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Home My WebLink About12-072CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240 1826 ci3�356-504��1vldn �I)� (319) 356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) First Middle Last 1. Name 772/ " c—�_� 2. Mailing Address Yl 2 (2A/'�.9��I� A✓u�- 3. Telephone: Home 3Ift ?3C,; 21`*3 Other: 4. Prior experience in transportation of Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When lel- 72 - (Office Use Only) S Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five /ears? ASD - M( Ve:_P,_- TVpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? S Type of offense Where When �'5dE6�—F'� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ti)U AlewtE '\ TVDe 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 S�rlFlFn 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) derk idnvbadg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number _74 4 K r- C'5' 5) G y . 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 MAac�r /41, oz� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed andsworn �p re ma h On this /3 �h day of ay"Y SONDRAEFO T Commission Number 159791 C My Co missionF�Ires 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). Signat re of Police G f or designee/ iY d�LV SigSig t�ity 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. Office Use Only Approved application DCI report State certified driving record Website update de, jdnmadgea,201 0. dm 09/2010 Mar. 9. 2012 2:12PM ` mar. 0. 012 IU:JUAM , Div of Criminal Investigation Clty Clerk — City of Iowa City To. YolYA bbysioll orCrlSuill6l Xh'VeAHgalldh Support operatrdns aurmm, lit olooe ZY3]L, 7'hs`treoE bsxh�pinor,Towa 50319 . (915) 725-6066 (616) I25-6000 Nnre Name No. 1258 P. 3/7 No. 2186 P. 2/2 I � i ,Y'Ie jF'ru4q I 1. ' 1 K t . on, J I ' •� ll1 X)CiAccountl�lhmber;—TU�•-'",t� (tFnppgpoG o) Irrom.% em or TSA GINX 0x=19 oalrzczy 410 VMS1MjG2jXXjREET IWA G7TY IWA 5724o plinh67 -41 9—q56,5041 khy7_ 41a -356—K491 _. Clce.�c� D �R1Ye}'IhformgYlan: W;ffioutss/A+nddWaYorlt'omlhesub,(ccsafthoyoyuea(•,acomp►eleohfl¢tnathlsbryrecardmnynot Ilo 1'dlegsa6le, perCado o£YotYp, Gbaptapd92,2.J9or• oc rrrnro�e•orlmPnaIh9stdyyreooxdtuPoxmatlon, asallowed 1Sy1d+i, n(Ways LrsNeW Ga acrcoyAwe permission for Ifo a6oYerequeslrngog(olel fo mnduo{ artYo�raollminN hrflory[leerd ehcok Wilk IheA�lisror(ofComtnal (Dep. Any er(mlnethisarydata c6etomlrtgnfolh,ftIAMA te14046y1hell01sney6orer§M64P1Alfoyvc4tyiaw, . .• .� ��4 oi. ♦i..Y4Y Y.Iy LIYWWA {y `lrA4V4.n. A`aNr7 UA 4l7 ��`I !;[q sill,.) �l As of C t G — a search ofthoprovided name aizd date o� biaihsavaaled: No16wa0-InlindRlstor/14cordfound withbCT %waG`tim➢na] lIstozglteeoxdattached,DOU 7JCtagitlals� n /1 I Received Time Mar. 6. 7017 10.17AM Nn.0A09 Mar. 9. 2012 2;12PM Div of Criminal Investigation No. 1258 P. 4/7 IOWA CRIMINAL HISTORY DCI 00755749 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2012/03/09 DCI:00755749 NAME: YENTER,KEITH-ELWOOD DOB SEX RAC HGT WGT EYE HAIR SKN POB /9581002 M W 511 170 BRO BLK IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20050722 AGENCY: IA0570600 MT VERNON PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSE CONTROLLED SUBSTANCE TRK#: 503164501 COURT DISPOSITION AGENCY: iA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06571 SRCRO62587 CHARGE CLASS: NON CONVICTION TRH#: 503/64501 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT lY 20051219 PROBATION )LY 20051219 COMMUNITY SERVICE 20H 20051219 DISCHARGED FROM 20060626 DEFERRED JUDGEMENT 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 Iowa Department of Transportation AO Office of DriwrSerAces (Toll Free) 80U-532-1121 PO Bar 9204, Des Mimes, IA 503015-92114 515-244-9424 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/1/2012 DL/ID #: 348CC5104 (IA) Name: Yenter, Keith Elwood Class: B Address: 734 Oakland Ave Audit #: 4047964 ;*-7 flNF. SEOS-c Office of Driver Services Issue Date: 01/27/2010 City/State: Iowa City, IA 52240 Expiration 10/02/2014 Date: Endorsements: L Mailing Address: 734 Oakland Ave Restrictions: Corrective Lenses, Vehicle without air brakes Date of Birth: 10/2/1958 Mailing City/State: Iowa City, IA 52240 Sex: M - History Information Convictions Citation Date Conviction Date ACD Explar 03/17/2010 ;05/04/2010 S92 ;Speed . Name: Yenter, Keith Elwood DL/ID: 348CC5104 Customer #: 2125762 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert None Status: CDL Med None Status: Restriction None Supplement: 7UR 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 3/1/2012 IOWA Gi CeV ;*-7 flNF. SEOS-c Office of Driver Services Lfib „-- Iowa Department of Transportation Name: Yenter, Keith Elwood DL/ID: 348CC5104