The URL can be used to link to this page

Home My WebLink About12-128r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number 12 —/a 8 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) \ s�tMjf1dI�L Last ' 0 Address 3. Telephone: Home Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 4e S Type of offense Where When 'An. GAr\\ 1�1_sl AoSv. �L] 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1(\U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? n.y Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? uj,\, tl) 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) Q)bt101Z I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 0 1161 -2 Z Z % `( ` 7 . I understand that if I falsely answer any questions in this application, that this applicati— on �iay 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 t A L Date x+xx+xx++++xxx+++aaa++++++x+x+a+x+a+xx+xxxaxxxa+xxx+axxxxxx+xx++x++xxx+x+xx+xx+xxx++xx++xxx+xa+xx+axxxxxx+xx+xx++xx+xxx++xxxx+xx+xxx+xxxxxx+++++ STATE OF IOWA ) COUNTY OF JOHNSON ) Su¢scdbed and sworn to before 11 JI -A2 I Z T� me by --� Li r t L I S—i-OL-c;>— . On this ) day of 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). Signi ofof Police or designee /bW-' � //. -&?� fl/ igntiLture of City Clerk or designee Date %-17-/�. Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. ++aaa+a+aaexa+++++aaaaaa+a+xxa+++++aa++axxx+++x+xxxx++xxx+xx+xx+xxx++x+xx+x»axx+xxxx+xa+rxxxx++xxx+xxxx+xxxxxaxx+r++»ax+x++a+axx++++aa++++a+xa Office Use Only Approved application DCI report State certified driving record Website update claM idnvb dgeapp2010 dm 090= x(01201 L Iowa Department of Transportation Office of Driver Services (Toil Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 7/17/2012 Name: Ulstad, Jeffrey Alan Address: 1131 3RD AVE APT 4B City/State: IOWA CITY, IA 522402013 Mailing Address: PO BOX 810 Mailing City/State: IOWA CITY, IA 522440810 Certified Abstract of Driving Record DL/ID #: 959ZZ3747 (IA) Customer #: 3363878 Class: D ID Status: None Audit #: 5381185 DL Status: VAL Issue Date: 07/20/2011 CDL Status: None Expiration Date: 09/23/2013 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: Corrective Lenses Restriction None Date of Birth: 9/23/1954 Supplement: Sex: M History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/11/2008 485651 IA 01/14/2010 549670 IA Name: Ulstad, Jeffrey Alan DL/ID: 959ZZ3747 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: .- -•aGi �4 r,�� 7/17/2012 IOWA •'�p W, \S r OAIVtR S� Office of Driver Services Iowa Department of Transportation Name: Ulstad, Jeffrey Alan DL/ID: 959ZZ3747 0(Jul.11. 2012 4:13PMCab Oiv of Criminal [fives tigat ;on ■an is . OF t Crim. 1 '. 1. •..1 .i. . 1...1= ' 1 Form 'fo: lolva Division of Criminal Investil:atfdh Support operations Bureau, V Floor 21517" Street Des Molties, Iowa 50319 (515)725.6066 (515)125-6080 Fax 1 am requesting ars laws, Criminal Iiiatory Iteaord Check nn - 319.338.2700e' 3134 P.11 1 DCI Account Number: _9967-F tiiaypliaabk) From: YoHow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone: Pax: (319)339-7362 Last Name (tnandalm) YBrs[ Name (mr161o1)' - i Middle Name (maommendc tDateoofirth (mandotory) Gend�er�mandeary) Social•Sectlri Number (monmaided) "3 I�Male ❑Fetrra3e 7 R _ _ ^- bi'aiver Informad0n: Wilhoat a signed waiver nrom the subject of the regge31s a c6mplete criminal history record may not be releasable, per Code oflowa, Chapter 6933, For complete criminal history record fntoYmht:ion, as allowed bylaw, always obtain a waiver signature from Oic subject of the request. atVe!'.lie%aSE: I herby give pzrmhsiM M thk AbO l2qu6llng uIIicid io condm4 w Iowa criminal hhtaryrcwrd cheek tho Division wlih arCrtmlntl InvM0Fi1i0n (DCW Any "iminal 5111my dem mncenang me (hot is mainmind by tha Wi my he mleutil as alIN*24 by )w.. WR.JpCP ailgJ3R1Nt'B: - . Iowa Criminal History Record Check Results Mc)peonh) 1 As of search of the provided name and date of birth revealed: i. ❑ 140 Iowa Criminal History Record [owed with DCl [owe Criminal History Record attached, DCI #-L1 q G D DCI initials DCI -77 (06/25/10) Received Time Jtll. 9. 2012 i2:00PM N0.9153 Jul.li. 2612 4:13PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00517960 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2012107/11 DCI;00s17960 NAME: ULSTAD,JRFF ULSTAD,JEFFREY ALAN DOB SEX RAC HOT WGT EYE HAIR SKN POB 19590923 M W 603 210 BLU GRY FAR IA ADDITIONAL IDENTIFIERS Sc R KNEE CCH RECORD 4*4 D1 ARRESTED 19960220 AGENCY: IA05202DO IOWA CITY PD CHAROE NO- 01 IA STATUTE IA70B-1 ASSAULT CAUSING INJURY TRK9; 022590301 COURT DISPOSITION AGENCY: IA052015J JORNSOM CO DIST COURT COUNT NO- 01 IA STATUTE IA706-1 ASSAULT CHARGE CLASS: NON CONVICTION TRK#: 022590301 SENTENCE DISP £PP DAT DEFERRED JUDGEMENT 19960815 DISCHARGED FROM 19970506 DEFERRED JUDGEMENT AN d REST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD "Ir ED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDE FICATION 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 SDBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No, 3134 P. 2