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Home My WebLink About12-018r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name LAW11A___ 2. Mailing Address Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) m(,riCan I—eq;Crt Last (Office Use Only) 3. Telephone: Home 631 O) N I v Other: 6z 12V Z I 4. Prior experience in transportation of passengers: I uwt r k e r e ct} C 6) ✓ t ver 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When /VliScifvnCatylo✓ �ULAI 01 2007(, A17 clemPan0( 1 00 6. Have you n convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When Syee,drrr9.Tvwa -20() i 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? II/yo Type of offense Where When 9. Have you ever applied to bean 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) ced midnWadn 09/2010 I hereby certi � )hat 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3Y 6 y y 3 . 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 rovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) u Signature of Applicant Date / 2 / 2— ++##HR#HR1fYf ##YHH##Hfef f41111H#H4##+#H#H#Hf*f 1fHRHH11f HHYf 1H1f1HlfHHf#!f ##ye#iff4f,4H#*M**H#Mf R1e*f#-1#Hf fH1ff f ff11f f f i+Y1f# STATE OF IOWA ) COUNTY OF JOHNSON ) 1 Subscribed and sworn to before me by —G `�/�� On this day of 0 CIA otary Public in and for the State of Iowa ,221819 _/_; _s . 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). "-) '/- IR 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. !{4l1H1H11H{N4H4#44f flfH#N#Hf{{4H+fff HHf1fH4f44fHH4{4444H44HflNHHlNHHNffN#-#-tr#+4!{4!f#-44#f�{#!f!#ff#-##fllflf f f f1fN444444{ Office Use Only Approved application DCI report State certified driving record Website update denNar dnv dgea,2010 a 09/2010 nor a�'vl.i iki 2012 4iuuuwMu, aho181owaultyriminal Investigation 319.338-2708o. 9 62 1 Pp11/4 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Tlivtsl0a of Crlminal lavestieallon SuppoA Operation Bureau, I' Floor 215 E. 7" Sireet Des Molnes, lowra 50319 (515) 7256066 (515) 725-6080 Fat I am Maestllla an lawn rriminnl Hicrnm RP ..ni flh. tr nn- DCI Account Number, __9967-I''' (Iropplicahle) Brom: Aellaw Cab of Iowa City P.O. Boz 428 Town, City, Lk 52244 (319) 338-9777 Phone: Fat; (319)'339-73D2 Last Name (mQQdwO I First Name (mm"f ) Middle Name Irecommeeded) Ala0 ; 6 I -an h G' i=dwmrci Date of Birth (mav"ary) Gender mawto Social Security Number (MMmmendad Li/26/68 Male ❑Female 2 , % _13-/ WoiV&1nfOr1wdOrl.' Without a signed Waiver from thesob)ect of the request, • complete criminal history record may not be releuable, per Code of IOwa, Chapter 6912. For complele criminal history record Iaformntlon,w allowed by law, always obtain a waiver siggatore Mom the sub eci of the request Wa(Ve,r Release: ! hwcby glue pamnrien for the aboVe requaang aaieiol to condvel an to"crimirul hinaryrecord check wllh va Oiv6loa ofCrimind JawcWgwica ICOM), Any aimlml hhmry Osis wntaning me all is me) bylhIDC1 me!7be W"Zcd as aaowed by law. ' �� i'aivetSignolure• �-- J'� (DC1 use only) As of I f 2 a search of the provided Dame and date of birth revealed; ❑ No Iowa Criminal History Record found with DCT 53 Iowa Criminal History Record attached, DCT # DCI initials DCT -77 (08/25/10) Received Time Jan. 4. 2012 9:I A No. 8264 0 Jan.11, 2012 4:25PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCL 00374255 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2012/01/11 DCI:00374255 NAME: MARTIN,LANNY EDWARD DOB SEX RAC ' HOT WGT EYE HAIR SKN POE 19680426 M W 508 275 BRO BRO FAR lA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ARM TAT R SHLD TAT UL ARM TAT UR ARM CCH RECORD *++ 01 ARRESTED 19880415 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321A-32 DRIVE UNDER SUSPENSION TRK$: L34035901 COURT DISPOSITION AGENCY: IA062015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321A•32 DRIVE UNDER SUSPENSION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L34035901 SENTENCE FINE $150 02 ARRESTED 19800903 AGENCY: IA0520000 JOHNSON CO S0 CHARGE NO- 01 IA STATUTE IA204-401-3 POSSESSION SCHEDULE I -MARIJUANA TRKN: L34036101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA204-404.4 POSSESSION SCHEDULED I MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L14036101 SENTENCE FINE $150 PAID SURCHG 03 ARRESTED 19000903 A AGENCY.: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-7 OPERATE MOTOR VHH WITHOUT OWNERS CONSENT TRK#: L34036001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714-7 DISP EVP DAT 19880722 DISP EFF DAT 19890210 No.9621 P. 2/4 Jan.11. 