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Home My WebLink About12-1554 r"III Z YIW®rQi� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name First Em Cr -.P— P- 2. 2. Mailing Address r2n -'s U- s C f 3. Telephone: Home :�1 v1 .6 [ a - O 4. Prior experience in transportation of passengers: Authorization Number A') - (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle Other: Last %1j, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offense Where When _/- : 6. Have you beenconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Tvoe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? / °s Type of offense Where When 7� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? n (� Type of offense Where When 9. Have you ever applied to bean 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 2 J 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) clerkAaxidrivbatlg 09/2010 r I hereby ce ity that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number" I i 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 ��J (�� /) ��,yt� Date e RR*******+*##4+4+*#**#R**RR***R***#Y*######444#*#*****RRRR*RR**RRR{RhhRR*YY***#*****Y##rtY4##########+#444##++*++#+#***R**RR***RR********######## STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed} and sworn to before me by rt Ocrnd:., On this ? day of SONDRAE FORT Cly F� i Commission Number 158791 my commission Expires Notary Public in and for the State of Iowa *********k}k***}#*########**#****kk*******{{*#*#######************************k*******}***}}*{t***#*########*#*t*********k***{k**k{}*{}}{##t#### 1 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). Signa re of y li Chief or designee Signature of City Clerk or designee qc-ja Date 7- f- 1--;2- 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. Office Use Only Approved application DCI report State certified driving record Website update — dedJtewdf WdgeWpX10.d 09/2010 r Aug. 6. 2012 2:40PM Div of Criminal Investigation No -7391 P. 2/4 Aug,z, i. tuft 4:»nn Ciry triers - t,ity U luwd t,iry NU.te)t P. ttt Em ,STATR+ OF IOWA Criminal History Record Check ][bequest �'01°m To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7'h Street .DesMolnes,Sowa 50319 (515) 725.6066 (515) 725-6060 Fax T�)C� I am reaueatinaT an Iowa Criminal Hisforv, Record Check on: DCIAccountNumber: 4O b a" 7- (lfapp)loAble From: CITYOVXOWA CITX CITY C) $ILK'S OFFICE 410 Y- WASOXGTON ST'BBET IOWA CITY IOWA 52240 Phone: 319356-5041 Fax: 319.356.5497 Last Name (mandatory) Mrst ]Middle Name 6ccommende C—, A�rY\Q Name(miadatoo 5M e e e GY G Date of Birth (mandatory) Geuder (mandatory) SOelal Seq]gk Number recommended OMale EfFemale ' Waiverl'nformallon: Without a signed Walvar lYom the subject of tharquest, st complete triminAl history record inay not be relensnble, per Code of Iowa, Chapter 6912. For complete, criminal history record lt,formatlon, as allowed by law, ahvays obtain awaiversl natureflomthesub ecto£there nest. WalPer.R61ease: I hereby give pemrlsdon fortho abovo iCquatins o61c(Al to conduct an Iowa orlmlael bisroryremrd check With the Division of Criminal Investlgallon(DCO. Any criminal fib[orydaiawncemiogmarlmthmoWalnedbythe ]XI ay 60Yelcescdesel1owedbylaw. e WaiverSlgitdiuret As of W' 6 -0' , a search of the provided name and date of birth revealed: 0, No Iowa Criminal History Record found with DCT Iowa Criminal History Record attached, DCI # DCIinitials Received TimerAug. 1.1(2012 4:35PM No. 0659 (DCI use only) S2" [ M (ni-n I 071!1 c� IZY ^ro ut `'t x r Zt— IV D 0 rage r or r Iowa Department of Transportation Office ofD Services (Toll Free) OW -532-7721 PO Bot 9204, Des Moines, IA 5030&9204 515-244-9124 �4= 1*0 FAX: 515-233-1837 Inquiry Date: Name: Address: City/State: 7/31/2012 Carodine, Emcee Nayram 703 PERRY CT IOWA CITY, IA 522455243 Mailing Address: 703 PERRY Cr Mailing City/State: IOWA CITY, IA 522455243 Convictions Certified Abstract of Driving Record DL/ID #: 445AF7886 (IA) Customer #: 5603884 Class: D ID Status: None Audit #: 5857043 DL Status: VAL Issue Date: 03/14/2012 CDL Status: None Expiration 05/14/2015 CDL Cert None Date: 'beat Belt Violation Status: IA . Endorsements: 3 CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 5/14/1976 Supplement: Sex: M History Information Citation Date Conviction Date ACD .:.. Explanation County ]UR .�.. _ 02/24/2012 _.._ X03/19/2012 _ __...... ._. 'S92 �. Speetl `52 , 1IA 1 03/01/2012 :03/28/2012 S92 Speed �52 _ IA _t 03/01/2012 '03/28/2012 `F04 'beat Belt Violation 92 IA . Name: Carodine, Emcee Nayram DL/ID: 445AF7886 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: ............ e, --1 7/31/2012 IOWA *�y D. 0. T. et c4V*V Q&1IW=A .......... Office of Driver Services y� OBIYt9,—= Iowa Department of Transportation Name: Carodine, Emcee Nayram DL/ID: 445AF7886 7/31/2012