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Home My WebLink About13-087� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1824 c i349T._3T6=SZ14Vj f�7\ .i-�15 (3 19) 356-5497 FAX First 1. Name �GI✓I1�� 2. Mailing Address a l l ;Q � 10 3. Telephone: Home 3l C, - L Sy O 11 4. Prior experience in transportation of passengers: Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Other: iM 3- 87 (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? V ( < Type of offense Where When -o3 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?[y( Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense /)c% r,'1 CU Where When 01 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? )(ZS Type of offense Where When 0 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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) GerWta,citlnvbatlg 03/2013 3A I her certify that t have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numb¢r U W W S 13 . 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 docyments relating to this application, and I further agree that, if a license is granted, to comply at all times with all of of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 5� 3 *R****RR*4##4*#44*R#*4R**R***!#4YY4####'####1f###4YY#YM4YtrYY#N##M##4#YYff#4#i##4NH1f4fYflf##YYf#YfN11f#f**f##YfYY#4iflffflf#41111fYf##*#Y4Y STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by skrvR lb I M.m n, dr r • On this /,G day of FORT 1 ROrt ' rey'4' n EAer AM 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). Signal re of P i 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. 2zl&fca At . L I/ Signatu of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5'/2" (height) and prominently displayed to all passengers. f1f11fffflfffaffatf{f{{ffllfiRR**f*R*R**##aaa+##Ra#4a4aaa++a+aa++aa+a+aaaaa++aae++aa+ea++++aaaa++faf+a++aa+aaaa+a++aa#++++a*++f+a+++#+a++a+aaaaa Office Use Only Approved application DCI report State certified driving record Website update aermaman Qeapp2oio'a 0312013 Ap r. 10. 20133 3`38PN ■ Y u Div of Criminal Investigation No.9638• P. 1/3 —1, vein �Nty V1 Juwa arty IVo. 33/7 r. Li ( i l :I' I I. f•' �: I � Y 1 '1 , n y+��U ��S is .�1 1.':f �: ties ��✓Y To: X01VA WoNf0Y70f Cr(m 111x1 XnVOYfi�atfOh support operatlona Eur0A11, I31 proor 2153�, 7o'Streot ' besTY(o(nev,Tow So319 0315) i3d D6 $ (5'15)12,5-6060 VAL Mo 4) 5— rg, Tc/ lygaVeFlfl�orltrurtoid; w1thouta bo Yorea4nble, per Coda ofxhwh, Ch Wrl1'Yer��z%dSs; 7Dc nl1'asllgalron (ACp. Any erE Wulver 0 Hisroo Re,c_ord Cheok on- ft y ll SbyIela1118 (,amda(6I 1]CIA.acountl�Tumbar: f �o� � 1f, (IPaprltsa6 >) worm CITY n17 TC x& .7TV CITY CL PKvS o) 22jcg 47�F_ 4rAS17T n3a cmeun!� s SOWA CITY IC•67 52240 kAouat iAY1 319-356-5/97 OlY r& C(I3'elrtala ed 4Y0YeplYout tbesuhf ectol"fflo Yequ X, 03,2Vol. coMnlefa'nrindnoihiatmro to 'A ✓+vel 80of91�Bolrfi -77RTi(olmnende r o 06 -Z6ac) 314 a complolo otDafupl hNfory record wap+too rcoordhlroYmctflon,asallowedbyrpv hrNuys hfsl0ty(uo(dcfleckWil(I IheDl+,¢1on OPCom(nhf dllotvc4Dy1�W. - - - -- •. ,.•. •.+e�vwFi nwua 4A��Y ',OJCI IItdbnly) As of /0'13 _,asearchdthe-WOVldedllama eRddatoObiltlrrevealed. ' No lows Caiminallj1dorYkecord Mind with)]C Iowa Crltnlnalllisroxy22eCordattaohec736(214, Da uaili deceived Time?:Apr, 8. 2013 2:29 Ni Nlo, --Apr.1,0. 2013 3:38PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00694606 NAME: MOOH,SAMUBL DAVID DOB SEK RAC HGm WGT EYE HAIR 19840510 M W 600 260 BRO BRO ADDITIONAL IDENTIFIERS CCH RECORD *— DCI 00694606 PAGE 1 OF 2 DATE PRINTED- 2013/04/Zo Sm POB IA 01 ARRESTED 20030201 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- oI IA STATUTE IA708-2A ASSAULT CAUSING DODXLY INJURY DOMESTIC ABUSE TRK#: 502015901 CHARGE NO- 02 IA STATUTE IA708-2A ASSAULT DOMESTIC ABUSE TRK#: 502015902 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- u IA STATUTE IA708.2(2) ASSAULT NO INTENT OF INJURY - 1978 COURT CASE ID: 06571 SRCR050284 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 502015901 SENTENCE DISP EFF DAT TIME SERVED 37H 20030830 SUSPENDED JAIL 2D 20030830 JAIL 4D 20030830 ,PINE $250 20030830 PROBATION lY 20030830 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 02 IA STATUTE IA708.2(5) ASSAULT COURT CASE ID: 06571 SRCRO50284 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 502015902 SENTENCE DISP EFF DAT TIME SERVED 37H 20030830 SUSPENDED JAIL 2D 20030030 JAIL 4D 20030830 PROBATION IY 20030830 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF XDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCS. 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. No.9638 P. 2/3 -Apr.10. 2013 3:38PM Div of Criminal Investi;ation DIVISION OF CRIMINAL XNVESTIOATION No.9638 P. 3/3 Tli .I. C Iowa Department of Transportation Office of Driver Services i toll F ree) 80() 532 1121 PO Box 9204, Des Manes, IA 50306 9204 51`x244 5124 oFAX 515 239 1831 Certified Abstract of Driving Record Inquiry Date: 4/8/2013 DL/ID #: Name: Moon, Samuel David Class: Jr Address: 2110 N TOWNE Ci Audit #: NE APT City/State: Mailing Address: Mailing City/State: Convictions Issue Date: CEDAR RAPIDS, IA Expiration Date: 524021952 Endorsements: 2110 N TOWNE CI Restrictions: NE APT 5 Date of Birth: CEDAR RAPIDS, IA Sex: 524021952 58OWW5113 (IA) D 6464764 11/13/2012 05/18/2018 3 NONE 5/18/1984 M History Information Customer #: 3728851 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date I Conviction Date ACD Explanation County 7UR 103/25/2009 104/30/2009 1 B64 I No Insurance Card 57 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR _ _ 09/25/2011 652500 IA Sanctions Type Effective End ACD Explanation Occurrence 7UR 7UR Suspended 08/05/2009 04/07/2010 D53 Non -Payment of IA IA Iowa Fine Name: Moon, Samuel David Jr DL/ID: 58OWW5113 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: 'vE}1G(fll, 4/8/2013 �,,.....,,I/`s 10wa ; D. 0. T. Office of Driver Services Iowa Department of Transporation Name: Moon, Samuel David Jr DL/ID: 580WW5113