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Home My WebLink About13-256 Authorization Number /, _.)5.6 4, I 1 (Office Use Only) iullir 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 Last 1. Name .L1 Il;/QZICF'/Oe `7-1/6,14A 2. Mailing Address —t ec, I. 7 . ' /S — 41 3. Telephone: Home .6133 3V 63 e¢U Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or els� w,aesr tr1•::tk 4. Type of offense Where _ When _ .5.. A 777— Fi- 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? AA, Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? YS.S Type of offense Where When sfFOM)c .fieNNsoAi >1- 3 -ca g .5 Wr 40//0,4, i ci a t uE //-45---,,e, 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ale' 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) e' 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Le-CLQ Y y L99,Z,g . 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 , i Date 1/ v/ 41 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by LO L, I L c S . On this I r t k day of )o\) dix SLC c9-cA a.�"`� WENDY S.MAYER Cul C/, VVEN to , Notary Public in antLtor the State of Iowa • My Commission Expires 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). //- G -/ 3 S gnatur of Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. �Il //lL�[ irk J:: \ • ee,- Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width)and 51/" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk taxidrivbadgeapp2010.doc 03/2013 • lir: . (IC4 gay 4-5 �j-OF Ppg4 - ,„,,i3 oy 1'c C {c oFr STATE OF IOWA >'e " `=4 �_ t,chh. ' Criminal History Record Check f ( '� a` F r ACflOf,ate`'` Request Form ` �'=; ,74-y� i1ll 1�', • DCI Account Number. 9861-F. • . • (if applicable) - To: Iowa DivisionofCriminal Investigation From: City Clerk's Office Support Operations Bureau,l'`Floor • • • 215 E.7t°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) :. 'fle es S`.,:. .. . . _ nt2• ( ID �'uGe;it)::e . . . Date of Birth(mandatory) Gender(mandatory) Social Security Number(mandatory) .0 II-if / :• • ` ›Male ❑Female 91 I —.SFf' Q.. Wa fiver Info?Malian:Without a signed waiver from the subject of the request, a complete criminal hi toffy 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:Ihcrcby give prnnicion for the-above requesting official to conduct an Iowa criminal history record check with the Division of rriminal 'Investigation(DCI).Any criminal historydata concerning me that is main.,! ed by the DCI may be released as allowed by law. Waiver Signatur- ._c., / ,,({ Date /en-/g-/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) SING rage i of i • Single Contact License & Background Check \ Results Criminal History Background Check Last Name Other Last First Name DOB SSN Name - Selection Thomas David 1949-August-11 479582965 Criteria Results Further research is required. Please await DCI's final response for criminal history. Please note: There may be multiple individuals with similar search criteria, requiring more research. Background Check Complete As Of 10/18/2013 2:12:54 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$1654.00 Generate PDF Search Again https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 10/18/2013 VL l• LL• LVID L• LV IYI v r V v lull Y 3O.Yi . b . ••-• ..... r • • Page 1 of 1 Submitted 2013-10.18 14:12:54.383 �.