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Home My WebLink About12-184' r 1 -4 cccccrIII, h A"=Itgq CITY OF IOWA CITY 410 East Washington Slreet Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 3S6-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 1. Name � ^i'U '�/� 2. Mailing Address 45 41,S 3. Telephone: Home 319-673 -)q 4. Prior experience in transportation of passengers: T (--of_ air 17A Other: it '✓eA a -lgy (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? YCS ro x:�-r.l•� Where Gll; Anell, 1A 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /P 7. Have you been convicted of any traffic offenses in the last five years? I Type of offense Where f When 900 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /I/L Tvpe 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) c�erWlaxmrlvbadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number SSS XX ,S�Q] . 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) IJ Signature of ApplicanDate STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by KS 6„L On this day of h -Y 2c�t �_-- 7ue� KELLIE K. TUME ., C—Ci'r_— I(::�_ 1 { : CommissioaNum� crz t ry Public in and for the State of Iowa 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). vry Ignature 6f Police Chief or designee / /I r/ ,V - �g, Signature of City Clerk or designee Date R-a'g, -ia- Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website ati 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 ai�wadWapczoioax 06/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 8/15/2012 Name: Stevenson, Daniel Barratt Address: 115 N 5TH ST City/State: WEST BRANCH, IA 523589615 Mailing Address: 115 N 5TH ST Mailing City/State: WEST BRANCH, IA 523589615 Convictions ICita Uon Date 05/16/2008 03/17/2009 Conviction Date 06/02/2008 04/16/2009 Certified Abstract of Driving Record DL/ID #: SSSXX5497(IA) Class: D Audit #: 4518598 Issue Date: 07/16/2010 Expiration Date: 07/20/2015 Endorsements: 3L Restrictions: Corrective Lenses Date of Birth: 7/20/1977 Sex: M History Information Customer #: 1217962 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: ACD Explanation S92 Speed Speed (10 mph & under in 35-55 mph zone) Name: Stevenson, Daniel Barratt DL/ID: 555XX5497 County 3UR 16 IA 70 IA 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: ....... 7r o", 8/15/2012 IOWA 9F gE, Office of Driver Services ORIVEN Iowa Department of Transportation Name: Stevenson, Daniel Barratt DL/ID: 555XX5497 9 OAug_ 15,-2012 2 06PM,ab oDiv of Criminal Investigation s ■ OF f b�=z Criminal HistoryRecord C{� J71`i•Request Form To: Towo Division or Criminal Investigation Support Operations Bureau, l" Floor 2151~ Ill street Des Moines, rawa 50319 (515)725-6066 (515) 725-6050 Fox I am reouestine an Iona Criminal Iiionry Recnrd Cheek nn- 315.338-2708 No. 9Uhh Yr„ 1 DCS Account Number: _9967 F (u appiieable) From; Yellow Cab of Town City P.O. Box 428 Iowa City, U. 52244 (319) 338.9777 Phone: FaXs (319) 339-7302 Last Name (manda ) First Name (mandato) Middle Name (r c nuncndod) StC' V G ✓15on}- Date of Birth (mmmo y) Gender (mandmory) 'Social Securi • Number (reremmeuded) 71M 7 �- 0male (7Female 3Y3 -1) - �4,5�O Waiver Injormalt0n: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history -record information, as allowed by law, always obtain a waiver signature from the subject of the request ' Waiver Release: I hreby give pemtlssion far the abuse requetting oliciel to conduct in Iowa uirrinal historyracord check with Me Division o[Criminal Invwvantion(DCI). Any criminal binaD•dolaconccmingme shat is etnulned b) -the DCl maybe rcl=cd as alloacd bylaw. Waiver Signature: Criminal History Record Check Results (DCI use only) ®Iowa As of a search of the provided name and date of birth revealed: r, No Iowa Criminal HistoryRecord found with DCT Nr � inrn c) -T, ❑ Iowa Criminal History Record attached, DCI 6 �a D DCI initials r w DCI -77 (08/25/10) Received Time Aug. 8. 2012 4:02PM No.1086