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Home My WebLink About12-228�1 f... -4 i.r'lll�� pvq `rt.Y, CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2240-1826 (3 19) 356-5040 Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) (Office Use Only) (319) 3S6-5497 FAX First // Middle /] 1. Name Shcz rr w ✓e .� Last cfg 2. Mailing Address 1-7 0%.� N,.. --_Z 6 3. 4. Telephone: Home 9_1 T- L11.3 7 Other. 3% C/) Prior experience in transportation of passengers: e� CX V/' //7 3 L 't v. !r% 5. Have you ever been convicted of any misdemeanors and/or felonies in this State Type of offense 7 W/h/e're or elsewhere? 1Whenq 049 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? !i o Tvoe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ? S Type of offense Where When Cl 8. Has your drivers license or chauffeur's license been suspended or revoked in the Tvoe of offense Where last five years? !7 0 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) deNt.idNbadg 09/2012 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 / 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) J A s Signature of Applicant 1 jam — Date ff f f ##H##HH4##444*****tielf tffHHHf#M###Y##41*Ht***H*H#tt*ftf*Hftf*H*HfHf1i#111111111HN######*##feflH#*Ht*#*#f fr#tt#HHtffitfHf STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by S k1, On this 0-1 day of so„ dl�e_ dd b Notary Public in 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). , #. Sign ture of Policeii9bief or designee 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. Signbture 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--x45- i a Date d�maria W M10a 09/2012 Iowa Department of Transportation Office of Driver Services (Toll Free) 600-532-1121 PO Bax 9204, Des Moines, IA 50306-9204 515-244-9124 FAX* 5115-2319-111137 Certified Abstract of Driving Record Inquiry Date: 9/21/2012 DL/ID #: 237CC1516 (IA) Name: Augustine, Shaun Andrew Class: D Address: 1729 LOWER OLD HIGHWAY Audit #: 2909937 None 6 RD NW Issue Date: 01/09/2009 City/State: OXFORD, IA 523229214 Expiration Date: 04/23/2013 Endorsements: 3 Mailing Address: 1729 LOWER OLD HIGHWAY Restrictions: Corrective Lenses 6 RD NW Date of Birth: 4/23/1981 Mailing City/State: OXFORD, IA 523229214 Sex: M History Information Convictions Customer #: 3385482 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County IUR 07/17/2012 09/02/2012 S92 Speed (10 mph & under in 35-55 mph zone) 52 IA Name: Augustine, Shaun Andrew DL/ID: 237CC1516 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: "•"'•?�9,p'4� 9/21/2012 IOWA0. `:-0 ....VER Office of Driver Services Iowa Department of Transportation Name: Augustine, Shaun Andrew DL/ID: 237CC1516 Iowa. City DL Station Eastdale Mall 1700 S First Avenue Iowa City, IA 52240 Statement Receipt: 27759192 Customer Information Name: Augustine, Shaun Andrew Address: 1729 LOWER OLD HIGHWAY 6 RD NW OXFORD, IA 523229214 Phone: Fax: Email: Attached Customers Augustine, Shaun Andrew Transaction Office Information Date: 9/21/2012 12:44:02 PM Location: Iowa City DL Station Name Type Description MISC Finance Transaction - Augustine, Shaun Andrew Product Sale of Records - Certified Payments t Amount $5.50 Amount $5.50 Total Due: $5.50 Payment Method Payor Payor # Number Amount Tendered Cash Augustine, Shaun Andrew 3385482 NA $20.50 Total Tendered: $20.50 Cash Back: ($15.00) Sep.20. 