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Home My WebLink About12-199' r 1 _ i MIYI®r�1\ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name T 2. Mailing Address _5 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.) �ast e_ 3. Telephone: Home Ol l S std 8/c (9 Other: 4. Prior experience in transportation of passengers: 1 Yzci rP w � C,-)` 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have yo y leen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1U 1 Type of Offense IJo 17. L A�U I,y5 ti a 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where Where Y�-7C4��'ly COl-lN When 3-1/-02 q -)2-b7 241-0, 3-?- 6q When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ye _5 Type of offense 4 Where When 9. F e you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0 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) uerknaxitlrivbadg 06/2012 I NT Vrb that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number S/ y3ro3 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) Signature of Applica ✓/� Date ,5 /-6 -� STATE OF IOWA COUNTY OF JOHNSON S seribed a d sworn to before me by J e On this f r f ` day of ,„ . xELLiE K. TUTfLE _ ._ Notary Public in and for the State of Iowa 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). or of City Clerk or ?-/a 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. !t#***f*f*#!f}#fe*ffffflfffYY######Yf####f;!##**###***#***f#lffff#f41fllHffffffff11ff11fff1ffYfiff#f!f#i###i#####*******!M!!*f*lfrflffllffMYk##* Office Use Only Approved application DCI report State certified driving record Website update deikfl Anvbadg aW2010 d 06/2012 0 1Aug.17. 2012 3:04PM;ab tDiv Of Criminal fovesligation r� 319-338.2708 i4o. 9526 P. 1/2 S'L'ATE 016' j()WA Criminal History Rt'eo+rd Check Request Form To: fawa Dtyl919n of Criminal Iavesagatien Support Opera tions Bureau, I" F!oor 215 E. 718 Street DSS Moinee, Iowa 50319 (515) 7256066 (S)5) 925-6980 Fes I am requesting an Iowa Criminal Hismry Record Check on: DCI Accopni Number; 9957-F pt-apptiwbte) From; Yellow Cab of rows City F.O. Dex 416 Iowa City, LA. 52244 (319)33&9777 Phony Par: (319) 339-7302 ! Last Nam (mmnd:tay) First Name (mandatory) Noddle Name reoommmoed) 8ttiJ ir 1V !.(i/O Jim r" �J, As of a search ofthe provided name and date of birth revealed; Date of Birth unmdawry)/ !Fender (manila ay) Securi Number (recommended) 'S�occial<),? / �07 ONiule ❑Female 9i07` Waiverinforfnation: Without a signed waiver from the subject of the request, a complete crimtnal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal blstory record Information, as allowed bylaw, always obtain a waiver signature from the sub cct of tha request, WaiverRelease., l hereby give permission Ihr the abave requesring official m cond0ct on Iowa cdminas hisloty teenrd chakwaa the nlvisian orCommal lnveuigmion(I)CO. Any crimlw history data co mg no ¢ar k mainTolnW by The DCl/maayy be salumd os allowed by law. . Waiver Signafure: �' /- Iowa Criminal ffistory Record Check Results (DC1 :!_ ', _,< oao caly) v ;S; va t As of a search ofthe provided name and date of birth revealed; f r_ U—)v M No Iowa Criminal History Record found with DCI T_ z t V� Iowa Criminal History Record attached, DC14 p y n D 1 DCI initials r s� DCIM (08125/10) Rereivei Time Aug. 14. 2012 8;19AM No. 8660 Aug.17. 2012 3:OM Div of Criminal i veshgalion No.9526 P. 2/2 IOWA CRIMINAL HISTORY DCI 00763235 NON CONVICTION PACE 1 OF } DATE PRINTED - 2012/08/17 DCI:00763235 NAME: DECHARD,JEREMY J RNN,JSRNHY NICXOLAS DOB SEX RAC HGT NOT EYE HAIR SKN POB 19041230 M W 507 220 ERO BAO XX ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD *'w 01 ARRESTED 30051104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(4) THEFT 4TH DEGREE TRK){: 101696901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(4) TNBFT 4TH DEGREE - 1976 COURT CASE ID: 06521 SRCR074226 CHARGE CLASS: NON CONVICTION TRKv.: 101696901 RE971TUTIOW SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060303 PROBATION lY 20060303 20060903 DISCHARGED FROM 20061011 DEFERRED JUDGEMENT 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 INO'KIIRY, DIVISION OF CRIMINAL INVESTIGATION 42 ARTS Page 1 of 2 Iowa rSDepartment of Transportation Office of ervices (Toll Free) 80-532-1121 PO Box 9204, Des Maines, IA 503DM204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/5/2012 Name: Rew, Jeremy Nickolas Address: 2100 S SCOTT BLVD Issue Date: TRLR 96 City/State: IOWA CITY, IA Date: 522403037 DL/ID #: 775YY4363 (IA) Class: D Audit #: 5470394 Issue Date: 08/25/2011 Expiration 12/30/2014 Date: Endorsements: 3 Mailing Address: 2100 S SCOTT BLVD Restrictions: NONE TRLR 96 Date of Birth: 12/30/1984 Mailing City/State: IOWA CITY, IA Sex: M 522403037 History Information Convictions Customer #: 1424101 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: Citation Date Conviction Date ACD Explanation07 County ]UR 08/16/2007 09/12/20 _ B51 No Driver's License_ j70 IA 12/14/2007 ,01/04/2008 B51 No Driver's License t70 4A 03/11/2008 04/06/2008 ,B51 No Driver's License 70 IA 02/15/2009 ,03/10/2009 B64 No Insurance Card 52 IA 02/15/2009 03/09/2009 B51 No Driver's License ;52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/25/2011 ;664966 SIA Name: Rew, Jeremy Nickolas DL/ID: 775YY4363 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: `ooQ�EHICIf.�PN ' i `�_. IOWA 4 9/5/2001122 ;D. 0. T..:- A http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 9/5/2012