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Home My WebLink About12-062� r r"III�a CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name 2. Mailing Authorization Number 12 - b2 - (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 3. Telephone: Home k- lei 'B�3 Other: 4. Prior experience in transportation of passengers: dJ� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When �F —S -r CSUr� 3 ��t Iticse osucr� o �i 1-2 r3y7 Z -i3 -07 6. Have you pegn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? tv J Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? l (ps Type of offense Where When "rI c(n(6+it, 1� 23-\3-c;7 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) Ged0laxidrivbadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I) �� C t/ �i . 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 t govisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican Date 2 -7-9- t 7- YNNY4YY###4#4NH#N#4NMR44HH441R�!#RH4RRHRl4lH4RR4#*44N444YY44NY#N#!f Nf f #1111 f f Hf 1H*H1fR#RM4f1HNHtM44;YF#iYF#M#MNNY#Y STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and s om to before me b T .r On this if day of Ft' a6 a91A� SONDRAE FORT CC z Commission Number 159791 3yCommission ,e Notary Public in and for the State of Iowa *R*R*Ht*itit#RHtitifitt*fffitfftlft*lftffH*fit*f*tf#iRRittfi***i**i*H*************************f*111111*tiff#ti*tffiHft***ttt*ftt*******R**R 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). A,��- S`lgnatureof Police Chief or designee Sign re of City Clerk or designee 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. 4MlMflHifltlHHHf11HM1flHHHNtf111fHfHlHHfllff!!1f!l1HlHHHHHM11Hf4f#NMf 1f1HlMHHH Office Use Only Approved application DCI report State certified driving record Website update d�m adgea 2010.� 09/2010 C �oRrtewomersmn�m Rox F�ex)movz-tintPOBw 9AC. �¢ Mdn�. W 50IDAd30< 51S2C<.813<FAK 5113]9-183]Lertllletl MetraR of Driving PewM��e��rvo:m: vmzvz Duro a: eis��n� szoraryHome: emy i�ames �O SRIu¢:pGCCreeu Wl 19iX PVE VprtA Putlit R: SB0035G OL Sbluu VPL02/112013tlry/Stile: 2NNLVILIP.IP Sti4L691 E�pl�elen UeR: 05/38/3015 eM1Bblus: IbGtlarwnenls: 3 CDL MeE 9Muc: IbMeiI�nB Addres¢: 80319iXAVE 11NrtP Nl�llmei Ras4l�lian NoneW BIM: L3&1983 SupPlemanUMallinpClty/AMe: COPPLV11lE.IP R3G116915ec M lowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 5030&9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/23/2012 DL/ID #: 117AC4879 (IA) Customer #: 5207471 Name: Davis, Jeremy Thomas Class: D ID Status: VAL Address: 802 19TH AVE UNIT A Audit #: 5804354 DL Status: VAL Issue Date: 02/17/2012 CDL Status: None City/State: CORALVILLE, IA 522411691 Expiration Date: 05/28/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 802 19TH AVE UNIT A Restrictions: NONE Restriction None Date of Birth: 5/28/1982 Supplement: Mailing City/State: CORALVILLE, IA 522411691 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/13/2007 '10/08/2008 A33 Drug/Drug Related Conviction 52 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 11/27/2008 ;05/25/2009 A33 Drug/Drug Related Conviction IA IA Name: Davis, Jeremy Thomas DL/ID: 117AC4879 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: • •:!�/j iy 2/23/2012 IOWA0. r T. T e $= MVE4 Office of Driver Services at Iowa Department of Transportation Name: Davis, Jeremy Thomas DL/ID: 117AC4879 oa/Feb. 26. 