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Home My WebLink About13-118 Authorization Number r/i) 1 (Office Use Only) III 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 52240-Ia$26 (319) 356-5040 (319) 356-5497 FAX rr First Middle Last 1. Name E-6 C_ 01) (7 Sort 2. Mailing Address 3 }Annekk JO C-f, 3. Telephone: Home Other: �]I1 5 0 X11 4. Prior experience in transportation of passengers: 016,1 _-C wi,'\ C t t7 Fc r ypo, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? iJ�S Type of offense L ) Where When p i (i5a,5 IQ✓` O'1 �r�A ��^��r7t9'�Ih��l�� =GWI, C 147 3(..-Cr 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1'J O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? l C 5 Type of offense Where When 51Pee d 1_0\ o. City a009 Steed Sows. C.+y 0 i 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N 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) Nr� 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) clerkftaxidrivbadg 03/2013 • hereby certify tthiat,J have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `j(H L 7 cie3 . 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 5-/� I 1 3 STATE OF IOWA ) COUNTY OF JOHNSON ) .scribed an. sworn 4 --�)L to before me by N-1 e__ S�YI . On this 2 -1day of K KELLIE K.TUTTLE /" e l� 1..L ''i, Commission Number 221819 Notary Public in and for the State of Iowa —My vo rr 7 o� 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). =i ,- �' _ c. " Signatur of Polio, C r�ef 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 derkitaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation I Office of Driver Services (Toll Free)800-532-1121 II) PO Bax 9204,Des Milnes,IA 50306 9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/28/2013 DL/ID #: 464KK6798 (IA) Customer#: 2301096 Name: Nelson, Eric Vernon Class: D ID Status: None Address: 1912 HANNAH JO CT Audit it: 6011555 DL Status: VAL Issue Date: 05/29/2012 CDL Status: None City/State: IOWA CITY, IA 522403080 Expiration Date: 06/05/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1912 HANNAH JO CT Restrictions: NONE Restriction None Date of Birth: 6/5/1976 Supplement: Mailing City/State: IOWA CITY,IA 522403080 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 04/08/2009 05/15/2009 S92 Speed 52 IA 1 01/16/2011 02/10/2011 .S92 Speed (10 mph&under in 35-55 mph zone) '52 IIA Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/06/2008 ____ ____ 1451902 ___ IIA 10/20/2010 _ 596002 IIA Name: Nelson, Eric Vernon DL/ID: 464KK6798 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: _Oi"*** * �y4' 5/28/2013 : IOWA ...:* e� fid: :O 4��:,D. O. T. it fl'1ke jl�f QBN %., Iowa Department of Driver teof ServTranspices Name: Nelson, Eric Vernon DL/ID: 464KK6798 05/tMay_ 15. 2Q133 -4:24PM Div of Criminal Investigation 4 DCI IOW,. P. 4/6ins ,0 5 �a S.30 STATE OF IOWA '. Criminal History Record Check t Request Form • - DCI Account Nether: 4)15-Fe Br makable) To: Iowa DivbionofCrlodnelIevmnptioa " From; Marees Tixi &ippon Operations Buren,1"Floor 4 ,5k O 215S7sstreet 4f Ttitcas r• ,l Doe Moto ter Iowa 50319 loth C r , I b Say O (515)7154066 �L�yIL( f 1 (M5)7254080 Fel ;(314 338- vy• - Phone; • Fat:,- (911 351-$Mil _ 1 tun quesdng an Iowa Criminal Rh Rim*roonl Check on:' - •- Leat Name(ns amt) First Nome hualikq) Middle Nemttpaamn adee) Net5On EC\(_ - vel-110; 1 Date of Birth tww wy) Gender(owdatwy) - Social Security Number Prrrouredoa) G/5/7 6 ISMah CiFemele 4 )0 U 1 `3 Waiver hi/ontrallonf Witboet a input waiver 190m the eabject ertpe request,a complete criminal binary record may Dot be relwablo,per Code of Iowa,Chapter 692.2.Par s=212/2 criminal history record luformalton,es allowed by law,always arum a welter altuaturc beta the aubleet of the moot. • Waiver Release:ieuety en roiaiabn fol as don r que etel Aka/la est et at Iowaethsurt throw sold deck with S DMaeo otComind tnr.aotla(DC1).hey at. ird Bony data to no SI bmr matc.vl awedry Jew, • Waiver Signature: _ Iowa Criminal History Record Check Results (DCI tie only) As of 5—/S—/3 ,e search of the provided name and data of birth revealed: ❑ No lova Criminal Hlstary Record found with DCI AJ Iowa Criminal History Record attached,DCI 4 grg<-3t� . -- DCI initials DCl 77(08/25/10) Received Time May. 9. 2013 11 :46AM No. 2650 May. 15. 2013 4:25PM Div of Criminal Investigation No. 3334 P. 5/6 IOWA CRIMINAL HISTORY DCI 00518350 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2013/05/15 DCI:00518350 NAME: NELSON:ERIC VERNON DOB SEX RAC HGT NOT EYE HAIR SHE POB 19760605 M W 602 250 BLU BRO FAR IA ADDITIONAL IDENTIFIERS . PHOTO AVAILABLE: Y CCH RECORD ••• 01 ARRESTED 19960229 AGENCY: IA0520400 IOWA CXTY UNIV SEC PD CHARGE NO- 02 IA STATUTE 1A124-401-3 POSSESSION/SCHEDULE I/MUSHROOMS TREE: 018655802 CHARGE NO- 03 IA STATUTE IA124-401-1D POSSESSIONW/INTENT DELIVER MARIJUANA TRICE: 018655803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE SCHEUDLE I/ MUSHROOMS COURT CASE ID: FECR40720 TRIO: 018655801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960620 PROBATION 2Y 19960620 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA124-401(1) (D) POSSESSION/ W/INTENT TO DELIVER/ MARIJUANA COURT CASE XD: FECR040720 TRK*: 010655802 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960628 COURT COSTS 19960628 PROBATION 2Y 19960620 02 ARRESTED 20070422 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRKU: 1A001A002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO PIST COURT COUNT NO- 03 IA STATUTE IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 FECR079287 CHARGE CLASS: MISDEMEANOR CONVICTION TRK9t: 1A001A003 May. 15. 2013 4:25PM Div of Criminal Investigation No. 3334 P. 6/6 DCI 00518350 PAGE 2 OF 2 r SENTENCE DXSP EFF DAT JAIL 2D 200'70919 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 INQUXRY. DXVXSION OF CRIMINAL INVESTIGATION