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Home My WebLink About13-202 Authorization Number t 3 — 1 (Office Use Only) III tills ga ii APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa S2240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name �k-w-� 1J �nG�io�4 / �tw 2. Mailing Address Zf D 1(5 e��L,-t ,7'✓Gv�✓� << 1` S 4Z y& 3. Telephone: Home ,717 57 2 (51 7 Other: / 4. Prior experience in transportation of passengers: Ye---//01-1"( QLv CQ`j 27 ,is 5. Have you ever been convicted of any misdemeanors and/or felonies in this Stat ,;: r-.,...+1 15671 T e of offense /k Where larnIftr .1../ 6. Have you peen convicted 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? ye--7 T e of offe seWhhere When R `1 ,71 ` A- ,3 8. Has your drivef's license or chauffeur's license been suspended or revoked in the last five years? 17 U Type of offense Where When 9. Have y9u ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) VV el) 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) clerIdtaxidrivbadg 03/2013 I a-;-by certify, the have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number '7 77 /3�o.' ? . 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) / G� — Signature of APP licant�` (((�7' Date / `3 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me byc;Q 1 tv� jJ t��, �'� . On this `3t.-\., day of Noita'ry Public in d for the State of Iowa c Convnissi oriltir • ************* * M* *********************************************************************************************** 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). 'if b v10 �1J Sign- re of P.! 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. - 4 Signa ,e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 I/2" (width) and 5'/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 Page 1 of 2 Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 ir PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/5/2013 DL/ID #: 775YY4363 (IA) Customer#: 1424101 Name: Rew,Jeremy Nickolas Class: D ID Status: None Address: 2804 MUSCATINE AVE Audit#: 5470394 DL Status: VAL Issue Date: 08/25/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 12/30/2014 CDL Cert None 522402801 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2804 MUSCATINE AVE Restrictions: NONE Restriction None Date of Birth: 12/30/1984 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522402801 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/16/2007 ;09/12/2007 1B51 'No Driver's License ;Muscatine IA 12/14/2007 01/04/2008B51 iNo Driver's License ;Muscatine IA 03/11/2008 j04/06/2008 :B51 iNo Driver's License Muscatine IA i 02/15/2009 _ 03/10/2009 B64 'No Insurance Card ',Johnson IA 02/15/2009 03/09/2009 B51 No Driver's LicenseJohnson IA 11/30/2012 12/28/2012 M14 - Fail to Obey yraffic Sign/Signal _..:Johnson IA 02/08/2013 03/06/2013 :592 Speed Henry IA 05/30/2013 06/26/2013 ;Improper Registration 'Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/25/2011 ,664966 IA Name: Rew,Jeremy Nickolas DL/ID: 775YY4363 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: O`OiiiiIf p„metol i g r IOWA ' �y 9/5/2013 9/5/2013 Page 2 of-2 Office of Driver Services Iowa Department of Transportation Name: Rew, Jeremy Nickolas DL/ID: 775YY4363 9/5/2013 tr 0 Of Pub?, State of Iowa \ if,OF to..' Division of Criminal Investigation e� • * * 1-0 c q� 215E7thSt r o IOWA Des Moines IA 50319 = ' •" °"�"t Ph.515-725-6066 Fax 515-725-6080 -:.•''• 4.4 • oh. ''onoN a�� y. Iowa Criminal History Record Check "�MINp�� Walk-In Request Your name Z-G r.e, j,C J Address 2S'OY nit t5 , AVa City/State/Zip .1euja Grfy J'j' 5,)z9,0 Fill in all shaded areas. Phone#/F,S/,2-831 Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) 2�tAJ �Lre 1.11d1 ( Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) Z — 30 _ I? S9 0Male OFemale 03- 7 lit I a Wai ' Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) DCI USE ONLY Results As of ,a name and date of birth check revealed: El No record found \rERecord attached, DCI#---1AV✓)Th DCI initials VLS5 Receipt Number of requests t x $15.00 per last name=Total amount$ 5.00 Method of payment: cash ❑money order ❑check# El MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date f S IOWA CRIMINAL HISTORY DCI 00763235 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2013/09/04 DCI:00763235 NAME: DECHARD,JEREMY J REW,JEREMY NICKOLAS DOB SEX RAC HGT WGT EYE HAIR SKN POB 19841230 M W 507 230 BRO BRO XX ADDITIONAL IDENTIFIERS TAT R SHLD CCH RECORD *** 01 ARRESTED 20051104 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA714-2 (4) THEFT 4TH DEGREE TRK#: 101698901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2 (4) THEFT 4TH DEGREE - 1978 COURT CASE ID: 06521 SRCR074228 CHARGE CLASS: NON CONVICTION TRK#: 101698901 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060303 PROBATION 1Y 20060303 20060903 DISCHARGED FROM 20061011 DEFERRED JUDGEMENT 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