HomeMy WebLinkAbout12-038ly
CITY OF IOWA CITY
410 East Washington Street
Io�65
40-1826�y
(3
First
1. Name
2. Mailing Address ' /
3. Telephone: Home A
4. Prior experience in tran
Authorization Number )-L-3'0
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
T
—3d4—d7515 Other:
p of passengers: S simes-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AA9
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? A/0
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years? y 2S
Type of offense Where
Whe
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8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense
Where
When
A
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)
tlerWlaxitlrivbatlg
09/2010
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
. 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 al es with 11 of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) � � 1
Signature of
02/i1'1 /1;'
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STATE OF IOWA
COUNTY OF JOHNSON
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).
Signature of otic ief or designee
Signature of City Clerk or designee
Date
�2 - /y- /,,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
deA idrivbadgeaW201O.dm 09/2010
Feb.13. 2012 11:19AM Div of Criminal Investigation
Feb. 1. 2012 12:16PM City Clerk - City of Iowa City
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D CX db1t1919
Received Time Keb. 7. 9019 19.16PM Nn.AlU
Feb. 13. 2012 11:19AM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00751797
NON CONVICTION PAGE 1 OF 1
DATE PRINTED -
2012/02/13
DCI:00751797
NAME: DRILLING,BENJAMIN NASH
DOB SEX RAC MGT WGT EYE HAIR SAN POB
19780102 M W 602 175 BLU RED IA
ADDITIONAL IDENTIFIERS
CCH RECORD yWy
01 ARRESTED 20050 04
AGENCY: IA 20200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA321J-2
OWI
TRK#: 101551901
COURT DYSPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA321J.2(A)
OPER VEH WH INfi (OWI) / IST OFFENSE
COURT CASE ID: 06521 OOCRO72714
CHARGE CLASS: NON CONVICTION
TRK#= 101551901
DRUNK DRIVING SCHOOL
SUBSTANCE ABUSE EVALUATION
SENTENCE
DEFERRED JUDGEMENT
PROBATION 3651)
DISCHARGED FROM
DEFERRED JUDGEMENT
No. 8962 P. 3/3
DISP EFF DAT APPEAL DATE
20060120 20060720
20060120
20060131
AN ARRKST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
FAINRD BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ORCEMENT 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
Iowa Department of Transportation
Office of DdvLr Services (Idi Free) 8011-532-1121
PO Bcn 9264, Des Moines, fA 5030fi-tJ204 515-244-9124
.FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/7/2012
DL/ID #:
185AD6305(IA)
Customer #:
3727257
Name:
Drilling, Benjamin Nash
Class:
D
ID Status:
VAL
Address:
2142 DAVIS ST
Audit #:
5783389
DL Status:
VAL
__...__ _.___..._...
01/23/2011
_.._.. .___...
03/17/2011
Issue Date:
02/07/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
01/02/2014
CDL Cert
None
522405813
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
55 REGAL LN
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
1/2/1978
Supplement:
Mailing City/State: IOWA CITY, IA
Sex:
M
522406765
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
3UR
01/26/2008
A2/15/2008
;B51�
�No Driver's License
352
mm IIA
03/20/2010
'05/12/2010
-M70
(Improper Passing_
_
5i 2
IIA
__...__ _.___..._...
01/23/2011
_.._.. .___...
03/17/2011
_. _._
M14
..__...._...
Fall to Obey Traffic Sign/Signal
_.._ .__ __.—
52
___ _-
IIA
Name: Drilling, Benjamin Nash DL/ID: 185AD6305
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:
"••"•%:�%'4
2/7/2012
IOWA�'c
D. 0. T.:;4?
Office of Driver Services
Iowa Department of Transportation
Name: Drilling, Benjamin Nash DL/ID: 18SAD6305