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Home My WebLink About12-083�r wr CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX First 1. Name 2. Mailing Address t" 3. Telephone: Home 4. Prior experience in transportation of passengers: Authorization Number 0- $3 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Cv, cC✓ UA Other: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ilio 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?_j,_ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? S r 5 PPP � , R A Type of offense Where When SPCedvn �(�� k41 clJ YA,VAI'115 Q%O 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tvoe 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 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) GerWlaxitlrivbatlg 09/2010 I�h relly�,ebiWat I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number g`1 - 1 II jjjj . 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) ((�� j,, Signature of Applicant �l t/lyhn SVG Date STATE OF IOWA ) COUNTY OF JOHNSON �/ S bscribed and sworn to before me by 1 �lrL� On this `f day of 12 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). `/- y i Date -/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. Office Use Only Approved application DCI report State certified driving record Website update cleM1tt idnvbadgaapp2010 doc 09/2010 E) ' CIowa Department of Transportation AO Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/15/2012 DL/ID #: 814ZZ0178 (IA) Customer #: 3391742 Name: Marck, Jeremy Jeffrey Class: D ID Status: VAL Address: 1910 GRETCHEN DR SW Audit #: 5853552 DL Status: VAL IA 06/04/2009 Issue Date: 03/13/2012 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 01/29/2015 CDL Cert None IA 524042223 Date: S92 Status: zone) 57 'IA Sanctions Endorsements: 3 CDL Med None Type Effective End Status: Occurrence JUR Mailing Address: 1910 GRETCHEN DR SW Restrictions: NONE Restriction None IA IA Date of Birth: 1/29/1977 Supplement: Mailing City/State: CEDAR RAPIDS, IA Sex: M 524042223 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/24/2008 06/30/2008 B64 No Insurance Card 57 IA 06/04/2009 06/17/2009 B64 No Insurance Card _ 57 IA 06/04/2009 06/17/2009 Improper Registration 57 IA 05/16/2010 06/16/2010 Improper Registration 57 IA 01/29/2012 02/27/2012 S92 Speed (10 mph & under in 35-55 mph zone) 57 'IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 11/25/2008 04/30/2009 D53 Non -Payment of Iowa Fine IA IA Name: Marck, Jeremy Jeffrey DL/ID: 814ZZ0178 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: —�VEWCIf p% a4 3/15/2012 y0f OBNEH � - Office of Driver Services Iowa Department of Transportation Name: Marck, Jeremy Jeffrey DL/ID: 814ZZ0178 o3Mai. 28__ 20121�,11:47AM Div of Criminal Investigation DCI 1DN� o.8981 P. 1/2 STATE OF IOWA Criminal History Record Check r Request Form To: Iowa Bwan of Criminal Ievertljatlae SupportOpmdoue Burne, l" Floor 215 G 7° Street bo Moiaer, Iowa 50519 (515) 72S6066 (515) 715.6020 Fax DO Account Number. `1383 `FG (IrelfJlnlJe) From: MixVU5 + a)cI 116 wens r, Phone, ,(31a) 338- Fat., .3(4) 551 0 Last Nawer First Some MlddleName wet. �(1 ar V)• de FCC j Date of Birth] � Gender owjw 8 1Secu�rl Number o%w=wkeoe "] `— a-9" -1 r OFemate qr v r — 13 ~9a\ / 2L/ Iowa CrimiYtel HistoryRecord ettaohed, bel 0 7J 7 Male c;, WOIpa L(fbrmallon. wmodt a algaod Waiver from the aubJat oftbe request, a complete cdeltad bblory rward mer pet he reletubtA per Code of low, Chapter 692.2. For comulgit crIm Wal bblory record lofaestatlau, w allowed by torr, always obtala a w1her tare from the subject of the rMunt. DClinillal WalaerReleod:tb"etyll" for am.emewgwwng.e.cltllataeduct.etonMmol hbMr W0**%vhhdeD"Imofcrfmbw hwe<dradom(l1q. Aoy admiral hiauy duo cowar br eethtl a m.hubW by rhe DCI mWbs rele®f o dlmwd by Yew. WaiverBignaftue: Ioiyya Criminal History Record Check Results As or l �)L, . a search of the provided name and date of birth revealed: N ❑ No Iowa Criminal History Record found with 1x1 2L/ Iowa CrimiYtel HistoryRecord ettaohed, bel 0 7J 7 !IC-) w V- �r � c;, DClinillal r-r W w DCI.77 (0825/10) Received Time Mar.23. 2012 10:39AM NO -8502 U11 Y•s :+ J 11i CD n ES 7� Mai. 28. 2012 11:47AM Div of Criminal Investigation IOWA CRIMIRAL HISTORY DCI 00510734 COURT DYSPOSITION PENDING PAGE 1 OF• 1 STATUS UNKNOWN DATE PRINTED - 2012/03/20 DCI:00510734 NAME: MARCK,JEREMY JEFFREV DOB SEX RAC HGT WGT EYE HAIR SKN POB 19770129 M W 600 150 BLU ELK MED XX ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19951104 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA124-401-1 POSSESSION CONTROLLED SUBSTANCE TRK#: 022921101 COURT DISPOSITION AGENCY: IA057015J LINK CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-1 POSE CONT SUB TRX#: 022921101 SENTENCE DISP EFF DAT PLEAD GUILTY 19960216 DEFERRED JUDGEMENT 19960216 COURT COSTS 19960216 PROBATION lY 19960216 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 SUR-18CT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 3 No.8981 P. 2/2