2012 4:25PM Div of Criminal Investigation DCT 00374255 PAGE 2 OF 3 OPER MOTOR VER WITHOUT OWNER CONSENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L34036001 SENTENCE DISP EPP DAT PINE 6500 19890213 PAY SURCHG-60DOLL COSTS 04 ARRESTED 20001107 AGENCY: IA0650000 MILLS CO $O CHARGE NO- 02 IA STATUTE IA124-401-5 POSSESSION CONTROLLED SUBSTANCE TO WITi MARIJUANA TRK#: 048872602 COURT DISPOSITION AGENCY; IA065015J MILLS CO DIST COURT COUNT NO- 02 IA STATUTE IA124-401-5 POSSESSION CONTROLLED SU83TANCE TO WIT -MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 048672602 SENTENCE DISP EFF DAT FINE $250 20010221 DL REVOKED 18ODS 05 ARRESTED 20010110 AGENCY: IA0780000 POTT CO SO CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE W/INTENT TRK#: 800697501 COURT DISPOSITION AGENCY: ZA078015J POTT CO DIST COURT COUNT NO- 02 IA STATUTE IA124-401(5) POSSESSION CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 800697501 SENTENCE DISP EPP DAT JAIL 2D 20010625 06 ARRESTED 20080109 AGENCY: IA0520200 IOWA CITY Pb CHARGE NO- 01 IA STATUTE IA124.401(1)(d)-P CONTROLLED SUBSTANCE VIOL. TRK#: lAO036FOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(1)(D)-P CONTROLLED SUBSTANCE VIOL. COURT CASE ID: 06521 FECR081963 No. 9621 P. 3/4 Jan.11. 2012 4:25PM Div of Criminal Investigation CHARGE CLASS: NON CONVICTION TRKN: 1AQ036F01 SENTENCE DEFERRED JUDGEMENT PROEATION DISCHARGED FROM DEFERRED JUDGEMENT 5750.CIVIL PENALTY 3Y DCI 00374255 PAGE 3 OF 3 DISP EFF DAT 20000711 20000711 20100224 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION QF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF,CRXJ41NAL INVESTIGATION, BUREAU'OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES EY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISABII. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR .INQUIRY• DIVISION OF CRIMINAL INVESTIGATION w Na, ,9621 P. 4/4 Iowa Department of Transportation AO Office of Driver Services (roil Free) BD4-532-1121 FO Box 8264, Des Moines, PA 50306-8204 515-244-9124 FAX, 515-238-1637 Certified Abstract of Driving Record Inquiry Date: 1/10/2012 DL/ID #: 713YY6453 (IA) Customer #: 681803 Name: Martin, Lanny Edward Class: D ID Status: None Address: 5081 AMERICAN LEGION Audit #: 4950812 DL Status: VAL RD SE Issue Date: 01/14/2011 CDL Status: None City/State: IOWA CIN, IA Expiration 04/26/2016 CDL Cert None 522409071 Date: Status: Endorsements: 3L CDL Med None Status: Mailing Address: 5081 AMERICAN LEGION Restrictions: Corrective Lenses Restriction None RD SE Date of Birth: 4/26/1968 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522409071 History Information Convictions Citation Date _ _ Conviction Date ACD Explanation County 7UR 04/24/20_06 05/05/2008 IS92 iSpe_ed ---- :52 IA 09/03/2006 109/23/2008 -j-Speed (10 mph & under In 35-55 mph zone) 52 IA ._ _. __.._........... 11/0.9/2008 01/06/2009 B64 �No Insurance Card _52 IA Name: Martin, Lanny Edward DL/ID: 713YY6453 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ""•%�T/W 1/10/2012 IOWA vA 10. T. r ' rZ �'••••'� SRS' Office of Driver Services `\ORIVtA,,= Iowa Department of Transportation Name: Martin, Lanny Edward DL/ID: 713YY6453 Iowa Department of Transportation Office of driver Services (Toll Free) 600-532-1121 PO Banc 9204, Des Moines, #A 503116-9204 515-244-9124FAX: 515-238-1837 Certified Abstract of Driving Record Inquiry Date: 1/11/2011 Name: Martin, Lanny Edward Address: 5081 American Legion Rd City/State: Iowa City, IA 52240 Mailing Address: 5081 American Legion Rd Mailing City/State: Iowa City, IA 52240 Convictions DL/ID #: 713YY6453 (IA) Class: C Audit #: 1989956 Issue Date: 04/11/2006 Expiration 04/26/2011 Date: Endorsements: L Restrictions: Corrective Lenses Date of Birth: 4/26/1968 Sex: M History Information Customer #: 681803 ID Status: None DL Status: VAL CDL Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County ]UR 04/24/2008 05/05/2008 S92 ,Speed 52 IA 04/28/2008 05/02/2008 F04 Seat Belt Violation 57 IA 09/03/2008 09/23/2008 Speed (10 mph & under in 35-55 mph zone) 52 IA 11/08/2008 _ 12/04/2008 F04 Seat Belt Violation 52 IA 11/09/2008, 01/06/2009 ,Improper Registration 52 IA 11/09/2008 01/06/2009 B64 No Insurance Card 52 IA Name: Martin, Lanny Edward DL/ID: 713YY6453 Pursuant to Iowa Cade §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: 1/11/2011 4--4 ie"Jl� Office of Driver Services Iowa Department of Transportation Name: Martin, Lanny Edward DL/ID: 713YY6453