20121 9; 55AM Div of Criminal Investigation DCI I011No.5635 P._ 1/4,,003 STATE OF IOWA Criminal History Record. Check kc Request Foram To: Tawe I VIllon of Criminal luvertlgadoa Support Operatious Bureau, I' Moor 113 L 70 Street Des Molati, IOWA W319 (!15) 73"M (1.119)7254090 14.1 ..,�l.,.a DCI Account Number: Jo qp 3 —FC Ndi " From:Mav'GSTakI 116 ski -s ur. Phocel F111 338- 0 i am reaucaurix an luwn a.rm:mu „��..,, Lgd Name (mygsygi ,. .........,...... IFltat Name :v.odsro IWIddle Name rogo V10 MA S Gander Social SecurityNulabar ,oro Date of birth srodrn Z Mite OFemale 595 SSS Waiver Informaikilt wNboat a 4aldwoleer ham the subject of the toques, a complete crtminal MMM regard meyaot ht rtuxuble, per Code of lowai Chapter 691.7. For comQjq!tt ettmlaai hhtorr record Information, to allowed by law, always obtain a WelVer r sturehom JkLAuNectortherequest. Waiver Releam:lhmby elvapamlabn tads ■bgronquadeloffmw to wnduolm Tom erlmhl haw mm:d ow W:honDlralm erLrhm IMadisdua(DCil. Anyedndul Wray drb e1W:smrkokoib/aa DCCmWbomleuedurllmmdglrW. WoiverSignalare. As of a search of the provided name and date of birth revealed; ❑ No Iowa Criminal History Record found with DCI , Iowa Criminal iiisrory Record attached, DCI i! 6Q DC1 Received Time Feb.23, 2012 10;90AM No.9932 -Feb.28. 2012 9:55AM Div of Criminal Investigation DCI :00811609 NAME: DAVIS,JEREMY THOMAS DOE SEK RAC 19820528 M W ADDITIONAL IDENTIFIERS TAT L SHLD TAT R SHLD IOWA CRIMINAL HISTORY DCI 00811609 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED - 2012/02/28 HGT WGT EYE HAIR SKN POS 605 160 HAZ ERO MBD FL PHOTO AVAILABLE: Y CCH RECORD ttt 01 ARRESTED 20070813 AGENCY; IA0520100 CORALVILLE PD "CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A0023R02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 VECROB0455 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0023RO2 LICENSE REVOKED SENTENCE JAIL IOD FINE $315 02 ARRESTED 20071305 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 TA STATUTE IA155A,21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK#: 5AO043501 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG COURT CASE ID: 06571 $RCR074931 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 5A0043501 SENTENCE FINE $315 03 ARRESTED 20071213 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE TRK#: 1A0030Y02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- DISP EFF DAT 20001000 20001008 DISP EFF DAT 20080425 No.5635 P. 2/4 2 Feb.28. 2012 9:55AM Div of Criminal Investigation DCI 00611609 PAGE 2 OF 3 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 PECRO81761 CHARGE CLASS: FELONY CONVICTION TRK#: 1A0030Y01 RESTITUTION SENTENCE DISP EFF DAT FINE $750 20080919 SUSPENDED PRISON 5Y 20080919 PRORATION 3Y 20080919 PARTICIPATE IN DRUG TREATMENT COURT PRISON 5Y 20000919 IMPOSED 20090204 REVOKED 20090204 04 ARRESTED 20060424 AGENCY: XA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124.213 PHARMACY PURCH >7500MO PSEUDOHPHEDRTNS TRO: 1A003Z301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.213 PHARMACY PURCH >7500MG PBEUDORPHEDRINE COURT CASE ID: 06521 SRCRO81795 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A003Z301 RESTITUTION SENTENCE DISP EFF DAT JAIL -10D 20001008 FINE $315 20081000 05 RECEIVED 20090206 AGENCY; IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE TRK#: CB005WBOI INMATE #: 6747211 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE CHARGE CLASS: FELONY CONVICTION TRK#: CB005WB01 SENTENCE 5 YRS N0. 5635 P. 3/4 _ Feb.28. 2012 9:55AM Div of Criminal Investigation No.5635 P. 4/4 DCI 00611609 PAGE 3 OF 3 CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 20100024 PAROLED CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC B 20110506 DISCHARGED AN ARREST WYTWOUT DISPOSITION IS NOT AN INDICATION OF QUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF PING$RPRINTS 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 w