HomeMy WebLinkAbout12-174r
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IIIA
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 3S6-SO40
(319) 356-5497 FAX
1. Name
2. Mailing Address I U I
Authorization Number /,Q — / 77
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
r.1
3. Telephone: Home 3(� LI001 WOther:
4. Prior experience in transportation of passengers: _hI Ci
Le
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
''1
ib5E55fo
Where
6. Have you bnvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? e
Type of Offense
Where
When
7. Have you been convicted of any traffic offenses in the last five years? t)
Type of offense
Where
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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)
derwtaridwbadg 09/2010
I he eb erti tat I ve i ed to me b the Iowa Department of Transportation a valid Chauffeur's license Humber
3 U Y P P
Oti�j I I understand that if I falsely answer any questions in this application, that this
applicati n�be denied. Iuu derstr� 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 rov' ' s of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant l CDate L, Z
#!######*#*R******R*f**#f*fffN#f!f####H#####H#####R*Rf**RRMRR*f*R1**ff*RRlRlIfRHf#f*ftfiflffHffffffffRl14ff4###ffif####i##**R#*#ffifR*f*f4
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by Q/t< On this —� day of
s0NDRAE FORT
z Commission Number 159797
MY �om�sso�E q�es Notary Publ� and for the State of Iowa
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).
Signa re of P i Chief or designee
L!it / L
Signa a of City Clerk or designee
0(--a/Lia
Q 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
DCI report
State certified driving record
Website update
dannaud,acadgeaW2010 « 09/2010
ARTS Page 1 of 1
Iowa Department of Transportation
CAM
Office of Driver Services (Toil Free) OW -5532-1121
PO Boat 9204, Des Manes, iA 503DB-92U4 515-244-9124
140 FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
8/14/2012
DL/ID #:
434ZZ7664 (IA)
Customer #:
4723324
Name:
Allen, Drum Dan James
Class:
D
ID Status:
None
Address:
701 20TH AVE APT 1
Audit #:
6192265
DL Status:
VAL
Issue Date:
08/07/2012
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration
02/07/2017
CDL Cert
None
522411639
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
701 20TH AVE APT 1
Restrictions:
NONE
Restriction
None
Date of Birth:
2/7/1961
Supplement:
Mailing City/State: CORALVILLE, IA
Sex:
M
522411639
,
History Information
CLEAR DRIVING RECORD
Name: Allen, Drum Dan James DL/ID: 434ZZ7664
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:
-""'•:;%4i'
8/14/2012
IOWA'.
). 0. T.:«
r''••••'••grv�s�
Office of Driver Services
he
Iowa Department of Transportation
Name: Allen, Drum Dan James DL/ID: 434ZZ7664
http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/14/2012
o%8 21. 2012,810: 18AM
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Div of Criminal Investigation -, DCI IAo, 1797 P.
STATE OF IOWA... __..... ;..-
Criminal Hilitory Record Check
Request Form
Tot Iowa DWislon of Crtmbnal Invetrhrtlw
Support Operallou Irarsea, Ia Floor
215 P- 74 Street
Do MOlaee, lana W319
(515) 73"M
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be numbie,"r code d Iowa, Cbspter 6nl. Forygioukla eNm WI eletoryrecord Idorodbn, u aeoMed by law, ahraye
obtain awalrer etorefrontthesabearoftbe rowlest.
Iowa Crhninal History Record attached, DO 0
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Iowa Crhninal History Record attached, DO 0
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DCI inilials_(42 _
Received Time Aug. 14. 2012 4;09PM No. 1369
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'Aug.21. 2012 10:18AM Div of Criminal Investigation
XOWA CRIMINAL HISTORY OCT, 00574232
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2
DATE PRINTED -
2012/08/21
DCI:00574232
NAME: ALLEN,DANXEL JAMES
ALLEN,DRVM DAN -JAMS
ALLEN,DRUM-DAN JAMES
ALLEN, DRUMDAN JAMES
DOB SEX RAC HOT WGT EYE HAIR SKU POE
19610107 M N 509 165 SRO SRO MED IA
19610207
ADDITIONAL IDENTYFIERS
TAT UR ARM
CCH RECORD •t•
D1 ARRESTED 19900506
AGENCY: IA052010D CORALVILLE PD
CHARGE NO- 01 IA STATUTE IA321J-2
OWI
TRK#: 032272201
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA321J-2
Owl
CHARGE CLASS: MISDEMEANOR CONVICTION
TRKB: 032272201
SENTENCE
JAIL 2D
FLNE $500
PRORATION lY
SUSPENDED 281)
SAE/TREATMENT
02 ARRESTED 20000811
AGENCY: IAOS20100 CORALVXLLE PD
CHARGE NO- 01 IA STATUTE XA124-401-5
POSE BCH I MARIJUANA
TRK#: 047864401
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- Ol IA STATUTE IA124.401(5)
POSSESSION OP A CONTROLLED SUBSTANCE - SR
COURT CASE ID: 06521 SRCROS5464
CHARGE CLASS: NON CONVICTION
TRK#: 047864401
SENTENCE
DEFERRED JUDGEMENT
PROBATION 365D
DISCHARGED FROM
DEFERRED JUDGEMENT
DISP EFF DAT
19980901
19980901
19980901
19960901
DISP EFF DAT
20001201
20001201
20010724
No.1797 P. 2/3
�Aug.21. 2012 10:16AM Div of Criminal Investigation No. 1797 P. 3/3
DCI 00574232
PAGE 2 OF 2
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 OF CRIMINAL INVESTIGATION
"1