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Home My WebLink About13-0881 r t X11 -. III AiWllm�� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa S2240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name 7A c -l4 Authorization Number /3 -s 0 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Middle (30.770 t//O 2. Mailing Address ? o i.j/i5cy1 Al 3. Telephone: Home 3/9�- 3,5 3 -2-R'2-1? Other: 3 /4? 38 q - v Slog' 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where q When G Con!ZZnn ipj)en1 Th�oX re 2Gr PaO/-'l%�S 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When 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) // .7 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) a�g 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number S—,e 7 -z,Z 69 b/ . 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 ofApplica,., Date �/ Applicant,., STATE OF IOWA ) COUNTY OF JOHNSON 1 S cribed and sworn . before me by Z0LC-4L o� CE�( � O On this i � day of SOI KELLIE K. TUTTLE- _I Notary Public in and for the State of 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). Sign T re of P li a 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. 3W� 51e/ - Signahtte of City Clerk or designee 14-17-1-3 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/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 Gem idnwadgeaW2010 d - 03/2013 r Apr. 3. 2013 11:49AM DCI:00167368 NAME: COCHRAN,JACK COSTELLO,JACK DOB SEX RAC 19420613 M W ADDITIONAL IDENTIFIERS MISS R PGR TAT IF ARM TAT RF ARM 01 ARRESTED 19691004 Div of Criminal I-rvestigation IOWA CRIMINAL HISTORY DCI 00167368 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2013/04/03 MGT WGT EYE HAIR SKN POB 601 195 HAZ BRO MED OK CCH RECORD *rt AGENCY: IAD570100 CEDAR RAPIDS PD CHARGE NO- 01 ASSAULT INTOX COURT DISPOSITION TRK#: L05412101 AGENCY: IA057015J LINN CO DIST COURT COURT DISPOSITION ASSAULT AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1978 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L05412101 COURT COSTS SENTENCE FINE $26 02 ARRESTED 19820204 AGRNCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- OS ASSAULT TRK#: L05412201 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L05412201 SENTENCE PLEAD GUILTY FINE $100 COURT COSTS DISP EFF DAT 19691010 DISP EFF DAT 19820610 19020610 19820610 No.8736 P. 2/3 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 DCS. IN THE ABSENCE OF FINGVRI FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FWE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF UIRY. DIVISION OF CRIMINAL INVESTIGATION Iowa Department of Transportation L Office of Driver Services (Toll Free) W0332-1121 PO Box 9204, Des Manes, lA 50306-9204 515-244-91244 FAX: 515-239-1037 Certified Abstract of Driving Record Inquiry Date: 4/11/2013 DL/ID #: 809ZZ6961 (IA) Customer #: 415986 Name: Costello, Jack Cochran Class: A ID Status: None Address: 280 Wilson Ave Sw Audit #: 3410861 OL Status: VAL Issue Date: 06/16/2009 CDL Status: VAL City/State: Cedar Rapids, IA 52404 Expiration 06/16/2013 CDL Cert None Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 280 Wilson Ave Sw Restrictions: NONE Restriction None Date of Birth: 6/16/1941 Supplement: Mailing City/State: Cedar Rapids, IA 52404 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/06/2012 j04/03/2012 ; [Miscellaneous ,10 IA Name: Costello, Jack Cochran DL/ID: 809ZZ6961 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: ..........-'P I 44 4/11/2013 IOWA / r •• • ' •S` S� Office of Driver Services Iowa Department of Transportation Name: Costello, Jack Cochran DL/ID: 809ZZ6961