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Home My WebLink About13-260 Authorization Number ) — C' 1 _ 1 (Office Use Only) EEG 6466. ,�r VIII nt IMO 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: / Mime Last 1. Name -'l/( /c/'?a. ! i 2. Mailing Address / 3 " 11 `' ; S 3. Telephone: Home 3 5 59( - F Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? f= c Type of offense Where When 6. Have you beet 99Avicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? / , Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? / ` _0 f 13,e Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) cleNtaxidrivbadg 03/2013 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number --7-3-1 X V `_'5-ci.ti . 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 Applicantt v( Date //-- X— /. ***************************************************** ,,,,************************************************************************************* STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn before me by r c G E l I. c...„L.p . On this ?,-CAA day of (k)Olt i 6Z L- J. . . . - LA. X01"'' WENDY S.MAYER Notary Public in qi d for the State .i,Iowa - Cunm tasrun NtnrolierTz942a • My Commission Expires -7-1 -1 lo ************************************************************************************************************************************************ 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). Signatur of Poli 7 ief 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. 7 72,Z .. -7` Z I/ /' Signa re 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 clerkltaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation J. Office of Driver Services (Toll Free)SIM�532-1121 t PO Box 9204,Des Manes,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/29/2013 DL/ID II: 721XX1598(IA) Customer is 1210294 Name: Lane,Michael Truman - Class: D ID Status: None Address: 43 20TH AVE SW Audit is 7477852 DL Status: VAL Issue Date: 10/29/2013 CDL Status: None City/State: CEDAR RAPIDS,IA 529095913 Expiration Date: 06/29/2016 CDL Cert Status: None Endorsements: 3 COL Med Status: None Mailing Address: 93 20TH AVE SW Restrictions: NONE Restriction None Date of girth: 6/29/1965 Supplement: Mailing City/State: CEDAR RAPIDS,IA 529095913 Sex: M History Info•ntat!on Convictions Citation Date Conviction Date ACD Explanation County IUR 12/16/2009 01/08/2010 592 Speed(10 mph&under In 35-55 mph zone) Linn IA Name:Lane,Michael Truman DL/ID:721XX1598 Pursuant to Iowa Code 4321.10,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: =_p6 JC1E4Ii�i O1: 4 10/29/2013 s4 IOWA 'S', 'n: S• oy VD. O. T. � ftip 'i`` ces `% �A b Iowa OfficeDepaof rtment ofiver iTransportation Name:Lane,Michael Truman DL/ID:721X0(1598 State of Iowa PSF.Or/°w OF PUB�j 4"`" Division of Criminal Investigation y • ' * 's' aQQ• q� 215E7'hSt c ` £ IOWA Des Moines IA 50319 Ph.515-725-6066 Fax 515-725-6080 s • ';.,•'"� ' 160`ClION p�� Iowa Criminal History Record Check c4'1M1s'`�a Walk-In Request Your name /4i(79Q v /� T G�� C Address 9 3 a 1 4 00 _ S r (J City/State/Zip C r ,- ha. Qi d _ _/ FvV,n Fill in all shaded areas. Phone# 5(5 — _ T 7.5-- Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) ,/14C ( T.—sr' I Date of Birth Fecha Nacimienlo(mandatory) Gender Genero(mandatory) Social Security Number(recommended) C 2 S— 6 5 4=rMa1e ❑Female 7-eP j76. ?p Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) • Results DCI USE ONLY As of \a/Z\ , a name and date of birth check revealed: r � ❑No record found • • V21cord attached, DCI # 1-1 DCI initials r r., Receipt Number of requests ( x $15.00 per last name=Total amount$ 1 S•0 0 Method of payment: Ticash ID money order ❑check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Crg- Credit Card Number# Exp. Date • IOWA CRIMINAL HISTORY DCI 00417467 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2013/10/28 DCI:00417467 NAME: LANE,MICHAEL TRUMAN LANE,MICHEAL TRUMAN LANE,MIKE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19650629 M W 600 230 BLU BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19920701 AGENCY: IA0570200 MARION PD CHARGE NO- 01 IA STATUTE IA708-1 ASSAULT TRK#: L39480501 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA708-1 ASSAULT-DA-PE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39480501 SENTENCE DISP EFF DAT JAIL 7D 19920708 COURT COSTS 19920708 PROBATION 1Y 19920708 SUSPENDED 30D 19920708 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 '02 2