• tlr nt4194 ~� IOWA RECORD CHECK REQUEST cA IOWA 1j ;r k A • • FORMS • ACCOUNT NUMBER:9861-F To: Iowa Division of Criminal CITY CLERK-CITY OF Investigation From; CEDAR RAPIDS Bureau of Identification 3851 RIVER RIDGE DRIVE NE 215 E.7th Street CEDAR RAPIDS ,IA • 52402 Des Moines, IA 50319 (515)725-6066 Phone 319-286-5060 (515)725-6080(fax) Fax 319-286-5130 Contact Preference:F REQUEST (* indicates a required field) I am requesting IQSA CRIMINAL ItrtsTo! record check on: THOMAS BAWD EUGENE Last name* First name* Middle name NO Maiden/Other Last name Volunteer 81111.1999 . M 479582965 Date ofBirth* Gender* Social Security number* (DCI use only) RESULTS As of 10/22/2013 12:52:52 PM, a name and date of birth check revealed: CCII Record Attached X DCI# 151863 No CCH Record Found DCI Initials\ft Waiver on File yes I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation, Any information maintained by the DCI may be released as allowed by law. Received Time Oct. 22. 2013 2: 22PM No. 3417 Llb£ '°N WWI ELE U130 °mil paA ! 39 • TO -ON SDIVHJ ad SQIdi2I 2IYa3J OOTOLSOYI 'AJNSD' 5TTTTL6T a2LS8sly ZO W3lsxs 3DILSDP 9YNINTM3 WOa3 a3Da'HJSIa ZOTTLL6T d JAS 8'IO2IYd rLRnatt DSTOLLO'I 'xoNSDv xaossno aaROavd 8ZOL9L6T 2 JAS SROavd s'InaY OSTOLLOYI :ADN3D7 xaolsno NOIZLUITSNI uaHSO WOL$ NI Q32Is3dwwal 60605L6T a dSI NOSIOVW lsmd OSL09SOVI :ZONNOY 7Caos9n3 USXOAS? BROSVd TTZTtL6I 0 ASd2a SNZW VSONVNY JSTOESOVI 'AJN3SV AaOLSnO aarOavd 9T904L6T fl OAS 811011Vd lanai/ DSTOLLOVI 'AJNSDV XQOlSSO a3NOA8a S'Io va 9OtOEt6i m AI4aa SNSW VSOWVNV OSLOESOVI :x3NaOY xaossno 01901L61 AOT oaomaeSns O190TL61 NOILVUO2Id 0T90TL6T AMINO Q515'Id lYa . aa dsla SJNSIN2S TOOS56EOR '#)ffis NOISOIAINOO AN0'I3d :SSV'IJ SDUVHD ane TO -ON JNf03 J InOO JSIa OO NNIR LDSTOLSOYI :xoNaem NOIxasoasIa JIWlOO 100556E0a '0121J • 8'98 TO -ON NOUVH3 ad SOTdY2( aV020 00TOL50VI 1x3NEDm minket a3L98flV TO s.a a2I00Sa HDO 83NN a OS ESON OS • )IOV9 O5 SssI4IINaaI RYNOItIQaY 11806561 VI Q3W ONE( Nae 56T ITS M W 118061767 sod NMS sive 8x3 SDM .IFJH 3VH Xis 90Q SNSDON QIAVa'8VW0111 SAVa'SVWOHJI :3WVN E90TST00 TJa ZZ/OT/ETOZ -aflNIad alma E 40 T 30md HOYSOIANOO xnoxsa E9819100 TOG x!O.&IH ' VNINYsO VMOx If', m,..1 u n i r n 9 i r c n s u r i n n i m i i n in AIA W 10 7 .7 r1117 '77 nin DCI 00151863 PAGE 2 OF 3 BREAK & ENTER-HARR TRK#: 1.03455101 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 PAR REVIC CHARGE CLASS: STATUS UNKNOWN TRK#: L03455101 SENTENCE TO SERV SENT OF DOA 122370 03 ARRESTED 19730212 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 SHPLFTG TRK#: L03455201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 SHPLFT U-20 CHARGE LASS: MISDEMEANOR CONVICTION TRIC{: L03455201 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED 30D 19740510 UNDER COND HE MAKE FULL REST BY 051073 04 ARRESTED 19001122 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321-281 ONVW/INTOX OR DRUGGED TRIO: L03455301 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA321-281 OMV W/INTOX OR DRUGGED CHARGE CLASS: MISDEMEANOR CONVICTION TRIC# - L03455301 SENTENCE DISP EFF DAT JAIL 2D 19810424 FINE $300 19810424 05 ARRESTED 19841106 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA321-201 OWI Received Time Oct. 22. 