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Home My WebLink About12-276CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX 1. Name 2. Mailing Authorization Number la` - a77& (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home 31?— 325__3 LGo Other: 4. Prior experience in transportation of passengers: & 0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? hO Type of offense Where When S��erka_ f*// -tet I`H „,f,60 --?05; 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? an Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? YI 6 Type of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /? CJ 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) YI D 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) deftUa jdriwadg 09/2012 I hereby certifTyy that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �jl� �1!(�1/�� I understand that if 1 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 Applicant, -?f U r Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Rr r . 4 Z c rn On this J 7 day of 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 Police Chi r 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. Signa0re 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 //- � 7 -1, -,:2 -- Date �idriv dgeapp2010dm 0912012 Iowa Department of Transportation Office of Driver Services (Toll Free) SM -532-1121 PO Box 9204, Des Mmes, JA 5030E -920d 515-244-9124 FAX: 515-239-1837 Inquiry Date: 11/27/2012 Name: Rasmussen, Perry Allan Address: 414 Pleasant St City/State: Iowa City, IA 52245 Mailing Address: 414 Pleasant St Mailing City/State: Iowa City, IA 52245 Certified Abstract of Driving Record DL/ID #: 430WW8558 (IA) Class: D Audit #: 3934016 Issue Date: 12/10/2009 Expiration Date: 12/18/2014 Endorsements: 3 Restrictions: NONE Date of Birth: 12/18/1960 Sex: M History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 430WW8558 Customer #: 1306832 ID Status: None OL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None 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: •:?P,to 11/27/2012 IOWA 0 5, ).O.T.:Ws' r'••••••' Office of Driver Services 010 --` Iowa Department of Transportation Name: Rasmussen, Perry Allan DL/ID: 430WW8558 SING Page 1 of 1 Single Contact License & Background Check g g Results Criminal History Background Check Last Name Other Last First Name DOB SSN Name Selection Rasmussen Perry 1960 -December -18 485906471 Criteria Results Not found in Database Background Check Complete As Of 1118/201212:12:42 PM NOTE: The first and last names, date of birth, and SSN displayed In the abuse registry and criminal history results are just as they were entered. on the screen. Billing Account 9861-F Cash Deposit Currently at $2094.00 Generate PDF Search Again https://www.iowaoiilinestate.ia.us/SING/81NGSQLProc6ss.aspx 11/8/2012 K,.j�, 09- q'i W I (Return to the City Clerk's Office) STATE OF IOWA (' Criminal History Record Check t _ , Request Form < ,•'' ,' DCI Account Number: 9861-F (if applicable) To: town Division of Criminal Investigation From: City Clerk's Office Suppnrt.Operatiots Bureau, 1" Floor 215 E. 7n' Street City of Cedar Rapids Des Moiues,lowa 50319 3851 River Ridge Drive NE (515) 725-6066 Cedar Rapids, lA 52402 (515)725.6080 Fnx Social .SCeul'1 Nllllrbei' (mandatory) 1 -1 Go Phone: 319-286-5060 �l �� i � "Gt(/ l Fax: 319-286-5130 I ani remtestine an Iowa Criminal History Record Check on: Last Name (inandmory) First Name (mandamry) Middle Name (mandatory) iI`CcS M tk SS (✓47 Pp—rr Oa Iq Date of Bil'th (mandatory) Gender (mm,dalory) Social .SCeul'1 Nllllrbei' (mandatory) 1 -1 Go eale l'J�VI ale ❑Fm �l �� i � "Gt(/ l Wal rel' Informatiot: Without n signed waiver from the subject of the request, a complete criminal history record cony not be releasable, per Code of down, Chapter 692.2. For complete criminal history record information, ns Allowed by law, niwnys obtain n waiver signature from the subject of the request. Wal per Release: I hereby give permission for the above regncsting op icial to conducl an Iot n criminal history record cheek with the Division orCrimtnal Investigation (DCI). Any criminal histary data eonceemjjing me Ibat is mu�nialoined by the DCI may be released as allowed by law. WaherSlgnnlftre: Dale �2 Iowa Criminal History Record Check Results I (DCl use only) As of , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DC1 DCI initials DCI -77 (08/25/10) (MAKE ADDITIONAL COPIES AS NEEDED)