2012 2:36PM 08/08/2012 11:24 FAX Div of Criminal Investigation No -5416 P. 1/3 4 DCI IOWA 1ouua STATE OF IOWA Criminal History Record Check F Request Form ®rv"11- i'o; lamal)IywmarCrlmlaalloyatiptloa Sopport Operdlou $arath 1" Floor 115 L 7m Guaet Da Modic, Iowa 50319 (SIS) 72361166 (sts)1254M Fat r` VCl Amount NumberT'4385-r; Fpa; {IV1arG.9 I �X) raeK; ,(3l4 338' paa; A ❑Seoole I `'/ 3!- 6 7- S.Z G G _ nag WAiVe/ Inforilla(blt: p'Mhort a elpted waiver r to lie nbloet alba tcgaeW o d lslo a enmun slowed D law, Almay* MrrlauabM,perC"deorlorte,Cbrpler[7L2.For�p)4$,�o4alDklaryneoedlalormKbw,uaMo*'ed Y Obtain a wdva a hon a min eat the •r• Wg(WrRdeare:Ihw0yan+v+mhiiatacheabove nQmftoakiatoommurmw.MoldhiDWw 10 as W01MMkimorcrimteal __� ._- �._.v..._..ar..wTeMlne1r siirbm�►uImI1N��'�'a;deree4uYlelwdglnr. I i t n / 4 19 11.1401 W. 1060 WahwSigivalard Iowa C ' nal His ors Record CheckResulb search of the provided netne and date of Unit wanled: As of a ❑ No Iowa Criminal Mtory Record found with DCI r• Iowa Criminal History Record aw(heed,, DCI # DC1 initials—J I i t n / 4 19 11.1401 W. 1060 b Sep -20. 2012 2:36PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00598330 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/09/20 DCI:00598330 NAME: AUGUSTIN9,SHAUN ANDREW AUGUSTINE,SRAWN ANDREW DOB SEX RAC HGT WOT EYE HAIR SKN POB 19610423 M W 600 160 GRN RHO FAR MO ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19990525 AGENCY: IA0570100 CEDAR RAPIDS PO CHARGE NO- 01 IA STATUTE IA714-2(4) THEFT 4TH DEGREE TRK#: 500350201 COURT DISPOSITION AGENCY: IAO51015J LINA CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-4 THEPT 4TH DEGREE CHARGE CLASS: NON CONVICTION TRK#r 500350201 SENTENCE DISP EFF DAT PLEAD GUILTY 19990826 DEFERRED JUDGEMENT 19990826 COURT COSTS 19990826 DISCHARGED FROM 20000324 DEFERRED JUDGEMENT 02 ARRESTED 19990707 AGENCY: 1ADS20400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESSION SCHEDULE I CONTROLLD SUBSTANCE -MARIJUANA TRK#: 016526701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016526701 SENTENCE FINE $250 COURT COSTS 03 ARRESTED 20090715 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 02 IA STATUTE IA708.2A(2)(13) DOMESTIC ABUSH ASSAULT WITHOUT INTENT CAUSING INJURY TRK#: 1A0079M02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO - No. 5416 P. 2/3 Sep. 20. 2012 2:36PM Div of Criminal Investigation . • DCT 00595330 PAGE 2 OF 2 02 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE INJURY/MENTAL ILLNESS COURT CASE ID: 06521 SRCROU7740 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1AD079M02 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL SBD 20100203 JAIL 90D 20100203 FINE $315 20100203 PROBATION lY 20100203 04 ARRESTED 30100730 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA724.26-2 RECEIVE/TRAN'SPORT/POSESS FIREARM FELON - 1990 TRKi$: lAO09VA01 COURT DISPOSITION AOENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA724.26(2)(A) DOMINION/CONTROL OF FIREARM/OFF WEAPON BY DON ABUSE OFFEND COURT CASE ID: 06521 FECRO9153S TRK#: IA009VA01 SENTENCE DISP EFP DAT DEFERRED JUDGEMENT $750 CIVIL PENALTY, $750 20111202 CIVIL PENALTY SUSPENDED PROBATION 3Y 20111202 COMMUNITY SERVICE 50H 20111202 No -5416 P. 3/3 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. rV,(�`II`�J\ DIVISION OF CRTMTNAL INVESTIGATION 0 � cP owc,L C)/ -3 81 31q