2013 2: 22PM No. 3417 Vw . LL• LV IJ G CV r • v v . .... . ... .. .._. - . DCI 00151863 PAGE 3 OF 3 • TRK#: L03455401 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 XA STATUTE IA321-281 OWI 3RD OFF CHARGE CLASS: FELONY CONVICTION TRK#: L03455401" SENTENCE DISP EFF DAT. FINE $750 19850417 PROBATION 2Y 19850417 SUSPENDED 5Y 19850417 DL REVKD 6Y 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 DCX, 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 INVESTIGATIO1NInIAy^/ • f • Received Time Oct. 22. 2013 2: 22PM No. 3417 ARTS Page 1 of 1 f Iowa Department of Transportation Office of Orrver Services (Toll Free)800-532-1921 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 10/3/2013 DL/ID #: 606YY6938 (IA) Customer#: 267039 Name: Thomas, David Eugene Class: D ID Status: None Address: 1325 3RD ST SW Audit#: 7401119 DL Status: VAL Issue Date: 10/03/2013 CDL Status: None City/State: CEDAR RAPIDS,IA Expiration 08/11/2017 CDL Cert None 524042811 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1325 3RD ST SW Restrictions: Corrective Lenses, Left Restriction None and Right Outside Supplement: Mirrors Date of Birth: 8/11/1949 Mailing City/State: CEDAR RAPIDS, IA Sex: M 524042811 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/03/2008 11/07/2008 S92 Speed Johnson IA •11/15/2010 •11/23/2010 S92 Speed Dubuque IA Name:Thomas, David Eugene DL/ID: 606YY6938 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: yy ir:Ok •***lf.:S 10/3/2013 14 IOWA '?'8 tisk*i :* a ateres.4 D. O. T. gs' ,+1j s �h..N, $z Iowa Department Office of Driver eof Transportation Name:Thomas, David Eugene DL/ID: 606YY6938 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 10/3/2013 ARTS: Statement Receipt Page 1 of 1 Cedar Rapids DL Station K-Mart Plaza 152 Collins Road NE Cedar Rapids, IA 52404 Statement Receipt: 31582176 Customer Information Office Information Name: Thomas, David Eugene As Of Date: 10/3/2013 10:38:24 AM Address: 1325 3RD ST SW CEDAR RAPIDS,IA Location: Cedar Rapids DL Station 524042811 Phone: Fax: Email: Attached Customers Name Thomas, David Eugene Transaction Type Description Amount DLM 267039-Thomas, David Eugene-Class D; END: 3; REST: 8,F; ISS: 10-03-2013; EXP: $16.00 08-11-2017 Product Amount Chauffeur 3 $16.00 Total Due: $16.00 Payments Payment Method Payor Payor# Number Amount Tendered Cash Thomas, David Eugene 267039 NA $16.00 Total Tendered: $16.00 Cash Back: $0.00 http://172.29.254.55/ATMM/Output/Receipt/Statement.aspx 10/3/2013 ARTS: Statement Receipt Page 1 of 1 Cedar Rapids DL Station K-Mart Plaza 152 Collins Road NE Cedar Rapids, IA 52404 Statement Receipt: 31582221 Customer Information Office Information Name: Thomas, David Eugene As Of Date: 10/3/2013 10:39:29 AM Address: 1325 3RD ST SW CEDAR RAPIDS, IA Location: Cedar Rapids DL Station 524042811 Phone: Fax: Email: Attached Customers Name Thomas, David Eugene Transaction Type Description Amount MISC Finance Transaction -Thomas, David Eugene $5.50 Product Amount Sale of Records-Certified $5.50 Total Due: $5.50 Payments Payment Method Payor Payor* Number Amount Tendered Cash Thomas, David Eugene 267039 NA $5.50 Total Tendered: $5.50 Cash Back: $0.00 http://172.29.254.55/ATMM/Output/Receipt/Statement.aspx 10/3/2013