The URL can be used to link to this page

Home My WebLink About13-163 Authorization Number (3- ( 3 I - 1 (Office Use Only) amponoW 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 lirst Middle Last 1. Name /�v\ I�tio��l IletA ��S 2. Mailing Address ) )y 5 St, A ' s 1 3. Telephone: Home 3/cf. 665 - Other: /c:'. `17/ . 03 4. Prior experience in transportation of passengers: Syt `,'T'inK, On 1 i tvi i 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? r1'� 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? yv9 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ✓lc9 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r. 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^. 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) • clerWtaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ' 7 2? AS 3?:,5" - . 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 0 7/f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed[ and sworn to before me by A �v,vy rvaS . On this 7'`�`' day of +"Crb ? .4-0/� s SONDRAE FORT �--- t zJ J.. T.I Commission Number 159791 4 +' I My C5�7slon ies Notary Public in and for the State of Iowa 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). � j Signature o PChief 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 iiatc�gov.org. ` Signa re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update • derWtaxidrivbadgeapp2010.doc 03/2013 "o71Aug._ 5. 20135 4:24PM Div of Criminal Investigation DCI IotN1o. 2511 P. 3/3 • STATE OF IOWA .4,..it ''r''� Criminal History Record Check i hF. Request Form ♦ • • DC1Account Number: ti5f5-Ft. ettorneetto) To: Iowa nlvWonofCriminetlavestlgadau • • Frog: 1M4 r...5-ran Support Operable Buneu,1"Floor . 715 R.7°Street J tf 546ete.s Qr, Dm Motaea,Ion 60319 • t (515)7254066 01?• G rt, A S Yf o (515)725400 Fee • Phone: 1311) 339-- SLa lq• Fent.. (31N) 551-212-91 I am requesting an Torn Criminal Hi Record Cheek on: • Last Name(nkkma) First Name(aadrm,y) Middle Name tnwm cc4sd • /*\ 5 AN%6ny A Date of Distil(medibry) Gender(reeds y) •Social Seoudty Number 4Roommei j < Mak L]vetnak `'.c6 i - 1 S - ,• % I l �`]1�1.��f f a i l �1. � _ Waiver Information:Witham A alpb waiver from the object of the request,a complete criminal Maury record may AO be rotemlbie,pr Code of Iowa,Cheater 6fl2.For complete eMmloaI!Story record tarormetba,oe arrowed by law,'brays obtain a Waiver Oaten from the mublacl of the request. Waiver Release:thereby (be an etornpaths O Wto mb&mIlkonMot hklay mord cercaria d.°Msion o&Criminal tnr aisloh(Da).AyptnindlSaryalacaem,dnevctit4 bt flims'mmimedwallows{tybac • WaiverSignofare: _ .�� /% .. Iowa ?rimiiial History Record Cheek Results (dere anyy As of' 9 ' I) ,a search of the provided name and date of birth revealed: _ ipf No Iowa Criminal History Record found with DCI 0 Iowa Criminal History Record attached,DCI ti • DCX initiait • DCI-07(01125210) - I • I ' Received Time Jul. 31. 2013 3:43PM No, 1156 1 UNATTESTED DRIVING RECORD TRANSACTION ID: 6757877VA SEARCH DATE: 07/30/2013 OWNER: ROOS, ANTHONY A DATE OF BIRTH: 04/24/1981 REQUESTOR: A ROOS LICENSE#: S83665920 DRIVING RECORD THE FOLLOWING IS A LIST OF ALL ACTIVE OFFENSES AND ACTIONS ON FILE. INCIDENT DATE OFFENSE DESCRIPTION COURT FINDING DATE 07/29/2007 SPEEDING BECKET R 08/01/2007 09/04/2007 SUSPENSION PAYMENT DEFAULT INDEFINITE 10/14/2007 09/18/2007 EXPIRATION PAYMENT DEFAULT RLS BECKET 09/18/2007 07/20/2012 DRIVING RECORD TO CHOICEPOINT 07/30/2013 DRIVING RECORD TO A ROOS 07/30/2013 DRIVING RECORD TO A ROOS CONTINUED ON NEXT PAGE Page 1 o12 • UNATTESTED DRIVING RECORD TRANSACTION ID: 6757877VA SEARCH DATE: 07/30/2013 OWNER: ROOS, ANTHONY A DATE OF BIRTH: 04/24/1981 REQUESTOR: A ROOS LICENSE#: S83665920 LICENSE INQUIRY INFORMATION LICENSE#: S83665920 ST: MA NAME L: ROOS F: ANTHONY M: A DOB: 04/24/1981 SEX: M HEIGHT: 6 00 ORGAN DONOR: N DRIVERS EDUCATION: N MILITARY: N MAH: N SELF CERT: EXPIRATION DATE: WAIVER: N STATUS LIC: ACT CDL: RESTRICTIONS: TIME: TO: TYPE CLASS ENDORSEMENTS ISSUE DATE EXPIRATION DATE L D 02/15/2007 04/24/2016 RESTRICTION CODES: END OF REPORT Page 2 of 2