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HomeMy WebLinkAbout12-160� r 1 + MIS®rill CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name 51jApEL 2. Mailing Address 7©4 Authorization Number `a—\�013 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) S o15l�CL 10g -re wjc? C 3. Telephone: Home 3�9 `/O° �//3 Other. 4. Prior experience in transportation of passengers: 3 hI of GnmPaliiFt _ I/E//O w. Vl-rc%` .4 WAa4 L�/ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? X i/ t Toub/e';n —,row,[ Type of offense E� SE SEE C!-i/rfina 6. Have you been convicted of operating a years? /16 Tvpe of Offense Where ieWat /; w while under the influence of alcohol or drugs in the last five Where When 7. Have you been convicted of any traffic offenses in the last five years? al %f 1 KF � Type of offense Where/ When p Ie�rsF SSE -D.62.1-, r"epor-f .r+�-rohE 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? //e 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 fi-�acht� 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) derkta idrivbadg 09/2010 I hereby ce9r ify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 5 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 withal) of the provisions of Ttle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicapY _ Date Cid/ AA G!r- f• :cc= U �rfoV STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Jv m u c l J zs ,,LN ��enn� On this y 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). Kgnre of Pgl cChief or designee re of City Clerk or designee o `yy/g Date 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 r/ DCI report rr State certified driving recordy Website update r% derMandmbadgeappM10. o 08/2010 Iowa Department of Transportation Office of Diner Services (Toll Ffee) BM -532-1121 3 PO- Box 9294, Des Anes, IA 593015-92134 515-244-9124 Will iw FAX: 515-239-1837 Inquiry Date: 7/27/2012 Name: Kenner, Samuel Joseph Address: 308 E BURLINGTON ST APT 106 City/State: IOWA CITY, IA 52240 Mailing Address: 308 E BURLINGTON ST APT 106 Mailing City/State: IOWA CITY, IA 52240 Convictions _; Date Conviction Date 07/17/2010 ,. .08/15/2010 12/12/2011 :02/28/2012 Certified Abstract of Driving Record DL/ID #: 332AE1495 (IA) Class: D Audit #: 4866587 Issue Date: 12/07/2010 Expiration Date: 05/03/2014 Endorsements: 3 Restrictions: NONE Date of Birth: 5/3/1973 Sex: M History Information Customer #: 1925346 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 11A ACD Explanation County _ JUR M75�Pessin4 School Bus ..._... ___._._..... -52 __ _ (IA _. ,. . M34 .i„...„„„,,...,...,.. (Fail to Obey Traffic Sign/Signal 52 IA D72 :Fall to Have Vehicle Under Control � _ i52 11A .__..._.._..,, _rw ._.....�._�._._ ACareless Driving _ . '52 fIA M14 §Fail to Obey Traffic Sign/Signal 52 =IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 02/09/2010 1565881 '.IA Name: Kenner, Samuel Joseph DL/ID: 332AE1495 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: ;. •""••:',/N 7/27/2012 IOWA' ,r D. O. T.. f BA Office of Driver Services tip. Iowa Department of Transportation Name: Kennen, Samuel Joseph DL/ID: 332AE1495 Jul.31. 2012 4:16PM Div of Criminal Investigation du•I,:1/, ZU12 4:5/rM City Clerk - City of Iowa City �`4,��4A;��,1• I 1 History Record 1 •1, Check Request Form Tei XowaDivision ofCriminalInvestigation Support Operattons Bureau, 1°r Floor 215 A 7'h Street Des Moines, Iowa 50319 (61S) 725-6066 (515) 725.6000 l+nx I am requesthm an Iowa Ki'",11C,U OS/D3 // 9 f �M UAL No.6462 P. 11/15 No.2636 P. 3 DCiAcoount Nnmbe,r: 4�0a— r— Qfepplicable) .From: CITY OF IONVA CITY CITY CLERIC'S OVVIC9 410.U. WASHTNOTON STREET IOWA CITY IOWA 52240 Phone: $19356-5041 Fax: 819"356.5497 [Ermale [betnale �oSEI'�l 4///- �zs- r;�,79 WrltV Y-THfo-POW11012: Without a signed viaiverfrotrtthe subject oftlterequest, aeomplecacriminal history rocordmay not be relensable, per Code OfXowa, Chapter 692,2. For pornRleto criminathlstoryrecord information, as allowed by law, always obtain a waiversiannimra t1•nm +hn o..>,re,.a..wt.e ..e......_. WalverReleasel i helebygive permission for the above rcqurating official to conduct es lava alminal distoq•rccWtd ohc"at ilio nivislon of ddminot iavenigellon(DCO. Any orlminelhistorydata ConcemingmerhatiaatofoVhWbyiheDClmay�e,rpid red os allowed bylaw. ."t.� _ ,_... Iowa i ival Histor Record Check Results tnamaeam,s9 As of al a seatoh of the provided mime and date of birth revealed: Q No Iowa. Criminal history Record found With bCI �X Iowa Criminal HistoryRecord attached, DCI # ]JCI initials ?eceived Time1'Jul. 27.IC2012 4:56PM No, 0375 Ju1.31. 2012 4:16PM Div of Criminal Investigation No. 6462 P. 12/15 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00451531 NAME: KENNEN,SAMUEL JOE X9NNEN,SAMUEL JOSEPH KENNON,SAMUEL JOSEPH DOH SEX RAC HGT 19730503 M W 603 DCI 00451531 PAGE •1 OF 3 DATE PRINTED - 2012/07/31 WGT EYE HAIR Sm POB 190 GRN BRO FAR TN ADDITIONAL, IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** Ol ARRESTED 19921216 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE TA321J-2 OWI TRK#: L43115001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VER WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; L43115801 RESTITUTION SENTENCE JAIL 40H FINE $500 02 ARRESTED 19950326 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321A-32 DRIVING UNDER SUSPEND TRK#; 014624201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321A-32 DRIVING UNDER SUSPENSION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014624201 SENTENCE FINE $250 03 ARRESTED 19950406 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 TA STATUTE IA321A-32 DRIVE UNDER SUSPENSION TRK#: 014626201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321A-32 DRIVING UNDER SUSPENSION DISP EFF DAT 19930910 19930910 DISP EFF DAT 19950519 'Jul.31. 2012 4:16PM Div of Criminal Investigation No.6462 P. 13M DCI 00451531 PAGE 2 OF 3 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014626201 SENTENCE DISP EFF DAT FINE $300 19950519 04 ARRESTED 19950524 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA321A-32 DRIVING WHILE LICENSE SUSPENDED TRK#: 012726701 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE IA321A-32 DRIVING WHILE LICENSE SUSPENDED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012726701 SENTENCE DISP EFF DAT PLEAD GUILTY 19950811 FINE $350 19950811 05 ARRESTED 19960417 AGENCY: IA0520200 IOWA CITY PD. CHARGE NO- 01 IA STATUTE IA124-401(3) POSSESSION/SCHEDULE I/MARIJUANA TRK#: 024159501 CHARGE NO- 02 IA STATUTE IA727-2 SALE OF FIREWORKS TRK#: 024159502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3-2 POSSESSION /CONTROLLED SUBSTANCE/SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159501 SENTENCE DISP EFF DAT FINE $300 19960906 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA727-2 SALE OF FIREWORKS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024159502 SENTENCE DISP EFF DAT FIN$ $250 19960906 Ju1.31. 2012 4:17PM Div of Criminal Investigation No. 6462 P. 14/15 DCS 00451531 PAGE 3 OF 3 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 XOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 1 1,