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Home My WebLink About12-021it rl)l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (3 19) 3S6-5497 FAX 1. Name 2. Mailing Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) fc9_ —a I (Office Use Only) 3. Telephone: Home 319 849 1 _3E>7 Other: 4. Prior experience in transportation of passengers: A V 4fo V Tv( k/ , t of 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AM 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? )ba Tvoe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? YcS Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? lid 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) derwnaoaa baea 09/2010 I hereby rti 'sh t I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number /LZ � �G � ;E . 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 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C L On this 91(�' day of aunurw,t rurc i G mmission Number 159791 enc Ir'N my �5 mmyul°,"lom Notary Public in and for the State of Iowa *******###43##}**#****#3#33###R#*k*****###**##3###34#}***R**************##***##**#*3####kkR*R*******************##*#####4####}R}}R*******#33#*4# 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). Signa re of Pol a hief or designee Signa re of City Clerk or designee /-'?0'-/a Date 7-, - 1 7 - 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 clerPo dnvbadg ap 2010, oc 09/2010 AClowa. Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50305-9204 515-2449124 OFAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/20/2012 DL/ID #: 428XX4965(IA) Name: Mcconnell, Christian Class: D Seat Belt Violation Wompshmack 03/13/2011x06/17/2011 Address: 1915 TAYLOR DR Audit #: 5534267 Issue Date: 09/27/2011 City/State: IOWA CITY, IA 522407054 Expiration 08/08/2013 Date: Endorsements: 3 Mailing Address: 1915 TAYLOR DR Restrictions: NONE Date of Birth: 8/8/1984 Mailing City/State: IOWA CITY, IA 522407054 Sex: M History Information Convictions Customer #: 4728578 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County IUR 12/14/2008 102/10/2_00_9 ;F04 _ Seat Belt Violation 52 IA 03/13/2011x06/17/2011 IS15 Speed OK Name: Mcconnell, Christian Wompshmack DL/ID: 428XX4965 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: •;!l'j� y� 1/20/2012 fF OBIYtR$ Office of Driver Services Iowa Department of Transportation Name: Mcconnell, Christian Wompshmack DL/ID: 428XX4965 12.�Zi%•iia`iv AU Vnn"" f M .� v� v� un�uui ui, so:15o:ien I". YIUU -� DCI* IOaA STATZ OF IOWA ,`'' '"'''' Criminal History Record Check P. Request Form , TO: lawn Division erCriminallave tiputoa Support Operation Bureau, I" Floor Des MolomIowa SOUP (gig) 725.6066 (515) 9256010 FAN I am wooeatine an Inwa Crlminnl tilarniv'Re" Check nn:• DCT Account Number; la •pp1 ) •. Froml _1MAYt:.STixL �'' � 5•fl'eve+.� QPM owe k sway n phvaet ,( 338• Mj Fax:. • .319) 5TI-56144 r' 42JOUJ/009 ,0 Lug Name MMOM First Name (nww bliddic Name ,!aM Date of Birth Lm9LdD41 Goder omauwGcm M.L& Olramak 26$6 WO1POr•1(/briwAvn: WSheot■dpledwelverfrom the nbiectoreberequeebacompletecrlminsiu1noryrwonrdmay not be rekaabl%perCodo orlom, Chapter 592.2, For tggbka erlmlaal h1Aaryredord lntormatloa, Iu allowed by law, rlwaya obbdo, walvey Wipatare Dom The vowed of Me reggert. Waiver Rekate:lb-ydyePa,ewimfold"euo,e/m��g\m,�ae"to= atm leaaimw1buryroweddiekwaaedrblonofCTIMM veu by ft DO lay be NWW u tllouid M 4w. rnlseloa(DC1). Aydeia�wYdO am pl* WatverSigna are: ybM As of u search of the provided name and data of bldh mvcalcd: ❑ No Iowa Criminal HW(ory Record found with DCI Iowa Criminal History Record acts hed DO # 0 DCI InitiOS I Received Time Dec. 20. 2011 10;35AM No. 6627 cDe ee onb) Uec. LO• L011 11; U4HIV1 VIV 01 blIOIIOdI lOVe5L19d1100 IOWA CRIMINAL HISTORY DCI 00706808 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2011/12/20 DCI:00706808 NAME; MCCONNELL,CHRISTIAN PATRICK DOB SEX RAC HGT WGT EYE HAIR SKN POB 19840808 M W 507 156 BLV BRO IA ADDITIONAL IDENTIFIERS CCN RECORD *** 01 ARRESTED 20030900 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA713-6A BURGLARY 3RD DEGREE TRK#: 100950301 CHARGE NO- 02 IA STATUTE IA712-3 ARSON 2ND DEGREE TRKO: 100950302 COURT DIDPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA712.4 ARSON 3RD DEGREE - 1975 COURT CASE ID: 06521 FECR063939 CHARGE CLASS: NON CONVICTION TRK#: 100950301 RESTITUTION SENTENCE DEFERRED JUDGEMENT PROBATION 3Y DISCHARGED FROM DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECRO63939 CHARGE CLASS; NON CONVICTION TRKO: 100950302 SENTENCE DEFERRED JUDGEMENT PROBATION 3Y DISCHARGED FROM DEFERRED JUDGEMENT DISP EFF DAT 20040130 20040130 20060330 PI6P EFF DAT 20040130 20040130 20060330 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF Z ENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW CEMENT AGENCIES BY THE DCI. 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. IVO. 4100 f. L/7