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HomeMy WebLinkAbout13-272 Authorization Number / 3 �a _ 1 (Office Use Only) � ---_ 1466., gesonstair 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 (319) 356-5040 (319) 356-5497 FAX Fir t Mid le Last 1. Name ?-c /1 / rs, /^G� T" 2. Mailing Address ' r`/ ev,51A- v,., # y -7` l4c-.7e„,e)c! G;Ty L ct 3. Home Telephone: r 15-7 — �S~t� / J p �/ 7 � Other: 4. Prior experience in transportation of passengers: Ye y�'S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /1/C2 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? i,! Type of Offense Where When / 7. Have you been convicted of any traffic offenses in the last five years? /L" C Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /Vv 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) lvC2 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerwtaxidrivbadg 03/2013 I hereby ;c i;x that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's (icer o number / f 2 Z 30 0 II . 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) Signature of Applicant Date Cl / 2 STATE OF IOWA ) COUNTY OF JOHNSON ) n Subscribed and sworn to before me by €-, 1}e_u1 �t _ (-,-e6r� . On this o2Yi c!� day of wENDY S.MAYER NotaPublic in an for the State of ow q").-*- ,. z Lommission Number 119418 My Comsssiikon Expires ow **********A**** ******),*** **14*t *******************,+***************************************************************************************** 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). ri r /c Signatu of Poli.' C,ief o .-signee 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. 74 I - X_I/j.41 / a -13 Signatu'ie of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 5'/z" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010.doc 03/2013 Nov. 27. 2013 7: 53AM Div of Criminal Invest igat ion No. 6570 P 1/2 nv.l'� LVIJ J.ivim ULU, viein vi ,r vi ,vna VILY v.v. 't ui I. Ue seat STATE OF IOWA 4"$I',,. G d lir 1(2401 Criminal History Record Check ?/ , 14,)own /. s P . Request Form ` <v�/ ' ,�a`r,,'� a.. • DCIA000untN•nmber: Litb..j.• (ifapplicabl) To: Iowa Division of Criminal Investigation From; CITY OF IOWA CITY Support Operations Bureau,l't Floor tkLTr CLERK'S OFFICE 215 E.7th Street 410 E WASHINGTON STREET Des Mollies,Iowa 50319 (515)7254066 ._XOWA CmIOWA 59240 (515)725-6080 Fax Rhone) 319-3565041 Fax; 319-356-5497 I ant requesting an Iowa Criminal History Record Check on: ' Last Name(mandolt?) _ rlirst Name(meodelury) ^ Mm Middle Name(recommended) - e (-© 7-' . 5 re ve-vt A. 14 n. Date of Birth(mandeloty) Gender(mendatoty) Social Security Number(recommended) © 9- I 2 a2 1 207 C/ Male �T+emale �7 71- ,2— g333 Waiver'IInformatlon:Without it signed waiverfrom the la bj ect of the request,a complete criminal historyrecord may not be releasable,per Coda of Iowa,Chapter 692.2.For complete criminal History record information, as allowed bylaw,always obtain a waiver signature from the subject of the request. Waiver_Release:IherebygivepcmtlsalontorrhoaboverequestingofficialtoconductanIowacriminal ktory mord check with!he Division ofCriminal inrestigenon(DCD. Any crimine(hialory dale concemin othat famein(elned by the DCI may ibank=d as allowed bylaw, Waiver Signature: �'� CL't/ Iowan "Criminal History Record Check Results (OCxuse on(y) (-A As of 1 1- 2- ' 1'3 , a search of the provided name and date of birth revealed: ElNo Iowa Criminal History Record found with DCI nI ' Iowa Criminal History Record attached,DCI if 1 Ck p n.S _ DCI initials, l AJ Received Time .Nov. 20. 2013 3:49PM No, 5811 1,.,x-7, tun,�,,,G, Nov. 27. 2013 7: 54AM Div of Criminal Investigation No, 6570 P. 2/2 'I . IOWA CRIMINAL HISTORY DCI 00706957 NON CONVICTION PAGE 1 OF 1 ' DATE PRINTED- 2013/11/26 DCI:00706957 NAME: GEROT,STEVEN ALAN DOB SEX RAC MGT WGT EYE HAIR SRN POB 19570922 M W 506 200 BRO GRY IA ADDITIONAL IDENTIFIERS CCH RECORD a s 01 ARRESTED 20030912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2(2) THEFT 2ND TRK : 100953201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE 1A714,2 (2) THEFT 2ND DEGREE - 1978 COURT CASE ID: 06521 FECR066430 CHARGE CLASS: NON CONVICTION TRIO!: 100953201 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040709 • PROBATION 3Y 20040709 DISCHARGED FROM 20121207 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OP 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 crill Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 11/20/2013 DL/ID#: 959Z73004 (IA) Customer#: 1549690 Name: Gerot,Steven Alan Class: A ID Status: None Address: 2254 S RIVERSIDE DR Audit Si: 6098137 DL Status: VAL TRLR 42 Issue Date: 07/05/2012 CDL Status: VAL City/State: IOWA CITY, IA Expiration 09/22/2013 CDL Cert None 522465850 Date: Status: Endorsements: LNT CDL Med None Status: Mailing Address: 2254 S RIVERSIDE DR Restrictions: NONE Restriction None TRLR 42 Date of Birth: 9/22/1957 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522465850 History Information CLEAR DRIVING RECORD Name: Gerot, Steven Alan DL/ID: 959ZZ3004 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: .#101.W ***. Fl1.elE'. i4 11/20/2013 0,1 IOWA issa a s , :D. O.T.; o •.. Aryikh IIIYEd Office of Driver t of s Moes Iowa Department of Transportation Name: Gerot, Steven Alan DL/ID: 959ZZ3004 V