When
9. Have yogi 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)
deN midrivbadg 09/2010
I herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
e 3`8 (�, Ci1VYX . 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 ofApplic Date J/y
STATE OF IOWA )
COUNTY OF JOHNSON
Subscribed and sworn to before me by �r1I/70/?/��(/KS On this/ day of
ZC/ �_ —� Ke c (( r— AL a #-�
/F! ue K. TUTTLE Notary Public in and for the State of Iowa
99181.9
r%sio, Ex fires
f1
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).
SSignture ofPoli�f or designee
Sign re of City Clerk or designee
A.23-/ Z
Date
-,.,71-42
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
de�drvbadgea,2010doc 09/2010
�ryry_Iowa Department of Transportatic
G7fJ Office of Driver Services
PO Box 9204, Des Moines, IA 503/)6-9204 (Toll Free) 9W-632-111
515-244-9124,,
FAX 515-239-1837
Inquiry Date:
Name:
Address:
City/State:
1/10/2012
Collins, Anthony
207 6th St Apt 1
Coralville, IA 52241
Mailing Address: 207 6th St Apt 1
Mailing City/State: Coralville, IA 52241
Convictions
Certified Abstract of Driving Record
OVID #:
288AE5480 (IA)
Class:
D
Customer #:
5342369
Audit #:
2885769
ID Status:
None
Issue Date:
01/02/2009
DL Status:
VAL
Expiration12/05/2014
CDL Status:
None
Date:
CDL Cert
None
Endorsements: 3
Status:
CDL Med
None
Restrictions:
NONE
Status:
Date of Birth:
12/5/1972
Restriction
Supplement:
None
Sex:
M
^•�•��o race ACD
History Information
_.._. _.._._....._.. County 7UR
iIA
ph zone] 52
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
ACf13iPn! n..a_
Number
Name: Collins, Anthony DL/ID: 288AES480
JUR
Pursuant to Iowa Code §321 10 1, Kim -Snook, tor Of Office of
o hereby
certify that I am the custodian of he records held cby the Office of rDriver iver eSery Services that this is a true and accurate co
Official record currently if the custody of said office, and that I have been authorizetl by the Director wa Department of
hes owaatDepadrtment of
Transportation to re certify, Department
n of
In witness whereof, I havb 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
'•' y 1/10/2012
IOWA+?�
4
F ��c Office of Driver Services
Iowa Department of Transportation
Jan.13.
2012
2:20PM
Div
of Criminal Investigation
Jin. 9.
2012
2:02PM
City
Clerk - City of Iowa City
b
n
STATE (0)F XOWA
�>ri lnxaal.fttoryRecolyd Check
RequestForm
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To: Xolvn plvbloyi orcrlminalYnves(tggt(oh
Support Operntlons Auronu, VITYoor
2X9 P. 114 Street
boab?Plrlos,Io1va 50319
(51S) Taa•60dd
(316) VM -boyo VAX
No. 9863 P. 3
No. 2009 ' P. 2
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xowa Criminal Mstory Record Check Resuffi , @Cl uroanly)
As of -3/1'a a neavoh oftho provided namo aild date of bl'l'thx6voaldd: '
No 1b'WS a-Iminal History Record fbllnd WADCT
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(08/25/10)
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Jan.13. 2012
2:21PM
Div of
Criminal Investigation
IOWA CRIMINAL, HISTORY
DCT
00916469,
NON CONVICTION
PAGE
1 OF 1
DATE
PRINTED-
DCI:0091b489
2012/01/13
NAME: COLLINS,ANTHONY
DOS
SEX RAC
HGT
ROT EYE HAIR
SEN
POB
19721205
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605
200 BRO BLK-.
DRK
IL
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
CCH RECORD •**
01 ARRESTED 20101130
AGENCY: IA0520100 CORALVILLE PD
CHARGE NO- 01 IA STATUTE IA708,2A(2)(B)
DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS
TRK#: 1AOOAOU01
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA708.2A(2)(8)
DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS(SRMS
COURT CASE ID: 06521 SRCRO92689
CHARGE CLASS: NON CONVICTION
TRK#: 1A00A0U01
SENTENCE DISP EFF DAT
DEFERRED JUDGEMENT $315 CIVIL PENALTY 20110330
PROBATION 1Y 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 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
w
9
No, 9863 P. 4