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Home My WebLink About12-107�rIII�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX 1. Name 2. Mailing Address 3. Telephone: Home Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) /'1�_ - io7 (Office Use Only) Middle ve00 Last Nelson ah So �- Other: 019) 530"8115 4. Prior experience in transportation of passengers: V eArs 6tv) CAS Ar'rJel 1+� hDWA C14V _. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Yes Type of offense Where Tfu a Pex r x Alffntxl lA 1ovio, C 6. Have you lb jj onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? tV Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 1 e S Type of offense Where When 5 eCA q} N fog SeAt 8 jal jpq P Sowo. C. �O 8. Has yo r driver's license or chauffeurs license been suspended or voked in the last five years? 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 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) derW [drhbadg 09/2010 I hereby ce i that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `y� K%1gg . I understand that if I falsely answer any questions in this application, that Phis 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 is-I�Cha 1#11{1{{1111{1flfffifYffYYYYYf#i#i####Y##YYYfi##Yi#f4'Ff{#Y+kl#Y###Yfi#Yf#YY#YYY4##YYY4#Y#####�Ff##YY#Y#YYi#Y##f###4#YYYYYYYf#ffYff4ffff YYYYYYffYY STATE OF IOWA ) COUNTY OF JOHNSON ) b cribed and sworn to before me by ��t L �l e �S1 On this �� day of Cj KEl LIE K. TUTI I E otary Public in and for the State of Iowa My Comm sio i es ow ifitifflfYYfffYYfffY*k*#tf###*titfitt4f334344i33#tiff fit 311113134tf3tt33lfftlHifttift43ff44ttfttfiftit4fif3#iii#444##tf#3#f#t#tit##tfti###f1 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). SI natur of Police Chief or designee Signature of City Clerk or designee 3rd- i2 Date 5- &O-1--,2 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. 11111{14!!1.11#f111ff.fYYYYY#Y#lY#Y{11111#11##M11f41«1111111111##1111fill!41Y#YY11f{#1Yii###YfYYYff#YffYYYYf#YYYY#YfY1YfY4YYf1ff4YYflffYYYlYff Office Use Only Approved application DCI report State certified driving record Website update r1eh midnvndWapp2010 d 09/2010 F21% Iowa Department Office of Driver Services PO Box 9264, Des Maines, IA 503156-92G4 of Transportation (Toll Free) BDO-532-1121 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/29/2012 DL/ID u: 464KK6798 (IA) Customer O: 2301096 Name: Nelson, Eric Vernon Class: D ID Status: None Address: 1912 HANNAH JO CT Audit #: 1304100 DL Status: VAL 01/16/2011 02/10/2011 Issue Date: 07/03/2007 CDL Status: None City/State: IOWA CITY, IA 522403080 Expiration Date: 06/05/2012 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1912 HANNAH JO CT Restrictions: NONE Restriction None Date of Birth: 6/5/1976 Supplement: Mailing City/State: IOWA CITY, IA 522403080 Sex: M History Information Citation Date Conviction Date ACD Explanation County JUR 04/08/2009 05/15/2009 S92 Speed 52 IA 08/21/2009 10/02/2009 F04 Seat Belt Violation 52 IA 01/16/2011 02/10/2011 592 Speed (10 mph & under in 35-55 mph zone) 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/06/2008 451902 IA 10/20/2010 596002 IA Nelson, Eric Vernon DL/ID: 464KK6798 :uant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I 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 office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: ;.••""••T!J�y 5/29/2012 IOWA'. > 4- D. 0. T..: v� �" Office of Driver Services `RRIVt1�,;= Iowa Department of Transportation Nelson, Eric Vernon DL/ID: 464KK6798 9May. 16. 2012 11:1BAM Div of Criminal Investigation No.5224 P. 12/1`4 , 1900'eN NV94:O1 2101 'Il'IQN awll paAia)ay cg 5'3\ STATE OF IOWA x Criminal History Record Check � Request Form To: Iowa Dlvlllau of Criminal Invesllealloo support Opemilona Bareaa, I" Floor 1151:. r street Des malael,Iowa W319 (515) 7SS6066 (S1S)725S6080 Fax Y _ __.:......, lnwe !`A...L.el T-Y:c�..w A�nnnl Chx4 nn•' VCI Account Number: 4383 - FG (1ropok") 'From; IMaYG3r0.X1 116 54VS-7 pr. phone:33Y- Fax:.. 3l9 3'lI W Lut Name Firat Nsm nnaa Middle Name trwommded 065on - Uerrlon Date of Hirth --,d ow Gender aanda Social Secovity Number ma G/5-/'76 2fr4ale ClFemde 4`�e— 4�{p� Wolper%rjfarrnaliart: Without a argued walrerfrom the sobjeclotiberequat,acomplete criminal btetogrecord maract be releaable, per Coda orlows, Chapter 692,2. For wmpleh crimlaml bMiory, record Information, u allowed bylaw, alwaya ablpim4WpdycrjlgXoioreftmabavublftnofibormuc§L W(Ifl'e/%ICie&Te:l hatbytiw peim6rbn W: dq IleYe ngoaiiq oflieYl ptgdual mloN� edmlul hinory rtcoN NeeY vNhJq phbioo arCdnitil loYampevutonl. Any alminal lib"dap eaaantolke that is m/ri�m%emdOYomncrr n*ybbo nlarea Y xNawWM im. Waiver Signature: ! &zs �I•owa Criminal Ilistory Record Check Results (pCiaaaalr) As of � ^ 16 —19— a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI - p i Town Ct9lnlnel History Record attached, DCI b DCI initials/ 6, DCI -77 (08125/!0) May. 16. 2012 11:18AM Div of Criminal Investigation No.5224 P. 13/14 IOWA CRIMINAL HISTORY OCI 00518350 -. MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/05/16 DCI:00516350 NAME: NELSON,HRIC VHRNON DOB SEX RAC HGT WGT EYE HAIR SKN POB 19760605 M W 602 250 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD rw 01 ARRSSTSD 19960229 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/SCHEDULE I/MUSHROOMS TRK#: 010655802 CHARGE NO- 03 IA STATUTE IAI24-401-ID POSSESSION/ N/INTENT DELIVER MARIJUANA TRK#: 016655803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE SCHEUDLE I/ MUSHROOMS COURT CASE ID: FECR40720 TRK#: 018655601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960625 COURT COSTS 19960628 PROBATION 2Y 19960626 COURT DISPOSITION AGENCY: IA052015U JOHNSON CO 111ST COURT COUNT NO- 02 IA STATUTE IA124-401(1)(D) P069ESBXON/ W/INTSNT TO DSLIVER/ MARIJUANA COURT CASE ID: FECR040720 TRK#: 018655802 ' SENTENCE DISP EFF DAT DEBERRBD JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960628 02 ARRESTED 20070422 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: IAOOIAO02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 FECR079207 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A001A003 May. 16. 2012 11:10AM Div of Criminal Investigation No.5224 P. 14/14 SENTENCE JAIL 2D DCI 00510350 PAGE 2 OV a DISP EFF DAT' 20070919 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 OE CRIMINAL INVESTIGATION 0 1