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Home My WebLink About18-015IDENTIFICATION NO. r 1 (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)356-5040 (319)356-5497 FAX First Middle Last 1. Name (REQUIRED) Theodore Alexander Ballantyne 2. Address (REQUIRED) 4890 Orval Yoder Tpke 3. Contact Information (REQUIRED) Email: Ballantyne099(a0mail.com Cell Phone: N/A (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 09/05/2022 b. Taxicab Business Name (REQUIRED) Yellow Cab of Iowa City 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Simple Misdemeanor Iowa City, la 2014? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Guilty Plea/Paid Fine 7. Have you been arrested/ charged with any traffic offenses in the last five years? NO Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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 availabteupon -wAuest i•� rri (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) c7--< --f c- f r" N � 07/2016 m , a APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 hereby certify that I have issued to me by the Iowa Department of Transportabn a olid Driver's license number 435ZZ2245 issued on 08/01/2014expiring on . I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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 Date a flrMhffef/,MRff f RffRlflf f flff fff if f1XX1if1f fNlfffftfMMfNlfffffffeRNfffff ffMlfNfMflflMfflffMNfff ffffMff STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me OLNEY this a n � day of of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license QW— Signature of Police Chief or designee 2lzl 2-A-,>/ 10 Date ii AFTER QROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE TUAN Ot YEAR FROM THE DATE LISTED BELOW. Signa"fCiW:IerIC9--�4I6signee Date m N Office Use Only Approved application DCI report State certified driving record Website update aeM1R IIDRIV P En PL92014eme,ded.D 07/2016 of Jan. 24. 2018;7 8:26AI�,b eDiv of Criminal Investigation (FAx)3ie33az7t.No.3254 STATE `,iy-,On,LSe S �OWA Criminal 1 Record Request Vorm :r.j •f'y laV li �.. �I To; Iowa Division of Criminal investigation Support Operations 9uraau, t" Floor 215 E. 1" Street : Des Molnes;lowa 50319 (515) 721.6066 (515) 725-611110. Fox I am reauestin2 an Iowa Criminal History Record Check on: P. 2/4 aoz rr; DCI A"ount Number: 9967-F (Irappllcable) From; Yellow Cab of Town City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phenol Fax; (319)339-7302 Last Name mandaicry) First Name mandalo ) Middle Name mwmmc' del Date of Blkll (mandatory) Gander (mandatory) Soaial•Sacurl Number reoommando 5 -� .Male ❑1temale Waiver Information; Without a signed waiver from the subject of the rcgpest, a complete criminal history record may no be releasable, per Code of Iowa, Chapter 692,2, For comp]61 oriminal history. record Informatlen, ns ellovved bylaw, always obtain a waiver sl nature from the jubl act of the re uest. Walver Release; 1 hueby 61va paanlsslod for the above requesting omalal cc conduct an Iowa criminal history record bhW with ale Dlvhlon ofCrlminsl IdvaUgatton (I)CO. Any criminal hlnory data eonacming me that Is malntalnad by Ihl 0Cl may be rcicased as ellowcl by law, Waiver Signature: As As of 12 8 18 a search of the provided name and date of bitth r ❑ No Iowa Criminal History Record found with ACI r,.I•, J' r' Iowa Criminal History Record att ched, DCI # ? 00 y DCI initialf DCI -77 (08/25/10) Received Time Jan. 23. 2018 2:10?id No. D)3 v art f� 0 C use only) M 0 . .,Jan.24. 2016 6:26AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00400312 PAGE 1 OF 1 DATE PRINTED- DCI:00400312 2018/01/24 NAME: BALLANTYNE,ALEX BALLANTYNE,ALEXANDER THEODORE DOB SEX RAC HOT WGT EYE HAIR SKN POB 19710905 M W 600 240 BRO ELK MED IA ADDITIONAL IDENTIFIERS CCH RECORD **- 01 ARRESTED/TAKEN INTO CUSTODY 19900121 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321A-17 DRIVING U/SUSP TRK#: L37421401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A-17 DRIV UNDER SUSP TRK#: L37421401 SENTENCE DISP EFF DAT FINE $150 19900423 PAID SURCHG 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 0^ A No. 3254 P. 3/4 N O C7 m n� 1 n N 9 C►ooT SMARTER I SIMPLER i CUSTOMER DRIVEN www,lowadot.gov Inquiry 1/23/2018 Date: �dtBlClf��6r4 ' Customer 2956512 NONE Restriction Name: Ballantyne, Theodore Restrictions: Alexander Address: 4890 ORVAL YODER DL Status: TPKE SW City/State: KALONA, IA 522479234 Mailing 4890 ORVAL YODER Address: TPKE SW Mailing KALONA, IA 522479234 City/State: Date of 9/5/1971 Birth: Sex: M Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 800-532-1121 1 Fax: 515-239-1837 www.iowadot.gov Certified Abstract of Driving Record DL/ID #: 435ZZ2245 (IA) CDL Permit Class: None Class: C Audit #: 8314432 Issue Date: 08/01/2014 Expiration 09/05/2022 Date: �dtBlClf��6r4 ' Endorsements: NONE Restrictions: NONE Restriction None Supplement: Restrictions: History Information CLEAR DRIVING RECORD Name: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 (IA) CDL Permit Issue None Date: CDL Permit None Expiration Date: �dtBlClf��6r4 ' CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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"„"y"Wp O m �dtBlClf��6r4 ' 1/23/2018 �O rn 10WA , w D. 0. T. '1Z° �n1 i ®RIYtt Office of Driver Services O v $. "tia".,�..+<" Iowa Department of Transportation'` Name: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 (IA) imuml4