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Home My WebLink About12-055�; 01 Ott� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 3S6-5497 FAX First 1. Name 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.) 3. Telephone: Home ��% 3071 w , / Other: !V 4. Prior experience in transportation of passengers: o rV e_ /A -5S (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? y� Type of offense Where When 6. Have you b e convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Z Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? )`"S t Type of offe se Where When 5A e_J'1-9 '2p h0l - _T12--7 ae0/� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4/0 Type of offense Where When 9. Have( u 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) deNJlaxitlrivbatlg 09/2010 I %r tFlat I hav issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 1/ �S"6 I understand that if 1 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) / o e/'\ Signature of Applicant G f:� - Date #Hf#fflflHlHifIHHHlfHHH*HMHIfffHlMff##fHfHIRHRH«HRHR%YYYRYYIfY#!!N!H!flifNlHHf#Hl1RR#f4«#RRRMMfIHHHIHNfHHflf#! STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,yak -. Leg -1`. Z On this J -i I#L day of SONDRAE FORT�� nission Number 159791 Commission Expires Notary Public in and for the State of Iowa 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). lo';'43, -27• .20/v9L Date J --27--4a 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. %-*RHHHR,H+R%1«R1««RR«««:FR#R««4«#«f«RR«HHYYfi««RRHHH.H*HHH.HHHff..f##««tf#'R«!«f f tMftYHHHf!!ff#1111#!#1HH*-t*1fIHfH«HfHHf Office Use Only Approved application DCI report State certified driving record Website update d�mimiwedoe�mio.a 09/2010 USA iJ� Vtl1"'^ IA 2027 TAYLOR OR IOWA CITY, IA 52240 rix DI No 347VV2563 i Iss 0710512011 exp ,Q OSJ2016 ctx..A F�, N y a r NOME Eyes BLU DOB0910511965-'' I DD 6534626160J1526M6566160 Iowa Department of Transportation Office of Driver Services (Toll Free) B00-532-1121 FO Box 9204, Des Moines, IA 5030"204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/9/2012 DL/ID #: 347VV2563 (IA) Name: Durgin, John L II Class: A Address: 2027 TAYLOR DR Audit #: 5346201 Restriction None Issue Date: 07/05/2011 City/State: IOWA CITY, IA 522407053 Expiration Date: 09/05/2016 Endorsements: N Mailing Address: 2027 TAYLOR DR Restrictions: NONE Date of Birth: 9/5/1966 Mailing City/State: IOWA CITY, IA 522407053 Sex: M History Information Convictions Customer #: 4277080 ID Status; None OL Status: VAL CDL Status: VAL CDL Cert Status: None CDL Med Status: None Restriction None Supplement: )7/28/2009 Citation Date Conviction Date ACD Explanation County JUR IO/01/2007 =11/13/2007 S92 Speed '92 SIA ]4/26/2009 05/13/200_9F04 .. _ • 'Seat Belt Violation - - 52 IA )7/28/2009 X09/18/2009 ;S15 `Speed »._ IL_ Operating While Intoxicated Test Refusal/Test Failure Violations occurrence ACD Explanation JUR L0/09/2000 Al2 OWI Test Refusal ;IA Sanctions i_y_pe__ Effective End _ ACD _Explanation _ Re _ _ _ Occurrence JUR7_UR _ voked _`10/20/2000 10/20/2002 _ Al2 •OWI Test Refusal -IA ,._.._ IA Name: Durgin, John L II DL/ID: 347VV2563 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: >O.`0•�•'....' �:T/�4r 2/9/2012 st: IOWA,.. - iC • ; Oi . D. 0.T s��.i /rrrrr��F O� Officeof Driver Services lies �...... Iowartme STransportation Name: Durgin, John L 11 DL/ID: 347VV2563 Feb 23 2012 1 53PM Div of Criminal Investigation No.5203 P. I b 2.. , ..a rvn Lab of wwa'sty 319-338-2706 p.1 STATE OF IOWA 414'e tt ILL History Record Check _" Request Form., r• To: Towa Division of Criminnl Investigation Support Operations Bureau, in Floor 215 E. 7"' Street Des Moines, Town 50319 (515) 725-6066 (515) 725-6080 Fox Iam rc uestin an Iowa Criminal Histo Record Check on: DCT Account Number; _9967-F (ifeppH ble) From: VellowCaboflowaCty P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone! Fax: (319)339-7302 Last Name (w,,dmory) FiMt Name Imandatory) Middle Name (mwmtnmdrd q L Date of Birth pnandno Gender (mmdmory) Social Security Number (ncommrnded) — !)�— f 6[� Male ❑Female yy — Waiver,rnformation. Without a signed waiver from the subject of the request, a comp100 crlinhul history record may not be releasable, per Code of Iowa, Chapter 092.2. For carriplate criminal history record Information, as allowed 6Y)AW, always obtain a waver signature from the sub ecf of the request. Waiver Reje4Ser l hereby give permission forthe abo ucslingo to nduet en Iowa criminal history record cberit with the Dhision aCCriminal rnvrsagaaen (oei), My criminal hatary Onra eonec+nin is mai 1 ed by I o DO may be aalma er bylaw. Waiver Signature! (DCr use, only) As of; c�J r/ U-- , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with ACI KTowa Criminal I•Iistory Record attached, DCT #� DCI initials DCI -77 (08125/10) Received Time Feb.20, 2012 9:11AM No,4626 Feb.23. 2012 1:54PM Div of Criminal Investigation No.5203 P. 2 PCI:00569657 NAME; DUkGIN,:IOHN L II DOB SEX RAC 19660905 M W ADDITIONAL IDENTIFIERS TAT R.SHLD 01 ARRESTED 19950218 IOWA CRIMINAL HISTORY DCI 00569657 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/02/23 HOT WGT EYE HAIR SKN POB 507 180 BLU BLN FAR OR CCH RECORD •++ AGENCY: IA0990000 WRIGHT CO 50 CHARGE NO- 01 IA STATUTE IA321J-2-1 Owl IST OFFENSE TRK#: 003707501 COURT DISPOSITION AGENCY; IA099015J WRIGHT CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2-1 owl IST OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 003787501 SENTENCE JAIL 2D FINE $500 02 ARRESTED 200D10D9 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA3219-2 OWI 2ND OFFENSE TRK#; 033729301 COURT DISPOSITION AGENCY; IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA123-46 PUBLIC INTOX CHARGE CLASSi MISDEMEANOR CONVICTION TRO: 033729301 SENTENCE FINE $100 COURT COSTS SURCHG/ATTY FEES 03 ARRESTED 20001124 AGENCY: IA0410000 HANCOCK CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVING WHILE REVOKED TRH#: 044024101 COURT DISPOSITION AGENCYT IA041015J HANCOCK CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-21 DRIVING WRILR REVOKED CHARGE CLASS; MISDEMEANOR CONVICTION DISP EFF DAT 19900515 19900515 DISP EFF DAT 20010507 20010507 Feb.23. 2012 1:54PM Div of Criminal Investigation TRK#: 044024101 SENTENCE PLEAD GUILTY Sc FINE $1000 COURT COSTS DCI 00569657 PAGE 2 OF 2 DISP EPF DAT 20010109 20010109 20010109 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT. 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 No. 5203 P. 3