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Home My WebLink About13-083�1 III Mak i+ Al®�m1\ rt.as._ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number ✓— ?)?� APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) (Office Use Only) First Middle Last 1. Name IA7/�2 V,1 ,-1 Y ill is S 2. Mailing Address 5`o i ryna -, s -�'- 3. Telephone: Home X79— .;�2 F3lz:�-o Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �� S Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?'Alb TVpe of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When S £F t o <2 (Z3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4/1 S Tvpe of offense Where When run_ SCI�.x-- 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) deWandrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 8 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 Applicant2:2—,2 Date I/ #H##ff#1HlfHH11HH111ffR1FFRFHHH#HHHHffYRHfflff f fl11411FH1H111F11FFFFfFF##F«*###Y###**#HYf f#HYifHHH#1Hf H#HFFHHf##RFH*F STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by �Qr; \ a' (3 1 --Z' \01n 1n On this day of ff##f1fHtRlttRHRR#RHR}#Hf 1fH##f##f#*H*Ht*f R1f 14R#R#!!R}f f}llffHfff f ffHli#fH###*#*###t1R4*F4#!RR#fff f ff4111!#!!#H#111##1!*#R***###*#*# 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). S gnatur of Police 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. gna rere o�rk� designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update d.M .briw d�,NIQd 0312013 AIowa Department of Transportation Office of Driver Services (Toll Free) SOM32-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/9/2013 DL/ID #: 300AE3184 (IA) Customer #: 5465920 Name: Nissley, Mervin Jay Class: C ID Status: VAL Address: 409 Main St Audit #: 6841732 DL Status: VAL 57 IA Issue Date: 04/05/2013 CDL Status: None City/State: HIIIs, IA 52235 Expiration 01/07/2014 CDL Cert None IA Date: Status: Type Endorsements: NONE CDL Med None Suspended 01/18/2012 03/18/2013 D51 Non -Payment of Child Support IA Status: Mailing Address: PO BOX 121 Restrictions: NONE Restriction None Date of Birth: 1/7/1965 Supplement: Mailing City/State: HILLS, IA 522350121 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/06/2009 11/25/2009 S92 Speed 19 IA 08/08/2010 08/31/2010 S92 Speed 92 IA 07/22/2011 08/05/2011 S92 Speed (10 mph & under in 35-55 mph zone) 57 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/05/2011 653099 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 01/18/2012 03/18/2013 D51 Non -Payment of Child Support IA ]A Name: Nissley, Mervin Jay DL/ID: 300AE3184 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: = tiOQ • �7G� �4 '• IOWA•'��y 4/9/2013 ,=OKI saw Office of Driver Services Iowa Department of Transportation Name: Nlssley, Mervin ]ay DL/ID: 300AE3184 State of Iowa Division of Criminal Investigation 215E7'hSt Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal History Record Check Walk -In Request Yourname -�f. /SS�y� Address '/09 City/State/zipl /�tLS ,�a 5-223 Phone# - r' 9 - 3--J '- S.z4-7 ReouestinR an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) n%i ssc�y �r-2.�• ^�i.� Y Date of Birth Fecha Nacimiento (mandatory) Gender Genero (mandatory) Social Security Number (recommended) / —7- &S— I LlMale ❑Female Z71&-�--- co,G-(5cY Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.) Results M USEONLY As of ' lQ - /— a name and date of birth check revealed: -_ - ❑No record found XRecord attached, DCI # 36 L9 93 DCI initials (7, . Receipt Number of requests _L x $15.00 per last name = Total amount $ s • U O Method of payment: Zfeash ❑money order ❑check # ❑MasterCard or Visa Cardholder's name DCI initials Last 4 digits of MC or Visa Credit Card Number # Exp. Date IOWA CRIMINAL HISTORY DCI 00301983 ` MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2013/04/10 DCI:00301983 NAME: NISSLEY,MERVIN JAY DOB SEX RAC HGT WGT EYE HAIR SKN POE 19650107 M W 601 140 HAZ BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19830322 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321-281 OWI TRK#: L23590401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321-281 OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23590401 SENTENCE JAIL 2D FINE $300 COURT COSTS $28 +PAY SURCHGE 02 ARRESTED 19830627 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321-218 DRIVE UNDER SUSP TRK#: L23590501 CHARGE NO- 02 IA STATUTE IA718-6 FALSE INFO TO LAW ENFORCEMENT AGENT TRK#: L23590502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321-218 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23590501 SENTENCE PLEAD GUILTY JAIL 10D FINE $250 COURT COSTS $29 +PAY SURCHGE PROBATION lY SUSPENDED 60D COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT DISP EFF DAT 19830603 19830603 19830603 DISP EFF DAT 19830818 19830818 19830818 19830818 19830818 19830818 COUNT NO- 02 IA STATUTE IA718-6 FALSE REPORTS TO LAW ENFORCEMENT AGENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23590502 SENTENCE PLEAD GUILTY FINE COURT COSTS 03 ARRESTED 19850108 AGENCY: IA0520200 CHARGE NO- 01 OWI 2ND TRK#: L23590601 CHARGE NO- 02 DRIVE UNDER SUSP TRK#: L23590602 COURT DISPOSITION IOWA CITY PD IA STATUTE IA321-281 IA STATUTE IA321A-32 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321-281 OWI 2ND OFF CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23590601 DCI 00301983 PAGE 2 OF 2 DISP EFF DAT 19840507 19840507 19840507 SENTENCE DISP EFF DAT JAIL 8D 19850426 FINE $750 19650426 PROBATION 2Y 19850426 SUSPENDED 22D 19850426 PAY SURCHGE COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA321A-32 DRIVE UNDER SUSP CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L23590602 SENTENCE JAIL 2D DISP EFF DAT 19850426 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 to