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Home My WebLink About12-176-4 • (tr"III �.aii� ■ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number /A _ / —7(10 APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) 1. Name First , , �� Middle 4 ✓: ! I 1 ) Last %1f 1 / 2. Mailing Address �C7t_) Z0c� fi S 4I� I h i`i 3. Telephone: Home l 2 ) '!:�/ % 7 2 Other: 7 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeurs 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) eierWtautlrivbaeg 06/2012 I hereb certi tha I have�'$s ed to me by the Iowa Department of Transportation a valid Chauffeurs license nGmber / I understand that if I falsely answer any questions in this application, that this . application may be den ed. 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) 2 Signature of Applicant Date l �� R#RR#R*f:lff#RfiffY##1#4Y#Yi##ii#####4H########kRRR##RR#*#RRRf*RRR###fR1flRRR#R#*#1R1fYRff#Yfi#1ff#f#f#4###fY#f#ffiffifi###frtk#R#pk4#RHRR#fR*RR STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by L Sio z On this as - day of My 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). a. vie f or designee Date ?-a--�--/rte or designee 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 deMfla vbadgeapp2010.tl 06/2012 Jul 2Ja1.30, 2012 1:52 PM CabOiv„of Criminal Investigation zJ 17U1T 1: UirM Cab O1v of brimf-nai '"05119a”" R 319-338-270bNo. 0452 P. 1/2 c• 319-336-z7afno, � 1 � r. v,, STATE OF TO WA Criminal history Record Check Request Form To: Cowe �lrtrion nfCHminal InvFst(gptfon Support Oporotlow Duretu, t•' Floor 2151), 7i°Sirmf ))es1%ions,iolra 50.119 (5f 5) 125-6066 Iowa Record DC1 ArceuntNumharc —9967-P. 6r•arlh.w Pfem: Yellow Cub of Iowa Cliv, P.O. Box 413 Topa Cley,1A, 52248 Pha na• (319) 3JS-9777 BaK: (319) 339-7302 fivuivtr Xnjorntaflan: Wllhoul a elgned waiver lYom the subject of the regklalr, a corop)ple erlminN hhtory ruord *ay not be releasable) per Code orIowo, Chapter 691,2. For complete esimlbal history record lnfortaaUon, as allowed bylaw, allays oarofn tl walverni Plure from the sub ectnf rha re vert. Walver Bdeorc:I hx by yrva pctminrod fv aM eb6NclatacA1ee QW102110 conduct ea lows Grin,@al hilloryaoxrd ehKk wish Iho Dhidon oCcarmlosl lmudaedan�Cb.Myatmha161n6rypsac eeteavolmeAU!sp�ph,.o,Hasdb' maybe rtleucn ai pnoW,m by)tt,. lYnlverSlgxalNret_ ] ��•fi�f' ' "AMAL Ata LVA """,.. LileGl:ll. ilCS V{LS As of I /i a search of dia, provided name and dwe of birth xc%2altdi ! ❑ No Iowa Criminal History Redord found with DC1 I 1r� Iowa Ct'iminal%lislo Record attache bCIR UM�PI DCI wit(atsj�b— DCI -77 (09/W10) Received rime Jul, 23. 2012 2:59M, fro. 5953 Received Time Jul. 25. 2012 10:18AM No. 0218 (DC use enlr) Jul,30, 2012 1:52PM Div of Crininal Investigation No.0452 P, 2/2 IOWA CRIMINAL HISTORY OCI 00600361 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/07/30 DCI;00600361 NAME; STORY,ERHRST ARTHUR DOB SEX RAC HGT WGT 19660227 M W 510 270 ADDITIONAL IDENTIFIERS SC R EYE TAT LF ARM TAT R CALF TAT RF ARM TAT UL ARM TAT UR ARM CCH RECORD **• EYE HAIR SKN POB BEO BLK MED MN 01 ARRESTED 19990628 AGENCY: IA0570100 CEDAR RAPIDS VD CHARGE NO- 02 IA STATUTE IA708-2(4) SIMPLE ASSAULT TRKA: 500389102 COURT DISPOSITIOta AGENCY: IA057015J LIM CO DIST COURT COUNT NO- 02 IA STATUTE- IA708-2 M SIMPLE ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500389102 SENTENCE DISP EFF DAT -PLEAD GUILTY 19990924 PINE $SO 19990924 COURT COSTS 19990924 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. 144 CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of TransportationriOffice of Der Services (Toll Free) BOD -532-1121 PO Box 9204, Des Moines, 3A 503€F6-9204 515-244-9124 t FAX: 515-239-1837 Inquiry Date: 8/1/2012 Name: Story, Ernest Arthur Address: 800 BRANDON AVE APT 2 City/State: HIAWATHA, IA 522331331 Mailing Address: 800 BRANDON AVE APT 2 Mailing City/State: HIAWATHA, IA 522331331 Convictions Certified Abstract of Driving Record DL/ID #: 580XX9476 (IA) Customer #: 1135116 Class: D ID Status: None Audit #: 5410153 DL Status: VAL Issue Date: 08/02/2011 CDL Status: None Expiration Date: 02/27/2013 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 2/27/1966 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County JUR 02/19/2012 04/17/2012 M42 Improper Lane(changing lanes) 52 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended '08/15/2012 INDEFINITE D53 Non -Payment of Iowa Fine 7A .IA Name: Story, Ernest Arthur DL/ID: 58OXX9476 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: Name: Story, Ernest Arthur DL/ID: 580XX9476 8/1/2012 C Office of Driver Services Iowa Department of Transportation Clerk -of -Court: JOHNSON COUNTY CLERK OF COURT Receipt Date: AUG -22-2012 PO BOX 2510 IOWA CITY, IA 52244-2510 (319)-356-6060 Case #: 06521 STA0096228 Rcpt #: 467429 Payor PIN: JO1922484 Citation #: IC226842 BatchID: REBE52 ERNEST ARTHUR STORY Remitted by: ERNEST ARTHUR STORY 2930 INDUSTRIAL PARK ROAD Payment Type: CASH IOWA CITY, IA 52240 Payment Ref#: Total Paid: $195.00 Balance Due As Of AUG -22-2012 $0.00