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Home My WebLink About12-090CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX Authorization Number ,'a _ O APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) First iddle ll Last 1. Name / G 2. Mailing Address % 3. Telephone: Home � )) Other: CF 4. Prior experience in transportation of passengers: T%10 r %L' /a/ Z7 r— 7u lit 14A i'C 7c � � tJC 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 1 y 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? 0 n Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? roc Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i,—'O Tvpe 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) Dery iemeatlg 09/2010 Ihers�h�ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number hy��[[jj . 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 andsio uments relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the pr s of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) A j Signature of STATE OF IOWA ) COUNTY OF JOHNSON ) Date 4-16' a0/o2 Subscribed and swom to before me by 41ri 9MrVZW JD/!rlSs�r/ On this ./6/ 941—day of tib ,10/� in and for the •teitxsRxxiix�wix��txa�x�xMtkff�t+*r.+,�,e+,ntaw+rta+reee�i��eeeNe»��+stt��+t+wwwMx��++,e�eeirn,�wwxar�nt�e++�eea�e��»�a�nx��k��wxxxx�y��iei++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). Z/_ & V Date Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at lcgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update d�a d�2010.d 0912010 Feb. 9. 2012 4:32PM 113 .. (Div of Criminal �Investigation, NNo.�3346 VU PP. X2/6 U. STATE O : I rel 1 n ave f rr ai w'�lr'-(4'SA f• Request Form F. r: To: Iowa M1s10h of Criminal InvasaghtUh Support Operallons Burouu,l"r Moot 2151;, I" S(root D69M91no4reiva 60319 (SIS) 720.6o6d (615)125-608o Valc Dn; DCI AccountNtlmber, r4 ! Qfeppl(ce�lnY Fro In: OSTY OF TO'WA GIM CxTX CLERIC'S OFFull 410 7C_ TyASR7%GT027 S�(trBT TOVA CITY nUrA 52240 P1100e1 --9'19-956•-Y041 _ Vol g19 -356-5D 97 C34fa1e ' 1�Remale I • �// �- 90 13 ahei Infor1o1r18nw without a signed wahrorfrom tho subloot of tbo regnaet, a comploto orl:gfnpl h lstory record mny Not bo koloosoble, per Code oflap/q) Chapter 69z 2.17or comnlota'orinthlalbistory rccordtnlorhtgtloh, asalYowed by Iqw, h(A'oys obtath 0 waiver slenatura lYom tho•subtoat offhe rAniAtt.' 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Il NoYowaWminolHistoryRecord fobndwithDCL 0 IOWA CiftainalHistoq Recordattached,llCY#42 022 ID C1 3eceived Time Feb. 3. 2012 1:35PM No.8117 Feb. 9. 2012 4:32PM Div of Criminal Investigation No.3346 P. 3/6 IOWA CRIMINAL HISTORY DCT 00611659 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/02/09 DCI:00611659 NAME: JOHNSON,MARC ANTHONY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19701203 M W 511 140 PLU PRO LER TA ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD *** 01 ARRESTED 19991220 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE XA708-2-2 ASSAULT CAUSING INJURY TRK#: 006770401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2(2) ASSAULT NO INTENT OF INJURY - 1970 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006770401 SENTENCE FINE $50 COURT COSTS PROBATION 365D SUSPENDED 10D 02 ARRESTED 20000702 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 02 IA STATUTE IA124-401(5) FOSS MARIJ TRK#: 034291502 COURT DISPOSITION AGENCY: IA092016J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 08921 SRIN006157 CHARGE CLASS: NON CONVICTION TRK#: 034291501 SENTENCE DEFERRED JUDGEMENT COURT COSTS PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 03 ARRESTED 20000919 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA124-401-1-C DEL SCH II METH TRK#: 100026301 DISP EFF DAT 20000324 20000324 20000324 20000324 DISP EFF DAT 20010208 20010208 20010208 20020103 Feb. 9. 2012 4:32PM Div of Criminal Investigation ACS 00611659 PAGE 2 OF 2 COURT DISPOSITION AGENCY: IA0520151Y JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(1 M CONTROLLED SUBSTANCE VTOL. COURT CASE ID: 06521 FECR0S6540 CHARGE CLASS: NON CONVICTION TRK#: 100026301 SUBSTANCE ABUSE EVALUATION SENTENCE DXSP EFF DAT DEFERRED JUDGEMENT 20010420 PROBATION 2Y 20010420 DISCHARGED FROM 20030226 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTXGATION, 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 No. 3346 P. 4/6 Iowa Department of Transportation Office of Driver Services (Toll Free) SM -532-1121 PO Box 9254, Des Maines, IA 5030-9204 515-244-9124 FAX: 515-239-M7 Certified Abstract of Driving Record Inquiry Date: 2/3/2012 DL/ID #: 198BB5629 (IA) Customer #: 1562171 Name: Johnson, Marc Anthony Class: D ID Status: None Address: 510 Elkhorn Tr Audit #: 2795203 DL Status: VAL Issue Date: 12/02/2008 CDL Status: None City/State: Iowa City, TA 52246 Expiration Date: 12/03/2013 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 510 Elkhorn Tr Restrictions: Commercial Instruction Restriction CDL Instruction Permit Permit Supplement: Expires 3/20/2009 Date of Birth: 12/3/1970 Mailing City/State: Iowa City, IA 52246 Sex: M History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 12/06/2007 :407788 IA Name: Johnson, Marc Anthony DL/ID: 198885629 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: ......... V9'4 2/3/2012 IOWA fly r D. 0. Of 6NIYE0 Office of Driver Services --= "� Iowa Department of Transportation Name: Johnson, Marc Anthony DL/ID: 198BB5629 // l j