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Home My WebLink About12-056r � r 3 �r'lll� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX Authorization Number /2 - S/- (Office b(Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 1. Name 4_4 r- S fon 2. Mailing Address 5/-3 3. Telephone: Home I `�J3o1 "% 3 y VOther: 4. Prior experience in transportation of passengers: ! 7— 21 19v)�9-s y Y -A 4'v Xl S49-r"t/1 C -C 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? -� �F--S Type of offense p Where When M" i I F1meS A'R 6. Have you been years? NU Type of Offense of operating a motor vehicle while under the influence of alcohol or drugs in the last five Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense I=l_ , 1—'q S"' Where When 5 When It lt4 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) tJ D 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) dery t.i&n Mdg 09/2010 I herebyy certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number f 51 X X 7 11 4 Z . 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 tPet., Date � ;?— lffRRRIR!!R!!1f!lHlHNf1HNHRNMllNHRNNf R1flfHlffRf##H#Rf ##HH#R#f NNf#111111f 1ff1fH1NNRR#IfNH+Yi#!#1tH###N#1N1f11Hf f f1NNf STATE OF IOWA ) COUNTY OF JOHNSON ) and swom to before me by Ale, La r !�,24 On this df day of ME FORT C Number 159791 ise.1411 Dome Notary Public in and for the State of Iowa YYNHtf iYiff#N#4ffNH#44Yfi4YYYYff4tf#*NYNf#11*itRR%RNNRf%R*f R*f11NRf f#H444ff4Yf##f4YHN*NY*%RR*RRRf f1R*f f f 1HRf 1f fNffN4ff4i4f##f#i 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). aZ04v�__ Siignn� ure of Police C/h/ef r designee Sigliature of City Clerk or designee Date 2- Z91 -/a 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. Hf f1ff11f 1HHH1Nf1NM11NHH1f f 11NN11Hf111Nfff 1ff f1fN111H11fif111H##########f#Nf#N#NN111fl1flflH#YR1Rf#####/.###NM'*#+FY#f ##### Office Use Only Approved application DCI report State certified driving record Website update GerkRaxitlrivbadgeapp2010 doc 09/2010 t CIowa Department of Transportation AO Office of Driver Services (Toll Free) 800-5324121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 516-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/28/2012 DL/ID #: 431XX7942 (IA) Customer #: 900797 Name: Larson, Alan Keith Class: D ID Status: None Address: 1540 PLUM ST Audit #: 5423120 DL Status: VAL ISpeed _ Issue Date: 08/05/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 07/13/2016 CDL Cert None 522402124 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1540 PLUM ST Restrictions: NONE Restriction None Date of Birth: 7/13/1954 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522402124 History Information Convictions Citation Date Conviction Date ACD Explanation County 1UR 10/27/2007 CoKftiv ca&v� 11/15/2007 592 Speed_ _ _ _ — _ _ 52 iIA_ _ 03/_25/2011 _- _ 4/08/2011592 _ _ ISpeed _ 152 ,IA SIA o3/26/2011 x04/13/2011 IM 4 (Fall to ObTraffic Sign/Signal ey 152 Name: Larson, Alan Keith DL/ID: 431XX7942 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: Name: Larson, Alan Keith DL/ID: 431XX7942 �- '•:��%ji44 2/28/2012 IOWA '4 tr CoKftiv ca&v� ..II.. Office of Driver Services Iowa Department of Transportation n State of Iowa Division of Criminal Investigation 215E7"'St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal History Record Check Walk -In Request Your name A7an ter ',? Let*—sorN Address l 5-qO P 1 S+ City/State/ZipT T cS Phone# 3 33 1 -I-z,-4k— Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) TT(;,)SON 6LAt j 1•T1—V Date of Birth FechaNacimiento (mandatory) Gender Genem (mandatory) Social Security Number (recommended) �) r1 != L 1 Male ❑Female b Waiver Signature Firman Of the request is on yourself,, please sign. If the request is on someone else, write N/A.) DCI USE ONLY Results As of ': a name and date of birth check revealed: - ❑No record found 1ORecord attached, DO # DCI initials Receipt 1 �J b Number of requests,��/x $15.00 per last name = Total amount $ • Method of payment:-Y_}cash ❑money order ❑check # ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number # Exp. Date DCI:00567329 NAME: LARSON,ALAN KEITH DOB SEX RAC 19540713 M W ADDITIONAL IDENTIFIERS SC FHD 01 ARRESTED 19980111 IOWA CRIMINAL HISTORY DCI 00567329 MISDEnrEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/02/27 HGT WGT EYE HAIR SKN POS 601 200 BLU BRO FAR IA CCH RECORD *** AGENCY: IA0850100 AMES PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE TRK#: 032094601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401(5) POSSESS CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 032094601 SENTENCE DISP EFF DAT FINE $250 19980331 COURT COSTS 19980331 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