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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
.n A First
1. Name
Authorization Number �a— %.I
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
Middle
Last
2. Mailing Address Z) 10 f\-)
3. Telephone: Home tci -'�j 3 L- —7>i Z Other: ""
4. Prior experience in transportation of passengers: l )LAQ_&---r60(_,3 '� V"tAiZCQ S
U0G — 7. 0
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /\-JC
Tyne 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? /VCU
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense �t Where When
S& I)VZl VLy2-S —�ti. !�
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? N G
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)
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)
ded0midrivbadg 09/2010
I h reby*certity that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number'
— D(� (� 6 ZCo 4Z . 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) — o
Signature of Applicant `' Date
STATE OF IOWA )
COUNTY OF JOHNSON ) //
S cribed and wom to before me by /�� i .ho,t I Case— I l \ y
i Y\ Q On this � J7 V da of
i `r�u[ KELLIE K. TUTTLE
I° W� Commission Number 22181 otary Public in and for the State of Iowa
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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).
Blgnature of Police Chief or designee
Signature of City Clerk or designee
M/G-/Z
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
cieddtaudrmbadgeapp2010 d 09/2010
0
' Apr. 12. 2012 12:01PM Div of Criminal Investigation No. 4379 P. 4/6 /, o
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I
STATU OF IOWA
Criminal History Record Check
Request Form µ
TO; 1OWM I)"loo of Criminal Invarlptloa
Support 01*ntioar Hor"u, 1° Floor
215 IL 70 Mroel
lose Motoes, IOWA SOW
(51S) 7254M
(SJS)725•60e0 Fn
DCI Account xumber:O
T care r
ttom: lMarG.S ` 4%1
.Phone:
Pax;
.7
Last Name mmsw)
Mddlo Name tacommdd
CS6- ,var jI2.
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PeTTIZ .
Date of Hirth omad,ww
Gender mudma
Soda[ Security Number Q
(?i -Z% -7 1� LI
le DFemale
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-33 Q —E(7) / Q C ,/ —
Waiver Igdnnadan: without ■ Aped niver nom the eubJect of the request, ■ complete orlmlurl Owns, record may not
be releasable, per Code of lows,Chopttr 691.2. For Jalholy1 criminal Unary record lofarmetloo, at &loved bylaw, olwayr
obbillo a vraWerallMajurp rrora the rubtxtofthe r nt.
Waiver Releaseah=b7 deo pwalulon M the aovvie4w4 olacw w ronammalom www hWwy retard obak WM k D6ulm of Crtmirol
famliynon (DCA. Nq etiminel lbury Ga.w-ow�nfar ne 1Mt 4'm^Jminadhy tle DCl mry b roleuode dto wd bl Nr.
Waiver $lggglara;
As of I[/;L//ct. a search of the provided name and date of birth revealed:
No Iowa Criminal History Record found with DCI
❑ Iowa Criminal History Record attached, MI M_
DCI
DCI -77
(DCI Ou onfy)
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Iowa Department
Office of Driver Services
PO Box 9204, Des Moines, IA 5030"204
Inquiry Date: 3/30/2012
Name: Casella, Michael Peterlr
Address: 114 W MAIN ST
City/State: OXFORD, IA 523229026
Mailing Address: PO BOX 442
Mailing City/State: OXFORD, IA 523220442
Convictions
of Transportation
(Toll Free) SCM -532-1121
515-244-5124
FAX: 515-233-1837
Certified Abstract of Driving Record
DL/ID #: 013BB2642(IA)
Class: D
Audit #: 4912226
Issue Date: 12/29/2010
Expiration Date: 12/27/2015
Endorsements: 3
Restrictions: NONE
Date of Birth: 12/27/1956
Sex: M
History Information
Customer #:
3959505
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
11/01/2009 11/30/2009
Citation Date Conviction Date
ACD
Explanation
County
]UR
01/19/2009 .02/17/20019
�M14
Fail to Obey Traffic Sign/Signal
X52
.IA
02/15/2009 03/17/2009
Injurlous Material on Highway
Y52
. +IA
11/01/2009 11/30/2009
S92
Speed
52
4A
12/09/2010 01/02/2011:S92
- _ _
Speed (10 mph & underin 35-55 mph zone)
:.16
'IA
Name: Casella, Michael Peter Ir DL/ID: 013BB2642
Pursuant to Iowa Code §321.10,,1, 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:
""•yw/-14
3/30/2012
IOWA '
'
D. 0. T.:
Jar
f OB�EP S=
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Office of Driver Services
Iowa Department of Transportation
Name: Casella, Michael Peter Ir DL/ID: 013BB2642