HomeMy WebLinkAbout13-102 Authorization Number
_ i (Office Use Only)
"4 AO gliallar
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (Police Department review must be made
410 East Washington strcct between 8 a.m. to 3 p.m., Monday-Friday.)
w�CitY. Iowa 52240-1826
(319) 356-5040
(319) ._ .
Last
1. Name ( �y�`>��-� ` -�dl `� ��J �t✓
2. Mailing Address 02'00 S,SC-bff 6-6)_
3. Telephone: Home ��'l- 350 --1 c\`-f 5 Other:
4. Prior experience in transportation of passengers: -rd-e-----4)7\--5-7 `ItiK3 b.4-7-07-4
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
b(.� SG'(9.25t Z t ( c1 1 z
6. Have you bv.ein convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? Ain
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
54,cei6 Cl Y -.,-O LC
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
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)
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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)
cterk/taxidrivbadg 03/2013
I hereby certify thAat I tha eyssued to me by the Iowa Department of Transportation a valid Chauffeur's license number '
n-15- \ ( 35 . I understand that if I falsely answer any questions in this application, that this
application- ay 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 cuments relating to this application, and I further agree that, if a license
is granted, to comply at all times with all of •_ •rovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant Date 45 gj (
41
********************************..***,:.k**,.*************.***************.***********************************************************************.
STATE OF IOWA )
COUNTY OF JOHNSON )
scribed and worn to before me by ;%a, / r
k(De fk_t I' frOn this day of
jj 1 :0141,f, COKELLIE K.TUTTLE ` `-C�
o i MM155101 Number 22181
Z "sv �iGsin ;�5 otary Public in and for the State of Iowa
OW
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).
/A, 1, ?at.?
Si ature of P ice Chi for 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.
Jif -v� '��
• / Li ') /(..62.7 O, o� /3
Signa114
re of City Clerk or designeeDate
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
clerk/taxidrivbadgeapp2010.doc 03/2013
Page 1 of 2
J. IowaDriver Department of Transportation
Office of Services (Tdl Free)800-532-1121
slile PO Box 9204,Des Moines,IA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 4/30/2013 DL/ID #: 075AA1185 (IA) Customer#: 2545540
Name: Schoenberger, Roman Class: D ID Status: None
Tim
Address: 2100 5 SCOTT BLVD Audit#: 4398269 DL Status: VAL
TRLR 40 Issue Date: 06/02/2010 CDL Status: None
City/State: IOWA CITY,IA Expiration 05/11/2015 CDL Cert None
522403032 Date: Status:
Endorsements: 3 CDL Med None
Status:
Mailing Address: 2100 S SCOTT BLVD Restrictions: NONE Restriction None
TRLR 40Date of Birth: 5/11/1949 Supplement:
Mailing City/State: IOWA CITY, IA Sex: M `
522403032
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
04/17/2010 05/03/2010 592 Speed 52 IA •
•
Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
09/12/2008 460768 '.IA
10/06/2009 531782 'IA
Name: Schoenberger, Roman Tim DL/ID: 075AA1185
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:
OfNCIf.y,
o40e• •''•
iit� 4/30/2013
sari IOWA '.zy
i0; ;Ci a
IIr1 lx i ,ams owaeDepartme Dof Driver epartment Services
Transportation
ORNEN
4/30/2013
:Max; 7, 2013 3:42PM (Div of Criminal Investigation NNNo. 2364 pP. L11/12
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Received 2530. _2013_10; lOAM_No. IDQ[��(o8/ 7101 •
May. 7. 2013 3:43PM Div of Criminal Investigation No. 2384 P. 12/12
I I IOWA CRIMINAL HISTORY DCI 00431906
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OE a
DATE PRINTED-
2013/05/07
DCI:00431906
NAME: SCHOHNBERGER,ROMAN TIM
SCHOENBBRGER,TIM
DOB SEX RAC HGT NOT EYE HAIR SKN POE
19490511 M W 601 190 BRO BRO NY
ADDITIONAL IDENTIFIERS
SC R THOH
CCH RECORD ***
01 ARRESTED 19920105
AGENCY: IA0850000 STORY CO SO
CHARGE NO- 01 IA STATUTE IA3210.-2
OWI
TRK#: L41122601
COURT DISPOSITION
AGENCY: IA085015J STORY CO DIST COURT
COUNT NO- 01 IA STATUTE IA321J.2
OPER VEH WH INT OWX
CHARGE CLASS; MISDEMEANOR CONVICTION
TRK#: L41122601
SENTENCE DISP EFF DAT
JAIL 2D 19920318
FINE $500 19920318
COURT COSTS 19920318
•
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