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HomeMy WebLinkAbout12-2262. Mailing Address IZS? S(c,441at-�Qf' QV2 3. Telephone: Home (3 (9 ) 5( 2 — g`7/ Z Other. 4. Prior experience in transportation of passengers: (u rc Y11 I (`C_ 0 /l l `4v D LAO ✓ l2i,a1�1 cl S 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? O Tvpe of Offense Where When I' w 7. Have you been convicted of any traffic offenses in the last five years? _Type of offense Where When f—a,Iwz I� Seo,\ ;J �A,((S —t ji- ©Icl 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) N 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) derMnaxidnwadg 09/2012 /a. — a ay7 Authorization Number r _ t (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday— Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name Qld Middle List �yA/�� (5( GUS 2. Mailing Address IZS? S(c,441at-�Qf' QV2 3. Telephone: Home (3 (9 ) 5( 2 — g`7/ Z Other. 4. Prior experience in transportation of passengers: (u rc Y11 I (`C_ 0 /l l `4v D LAO ✓ l2i,a1�1 cl S 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? O Tvpe of Offense Where When I' w 7. Have you been convicted of any traffic offenses in the last five years? _Type of offense Where When f—a,Iwz I� Seo,\ ;J �A,((S —t ji- ©Icl 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) N 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) derMnaxidnwadg 09/2012 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Sf L/ (' fb Q � _ 6 7 . 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) I n In Signature of Applicant ,� ry)((1,t %�"�> ^^ Date Z 1 STATE OF IOWA ) COUNTY OF JOHNSON ) Su scribed and sworn to before me by �Y a L I e On this C;_1 q4 -6 --day of (-7 )'4_C �(c I/_iu KELLIE K. TUTTLE Notary Public in and for the State of Iowa !f My Com is E ires ` ow 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 is Chle or designee S -a /-/-/a Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signa of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update 9--ate-ice Date deM1 idrivbadgeapp201 0 doc 09/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) MU -532-1121 PO Box 92114, Des Moines, IA 5030G -92G4 595-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/26/2012 DL/ID #: 846AA5505 (IA) Name: Deege, Donald Loynel Class: D Address: 1257 SLOTHOWER AVE Audit #: 6048995 Restriction None Issue Date: 06/14/2012 City/State: IOWA CITY, IA 522469403 Expiration Date: 11/20/2016 Endorsements: 3 ' Mailing Address: 1257 SLOTHOWER AVE Restrictions: NONE Date of Birth: 11/20/1961 Mailing City/State: IOWA CITY, IA 522469403 Sex: M History Information Convictions Date Date ACD Name: Deege, Donald Loynel DL/ID: 846AA5505 Customer #: 4101611 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: County 3DR 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 his 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: •:'e, i'4, 6/26/2012 IOWA . ' ¢,� ).O.T.` �= `ORIYER S� Office of Driver Services anm% Iowa Department of Transportation -,,n:: Deege, Donald Loynel DL/ID: 846AA5505 Sep. 24. 2012 10:37AM Div of Criminal Investigation No.5164 P. 1/2 bZK'dN M614 1101 11'"S awIi Pad,iaoaa STATE OF IOWA Criminal History Record Check Request Form sol Iowa Dlvmm orcrlmino lavmnp fiam Support Opersdoaa Bureau, l" Floor 210 It 7° Sheet D" Mobs, lows 50319 (Sis)72"M (1,S)72"080 Fax DCIAcoonntNumbor: 38_ 3`L -FG orpgiweie) From: Lavtes 'Faxl 45}aa..e dr. 4003 A 53440 pbe„• 1(313) 337- a•9H- Faai .. 5161 35"1-$919 L PM eeDe w �vn vr.......a....o.... G9 Name .._...� _..�.- _... First Name xanb Nddle Name(rommmFoAm (v' 3 rj-� •�0>ti H i d �-. a ti •fel E �- Date of Hirth Gender .Wgw Social SN"M Nambgr (O le OFemale 66q ~ e-1 I —%q % WdiWr Lifolmminn: WaboetM 8*0e wrltir f M the object ctele requed, a complete crimlusl Wtory record my not be releasable, per Code of lows, Chapter 69L2r For pryq$lq crlmiaai history record laforwatloa, w mHowed by law,ahms obuft a waiver gVeftre froze the orb ect Mks r Waiver Releaee:rhenbygive pnWownWbw µedsg06W to elamcime lhwwwrwmdcmkAheeplyw000rcriniud imealpdona0. Aro c0M1W M" duaeomem iwmk"1111 y n �o rclraeet uslkoed brlew. / Waiver Slgnalart. As ofV k\ U:� I V L.,- J e search of the provided name and date of bink revealed: ❑ No Iowa Ctim incl history Record found with DC1 Iowa Criminal 111story Record unwhed, DCT #, c I� -- — -- —'DCI initials— - -- 0 0701 be onb) r., — ria .0 DC2:00957566 NAME: DEEOE,DONALD LOYNEL DEEGE,DONTE E DOB SEX RAC 19611120 M W IOWA CRIMINAL HISTORY DCI 00957566 COURT DISPOSITION PENDING PAGE 1 OF 1 CONVICTION STATUS UNKNOWN DATE PRINTED - 20.12/09/24 HGT WGT EYE HAIR SKN POS 507 190 SRO ELK FAR CA ADDITIONAL IDENTIFIERS 'PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20120525 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123.47(4) SUPPLYING ALCOHOL TO PERSON UNDER AGE TRK#: 1A00EEA01 02 ARRESTED 20120520 A AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE' IA123.47(4) -2-SUPPLYING ALCOHOL TO PERSON UNDER AGE TRK#: 1AOOEEB01 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED EY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIRICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT. 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 NO