Loading...
HomeMy WebLinkAbout13-111 I Authorization Number 1 I i (Office Use Only) • it ®dr �III MIS , 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 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Ljast 1. Name01--Zi-19e 2. Mailing Address .5&5" (-/7 3. Telephone: Home Other: C-// .319— 4. Prior experience in transportation of passengers: ".. /k54--- L/ Ye-c- Ca �'✓�� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? W1.5 Type of offense Where When `Tott,t_q)1,- EA/04 o9r- - pLA1 tJL.I1L e L l�efewa/..t_ Co./it-47 7/5/ 7c z 6. Have youbeen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /VE) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 5et5 Type of offense W ere When `� j61,454).., CoJ 7 eiZeoy t(/Ze3 2/tet,!/ 12/to ( I g44-(e LA-5,04 C,oh ZJZo( � 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? rV0 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) 1'- v 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) deddtaxiarivbedg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number -7 ^7 O Y1-0 Z 'Z . 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 �� f Date �1 l #**#****#****#*********************************************#************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by i: PJ117- , n7 Yr . On this / 7 day of z47/ � 3��s SONDRAE FORT SerrIdtAx Commission Number 159791 Notary Public in and for the State of Iowa i' • AAy C yu 7 .e iw'5 3J a� ************************************************************************************************************************************************ 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). ja. Signa re of Poli 1 I ie 3r 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. Sign of�City Cl is or desI nee Date Taxi cab businesses ark quired 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 clerk/faxidrivbadgeapp2010.doc 03/2013 Or1111111 Iowa Department of Transportation s Office of Driver Services (Toll Free)800-532-1121 Pd Box 9204,Des Moines,IA 503[!6 92O4 515-244-9124 FAX.515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/17/2013 DL/ID #: 770YY0277 (IA) Customer It: 534866 Name: Rotzinger, David Roy Class: D ID Status: None Address: 505 D AVE Audit#: 5016398 DL Status: VAL Issue Date: 02/16/2011 CDL Status: None City/State: KALONA,IA 522479592 Expiration 11/11/2013 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 505 D AVE Restrictions: Corrective Lenses Restriction None Date of Birth: 11/11/1977 Supplement: Mailing City/State: KALONA,IA 522479592 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/08/2008 12/17/2008 _ ,592 Speed (10 mph&under in 35-55 mph zone) 16 IA 05/07/2009 06/01/2009 S92 ..Speed 52 IA 10/19/2010 11/22/2010 .592 Speed (10 mph&under in 35-55 mph zone) 52 IA 12/23/2010 02/01/2011 _ NOl Fail to Yield Right of Way 52 IA 01/27/2011 02/16/2011 _ .592 Speed (10 mph&under In 35-55 mph zone) 52 IA 11/10/2012 12/13/2012 .592 Speed 52 IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 12/23/2010 609302 IA Name: Rotzinger, David Roy DL/ID: 770YY0277 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: 16it1f""a 4.,?..`.*" -leo. ti, 5/17/2013 P. IOWA *% 4,, atevecrA PSr= D. 0. T.yI,I� Of oonicii$��`- Office of Driver Services • Iowa Department of Transportation Name: Rotzinger, David Roy DL/ID: 770YY0277 OF pi/e4 State of Iowa y< `t or ,0q`'°. Division of Criminal Investigation Wet- 215E7th St o IOWA Des Moines IA 50319 Ph.515-725-6066 Fax 515-725-6080 1� ^".•`' Jay A9� C770N p . Iowa Criminal History Record Check cR'"'"At. ,.‘ Walk-In Request Your name ; e I o - z2,A e Address OS c.v e_ •J City/State/Zip Jt c-1©4..m I o $ Z Z 41-7 Fill in all shaded areas. Phone# ci 6 f pc(f Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) y / Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) I t � Male ❑Female LIZ-3 Z- q Waiver Signature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) Results DCI USE ONLY As of 5 l`1 \ \3 , a name and date of birth check revealed: ❑No record found --c 'Record attached, DCI # 5 L09 15 5 DCI initials ca C- Receipt \ Number of requests x $15.00 per last name=Total amount$ Method of payment: Plash El money order ❑check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date IOWA CRIMINAL HISTORY DCI 00569557 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2013/05/17 DCI:00569557 NAME: ROTZINGER,DAVID ROY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19771111 M W 509 240 BLU BRO FAR IA ADDITIONAL IDENTIFIERS SC ABDOM SC R KNEE CCH RECORD *** 01 ARRESTED 19980209 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA715A-7 FORGERY TRK#: 016545401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A-7 FORGERY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016545401 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19980710 COURT COSTS 19980710 PROBATION 2Y 19980710 PRISON 5Y 19980710 PRIOR ORDERS 20000619 CONTINUED REVOKED 20000619 02 ARRESTED 20020705 AGENCY: IA0280000 DELAWARE CO SO CHARGE NO- 01 IA STATUTE IA321-561 DRIVE WHILE BARRED TRK#: 059782701 COURT DISPOSITION AGENCY: IA028015J DELAWARE CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED/ HABITUAL OFFENDER COURT CASE ID: 01281 AGCR005521 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 059782701 SENTENCE DISP EFF DAT SUSPENDED PRISON 20020809 03 ARRESTED 20060927 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA714.2 (1) THEFT/ 1ST DEGREE TRK#: 101987601 • DCI 00569557 PAGE 2 OF 2 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2 (3) THEFT/ 3RD DEGREE COURT CASE ID: 06521 FECR077354 CHARGE CLASS: NON CONVICTION TRK#: 101987601 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20081208 FINE $625 20081208 PROBATION 2Y 20081208 DISCHARGED FROM 20101207 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 ENFO' � MENT AGENCIES BY THE DCI. IN i:`: :.:SENCE 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