Loading...
HomeMy WebLinkAbout12-273Authorization Number /at .173 (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 19) 356-504 (31 - 497 FAX rst Middle Last 1. Name FiSn P /Z Y1f� id Ie Gi eN O 2. Mailing Address ;�R c/ S, /?i✓eNS!A, 3. Telephone: Home 3 / C/ ` 3 S / — qJ J 0 Other: 4. Prior experience in transportation of passengers: 17ro vL %i ,Y i /h 74 L �� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? lf/O 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? (V O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (VO Type of offense Where When B. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? !VO 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) d� .idnwa g 09/2012 I herl cert that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number c/ 2 Z 3 B© L/ 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 lis with all of the provi ns of Ti le 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)! Signature of Applicant +——�Date L/) 2 !J l ##Y++#####+4ffff f 1fHHY+YY#+##+RFHffffHHfiHH#HY###++##++##f H#f f f#Hif f!f!H#Hf#Yi#H#4HHH##H##4*##4ffflflHllHYH#YF+##HF##R##fR# STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by S.6e � f � G er OT— . On this 0/ day of ii SONDRAE FORT [I coni S, cossion Number 159791 My comrl(isslon E>ylres_ 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). 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. Signatbre 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 Date derkR drivb geaW2010do 09/2012 No v. 20. Chen*Requent Form 2012, 3:15PN1I Div of Criminal lnvestigaationy 4836 P. 1/2 ,. <r.<<,Record I1, To; Yovlabivision Of CrhnivalYnWesttgAtloh support op etsildns AQA Ouu, 331 Mo or 215L. Psfreot 3]wrX0taes,To7va 503]9 (au) 120-4066 (635) ISS -6080 PaYC �4 u l ant reiqmostln arLToWa LlimiIWHI �a9t`ab1 0 mond,[oJ T"- Dato ofnIVr L mandatory) � 1✓a6vei•InfaMngt'lap; W]thovtns(g brr l'olesofh sable, per Code o� 2,2, Chapi obtAih A watvorsl naturaIl'om tttasub 7pCTAocountNV�mber: �'�� a� �' (teappucab7c) Prom( arry 0 -rogA r.1gy _ CITY ct(mvg OwTCE 47 tl � dA NNr CON ST"tT TOVA r,TTP TOM 5774A Shone; 079-.�5e_sn�.r PnX: R7o.,aKF-.5497 fi /a �7 SocialSooli t:yNumbar(ruammer WAIVOrhom lhasubject Ortho repeat, a complptd ct.htnp(h(story TQcord )1my not 92,2,;Ror o Tete''ariminu]hletoryrecoYdlufa5-matlon,s.valTnWddbgrlovt,AfPlays YELr?(Lr6; f AafcLY&tve permisalertforlhoahove rog4etllex O�vial eo tondao[enTog4 atlminnl (rstory(eanrd aileckwl6 the D\wlan oiCrimlool IPSO.anykfminalhrsrotydamconwmingmolhntJamolalarne�bythevo�6oTateeae AvattawadhyraW. %3rGfVerSYg12lllG1'e; ' ^, - � ' -A,7 of Ld_ aseavahofthoprovidedname anddata ofbiLiha'aveakd, No 16wa ecord four d. W101DU .;;otyra Criminal Ii'istoryR00oYd attached, b CT � 6 (o g.5 Ila 3>7ifia19_� Received'T me—Noe; 13, 2012 1:02PM Ne.6106 SL C Nov.20, 2012 3:15PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20030912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) THEFT 2ND TRK#: 100953201 COURT DISPOSITION AGENCY: IA0520151T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(2) THEPT 2ND DEGREE - 1978 COURT CASE ID: 06521 FECROG6430 TRK$: 100953201 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040709 PROBATION 3Y 20040709 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. M THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVEE�R�STHE SUBJECT OF YOUR INQUIRY. D _� .OF CRIMINAL INVESTIGATION 'tA N No.4836 P. 2/2 IOWA CRIMINAL HISTORY DCI 00706957 COURT DISPOSITION PENDING PAGE 1 OF 1 STATUS UNKNOWN DATE PRINTED - 2012/11/20 DCI:00706957 NAME: GEROT,STEVEN ALAN DOB SEX RAC HOT WGT EYE HAIR SKN POE 19570922 M W 506 200 SRO GRY _IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20030912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) THEFT 2ND TRK#: 100953201 COURT DISPOSITION AGENCY: IA0520151T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(2) THEPT 2ND DEGREE - 1978 COURT CASE ID: 06521 FECROG6430 TRK$: 100953201 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040709 PROBATION 3Y 20040709 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. M THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVEE�R�STHE SUBJECT OF YOUR INQUIRY. D _� .OF CRIMINAL INVESTIGATION 'tA N No.4836 P. 2/2 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Mmes, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/13/2012 Name: Gerot, Steven Alan Address: 2254 S RIVERSIDE DR CDL Cert TRLR 42 City/State: IOWA CITY, IA CDL Med 522465850 DL/ID #: 959ZZ3004 (IA) Class: A Audit #: 6098137 Issue Date: 07/05/2012 Expiration 09/22/2013 Date: Endorsements: LNT Mailing Address: 2254 S RIVERSIDE DR Restrictions: NONE TRLR 42 Date of Birth: 9/22/1957 Mailing City/State: IOWA CITY, IA Sex: M 522465850 History Information CLEAR DRIVING RECORD Name: Garet, Steven Alan DL/ID: 959ZZ3004 Customer #: 1549690 ID Status: None DL Status: VAL CDL Status: VAL CDL Cert None Status: Iowa Department of Transportation CDL Med None Status: Restriction None Supplement: 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: D ;" ••:;7%''y 11/13/2012 IOWA D. O. f✓!9 Office of Driver Services na......!.' Iowa Department of Transportation Name: Gerot, Steven Alan DL/ID: 959ZZ3004