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Home My WebLink About12-243CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 k (3 19) 356-5497 FAX First 1. Name 2. Mailing Address — 3. Telephone: Home Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle �-ate (Office Use Only) Other: CEl( (736--VgU5" 4. Priory experience in transportation of passengers: 'I)t wE I_ or 3 �ly) , iwNu tyY b,, r O (ti -4- R� dC�t�� C�� Sit'✓tCLS. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? (0c) 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? N 0 Tvpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? O Tvoe of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 1� 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) clerWtmidrivbadg 09/2012 /9N 3a st' .2 5o I hWeby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number )"Y/re nn-Fknrl�Jnso.� . I understand that if I falsely answer any questions in this application, that this application may be denieaY 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 Tit'e 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) �, /,. Signature of STATE OF IOWA ) COUNTY OF JOHNSON ) Date /6L 4P -/W /� - %/-- / oZ S 69 ribe a d sworn to before me by I V CC rc- On this l l day of O / �- �ai KELLIE K. TUTTLE CC, -c- —eel Commission NumbeMr�?p8�9 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). Sigrfature of Police Chief 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. Signattife of City Clerk or designees Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update /O Date CerMt Idrlvbaa app2010 a 09/2012 Qct.10. 2012r10:42AN Div of Criminal Investigationy 1No,8596 1. 8596 5/7 .., .LVJU t ' of 40flle SVATI1/1 E I fel A' •\ f I ' Record r ryty�� y3.t F . �.. � NN l�F•�f'lj � To; Xa\VA bit -1210y( of criminal Ynvestfgatron Sapport OpOeAlfon3 71ur0nfr, I" kgtonr 2Y5 E. 9'h S[reaC bes]Yfolges,TowA 50319 01a) 7a5.6o66 (515) 725-6080 );ak Recard Cheok an; t)�D!vfs�r� DCT AccountN'um6or; G o� QPeppl/caDlc) FrIAB; fYTY OF Tf161'A VITP CITY CLEMIg 01-TICE 410 'R. 4TAR11TWGTONMMB-T ape $11' 11 ZT khoner aig—�s�—sn�� _ Naxt �yg_as�,a4gry 9�>� . I 4RM418 • Efvomala advel rtl/o)/hgttofl; Without u sl�ned N alverA om ihesu6JecC ofYpo xegnesF a complete cYlfainpi h7sfary revord lnny not Ba rofepsp6lo,bel�CodeofxoprA,Chepter692.2.7io1+coM /e abrlmfnaIhistoryreeordlofolmaC(on,asailowodhyiaVi,plWAye oDtainpwaivoa�sf natuYen-onethe.suliocsofYhea°e 4art: l�[tttieY�2eredS�rlhercDygivepem,issfon fbrlhoeDoYerequeslfngoRioiai (a wlldvol gRTown odminalhlamry feeofd check��Slh IheDYislon oi'Gimtrcof TwosffgatfoA(W)•Rry oslnlinefhfafely dtrq ae /nOto�srla�Nnfned6y mpyLorcicgrc?a�elmW�d Gy/a1v. ` WnlverStertalieve; FAQ r lwa v� w v. �c�cti xe�� uae� (DCI use only) a seuch o£tho provf dad name and data of blxthsevealed; F JC NO 1bwa C4WIWI VT StoxyAecord folind witfiDCT Yawn Criminal, YTlstoxyReeord w bc. ipiilals �[/� (`l DCI 77 (a/z5/ 0) deceived 0ima ct. 3. 2012 3:45PM No.4558 i -Oct.10. 2012 10:42AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00611659 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- DCX:00611659 2012/10/10 NAME: IOHNSON,rdARC ANTHONY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19701203 M W 511 140 BLU BRO LBR IA ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD +++ 01 ARRESTED 19991220 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE YA708-2-2 ASSAULT CAUSING YNJ'URY TRK#: 006770401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA700.2(2) ASSAULT NO INTENT OF INJURY - 1976 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 006770401 SENTENCE FINE $50 COURT COSTS PROBATION 365D SUSPENDED 10D 02 ARRESTED 20000702 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 02 IA STATUTE IA124-401(5) POSE MARIJ TRK#: 034291502 COURT DISPOSITION AGENCY; YA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06921 SRIN006157 CHARGE CLASS: NON CONVICTION TRKO: 034291501 SENTENCE DEFERRED JUDGEMENT COURT COSTS PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT ' 03 ARRESTED 20000919 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA124-401-1-C DEL SCH II METH TRK#: 100026301 DISP EFF DAT 20000324 20000324 20000324 20000324 DISP EFF DAT 20010206 20010208 20010208 20020103 No, 8596 P. 6/7 •O.ct.10. 2012 10:42AM Div of Criminal Investigation DCI 00611659 PAGE 2 OF 2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO D19T COURT COUNT 110- 01 IA STATUTE IA124.401(1)(C) CONTROLLED SUBSTANCE VIOL. COURT CASE ID: 06521 FECR056540 CHARGE CLASS: NON CONVICTION TRK#: 100026301 SUBSTANCE ABUSE EVALUATION SENTENCE 'DISP EFF DAT DEFERRED JUDGEMENT 20010420 PROBATION 2Y 20010420 DISCHARGED FROM 20030226 DEFERRED JUDGEMENT No.8596 P. 7/7 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. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation Office of Driver Services (Toll Free) 900-532-1121 PO Box 9204, Des Moines, IA 503D6-9204 515-244-9124 FAX: 515-239-1937 Certified Abstract of Driving Record Inquiry Date: 10/3/2012 DL/ID #: 198BB5629 (IA) Customer #: 1562171 Name: Johnson, Marc Anthony Class: D ID Status: None Address: 510 Elkhorn Tr Audit #: 2795203 DL Status: VAL Issue Date: 12/02/2008 CDL Status: None City/State: Iowa City, IA 52246 Expiration Date: 12/03/2013 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 510 Elkhorn Tr Restrictions: Commercial Instruction Restriction CDL Instruction Permit Permit Supplement: Expires 3/20/2009 Date of Birth: 12/3/1970 .'.fling City/State: Iowa City, IA 52246 Sex: M History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/06/2007 407788 IA Name; Johnson, Marc Anthony DL/ID: 198BB5629 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: °""v.ZIR/v4 10/3/2012 IOWA`a' I ...... Office of Driver Services %V: 1111111% Iowa Department of Transportation Name: Johnson, Marc Anthony DL/ID: 198BB5629