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Home My WebLink About13-266 * Authorization Number j — .(_Q— .(_Q(47 _ 1 (Office Use Only) --_a ini 42V.AIN Ile gg PITT 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 First Middle L st 1. Name '-d.ryy ,t((0 vt S Was-Se-4,i 2. Mailing Address 4/11-1- P/ ami .5 1 3. Telephone: Home .3(9—.3-.25--3`f C O Other: 4. Prior experience in transportation of passengers: (7 eevrx. 7/74c1' A / � 1�-v 1 Aa.4 ( 4 , r- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? t3 p 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? it)(,) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? rn 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? het 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) r c; 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) clerk/laxidrivbadg 03/2013 1 . I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `+,j 0 MAI ?-55-8' . 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 ,.� -ao.4 Date / 1—20— 13 STATE OF IOWA COUNTY OF JOHNSON ) r- qulfscribed and worn to before me by 12 G,crvv- ..cSSe . On this 2 day of 1e. C c ►C Ic_ t , E K.TUTTLE. . otary Public in and for the State of Iowa 1 fo't, Commissio fres my co ****** ***************** 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). Signature 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. 71V/4—{ e, I /a bh 3 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerkftaxidrivbadgeapp2010.doe 03/2013 L + s Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 92114,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/23/2013 DL/ID It: 430WW8558 (IA) Customer#: 1306832 Name: Rasmussen, Perry Allan Class: D ID Status: None Address: 414 Pleasant St Audit#: 3934016 DL Status: VAL Issue Date: 12/10/2009 CDL Status: None City/State: Iowa City, IA 52245 Expiration Date: 12/18/2014 CDL Cart Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 414 Pleasant St Restrictions: NONE Restriction None Date of Birth: 12/18/1960 Supplement: Mailing City/State: Iowa City, IA 52245 Sex: M History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID:430WW8558 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: ,$t- ..peri 10/23/2013 tt': IOWA -.?; D. O.T. fof.......•S` Office of Driver Services 'huh —' Iowa Department of Transportation Name: Rasmussen, Perry Allan DL/ID:430WW8558 • 0-0E-PUB& ti SIP STATE OF IOWA >Y>�o i a lotiv" Criminal History Record Check F r4 • °nom lOS- Request Form 'vIfi �' pi • • • DCI Account Number. 9861-F cif applicable) To: Iowa Division of Criminal.Investigation • From: City Clerk's Office Support Operations Bureau,1't Floor • 215 E.7th Street City of Cedar Rapids 101 First Street SE Des Moines,Iowa 50319 Cedar Rapids,IA 52401 - (515)725-6066 • (515)725-6080 Fax Phone: 319-286-5060 Fax:. 319-286-5130 I am requesting an Iowa Criminal History Record Check on: Last Name (mandatory) • • First Name(mandatory) Middle Name(mandatory) , :`42.asmuss y� O�e-rry `.,; Date of Birth(mandatory) Gender(mandatory) Social Security Number (mandatory) • - 1! : ` 01Clale ❑Female L gc�' cY�—C-L1- C l . Wdiver Information:Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable,per Code of Iowa, Chapter 692.2.For complete criminal history record information, as allowed by law,always obtain a waiver signature from the subject of the request Waiver Release:Ihereby give Permission for the above requesting official to conduct an Iowa criminal Watery=cord check with theDivision of Qiminal • Investigation(DCI).Any criminal history data concerning me that is maintainedaiai �by"the DCI may be released as allowed by law. Waiver Signature: ci —a —Pet Date /o 2171--/3 :'. • - - Iowa Criminal History Record Check Results (DCI 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,DCI# ' • DCI initials DCI-77(08/25/10) E vR ` . SING Page 1 of 1 + 4 Single Contact License & Background Check 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 10/2412013 9:42:17 AM 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 $1534.00 Generate PDF Search Again https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 10/24/2013