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Home My WebLink About13-224 • Authorization Number 3- a_ 1 (Office Use Only) mon N 1 CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 41 0 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 I Middle 4 Last 1. Name Jf� r��-. / v� , cv�- .9 s it, h t 2. Mailing Address I et OIc_Q h4.y G 3. Telephone: Home (3lcj) , 2Z-'-/i ) ' Other: 1 K) 936-5'� {- 4. Prior experience in transportation of passengers: „c/y + X cch 4 r,,.,„� f1IMIM a mom 5. Have you ever been convicted of any misdemeanors and/or felonies in this State oremio ►T Type of offense f Where I -.,.. eta ro3505,0 y C:9'( L�>n�-v�v st �s� , r-2 T o A+h S o-, . ,� /9 c' Uo,n.5I,,: /1 a „so, <<_, 1 ;ZOOS/ • Pas's< ��m • d . � q 6. Have you-Peen convicted of operating a motor vehicle while under the intuenc f alcohol or drugs In the last five years? o Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offensenWhere When S toed C /, 2/ 17/ ��1� . 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V) 0 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) 0 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) • clerldtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 7 /_ l / 5'1(, . 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 (7/-2 6 / 13 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by.:sArv0.1.( ,,, ,A►kxilc- 2,a,t,nuli,.� On this L,¢-t1� day of v� soc NENDY S.MAYER Notary Public i nd for the Statee Iowa r2Y4tn Expires ********** *******:�t*,BCW__ ************* ****************************************************,****** ************.***************** 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). 912G 3 Signature o fPolice 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. • • Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp2010.doc 03/2013 Sep. 23. 2013 2:45PM Div of Criminal Investigation No. 8718 P. 7/9 e siavizula to:z4 rnr , DCI IOWA X1003 STATE OF IOWA :: :;' Criminal History Record Check Request Form <= DCI AccountNwnben 43%5-PC- +� (If Applicable) et To: Iowa DivWon of Criminal lavntlgatlos From, MA Mr, IAM Support Operattoot Barna,l"Floor 21sE.76Street i Sheess dr• Dem Molas,Iowa 50319i sr} D (616)7256066 • A.GAM (51s)7166070 Fax • (314) 338• 7'1'f• panel Fox:. . (31 ) S511;11 I am requesting an Iowa Criminal Hiswp Record Check oni - LeltName j ienay) First Name(mmdale.y) diddle Name ted) Date of Birth(maw Gender(mu,domy) ,Social Security Number tretename) D Lt/2_3//e/5 / C Dvemate 113/ 6 7- S.) G Ca Waiver llt/dmladon:Without a skald waiver trete tbe subject of the requestomemplate nimbi]bletory record may not be reluesblq per Code orlon,Chapter 692.2.For melt ctmual hbtory record lulonnatba,as allowed by law,always oblate a waiver alpran a tom the,abject or um rawest. Waive Release:t teat,&relee.miwu.n rorem more rap :sting omclau toconduct w aewa oimrsl brwy.eea.dmm&ael the Milne orComiW IwadOaml MCO. /uq almNr lGtwy Si m,ma oodd[tthe DC my be mai rYlwed*law. • Watve/Swnature: J1/�nl Iowa nnCriminal History Record Check Results MCI am WA As of `1 -.??r 13 ,a search of the provided name and date of birth revealed; 0 No Iowa Criminal History Record found with DCI Iowa Criminal History Recast attached,DCI# SqS 5 .) DCI initials CO DC171(08/25/10) ' Received Time Sea. 19. 2013 10: 22AM No. 6621 Sep. 23. 2013 2:46PM Div of Criminal Investigation No. 8718 P. 8/9 IOWA CRIMINAL HISTORY DCI 00598330 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2013/09/23 DCI:00599330 NAME: AUGUST INE,SHAUN ANDREW AUGUSTINE,SHAWN ANDREW DOB SEX RAC HGT ROT EYE HAIR SRN POB 19810423 M W 600 160 CRN BRO FAR MO ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD •W* 01 ARRESTED 19990525 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE XA714-2(41 THEFT 4TH DEGREE TRK$: 500350201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-4 THEFT 4TH DEGREE CHARGE CLASS: NON CONVICTION TRK#: 500350201 SENTENCE DISP EFF DAT PLEAD GUILTY 19990826 DEFERRED JUDGEMENT 19990826 COURT COSTS 19990826 DISCHARGED FROM 20000324 DEFERRED JUDGEMENT 02 ARRESTED 19990707 AGENCY: XA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESSION SCHEDULE I CONTROLLD SUBSTANCE-MARIJUANA TRK#: 016526701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016526701 SENTENCE FINE $250 COURT COSTS 03 ARRESTED 20090715 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 02 IA STATUTE IA7013.2A(2) (B) DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY TRK#: 1A0079M02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- Sep. 23. 2013 2:46PM Div of Criminal Investigation No. 8718 P. 9/9 DCX 00598330 PAGE 2 OF 2 02 IA STATUTE 1A708.2A(2) (B) DOMESTIC ABUSE ASSAULT CAUSE INJURY/MENTAL ILLNESS COURT CASE ID: 06521 SRCR087748 CHARGE CLASS: MISDEMEANOR CONVICTION TRE}(: 1A0079M02 SUBSTANCE ABUSE EVALUATION SENTENCE DXSP EFF DAT SUSPENDED JAIL 88D 20100203 JAIL 90D 20100203 FINE $315 20100203 PROBATION lY 20100203 04 ARRESTED 20100730 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA724.26-2 RECEIVE/TRANSPORT/POSESS FIREARM FELON - 1990 TRK#; 1A009VA01 COURT DISPOSXTION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE XA724.26(2) (A) DOMINION/CONTROL OF FIREARM/OFF WEAPON BY DOM ABUSE OFFEND COURT CASE ID: 06521 FECR091533 TRK#: 1A009VA01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $750 CIVIL PENALTY, $750 20111202 CIVIL PENALTY SUSPENDED PROBATION 3Y 20111202 COMMUNITY SERVICE 50H 20111202 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OP GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OP IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW 6 /1 ENFORCEMENT AGENCIES BY THE DCI. XN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OP YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation 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: 9/26/2013 DL/ID #: 237CC1516 (IA) Customer#: 3385482 Name: Augustine,Shaun Andrew Class: D ID Status: None Address: 1729 LOWER OLD HIGHWAY Audit#: 6927354 DL Status: VAL 6 RD NW Issue Date: 05/08/2013 CDL Status: None City/State: OXFORD,IA 523229214 Expiration Date: 04/23/2018 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1729 LOWER OLD HIGHWAY Restrictions: Corrective Lenses Restriction None 6 RD NW Date of Birth: 4/23/1981 Supplement: Mailing City/State: OXFORD, IA 523229214 Sex: M History Information Convictions Citation Date Conviction Date ACD ._ County _ JUR 07/17/2012 09/02/2012 _ 592 Speed (10 mph&under In 35-55 mph zone) _W. ._ - -Johnson IA Name: Augustine, Shaun Andrew DL/ID: 237CC1516 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: wyyM$:... < , 9/26/2013 'Iier IOWA '411 e.:.:D. O. T. °c.% ,/,'Ill th OfficecDof Driver epartmr Sof Servicesiceansportation Name:Augustine, Shaun Andrew DL/ID: 237CC1516