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Home My WebLink About13-080CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX First Authorization Number L3 — gD (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 1. Name V�/\ cm neL_ 2. Mailing Address Z t 1 U W rJ 0 y 3. Telephone: Home 4. Prior experience in transportation of passengers: Last v v- S 7 - Other: 3 19 -936 --eo7j- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? _ 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? /,-/d Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Al 0 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) 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) dd 03/2013 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 0A 3 {� 6 2 L t- _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) ,t Signature of Applicant Date ++++++++++++++++#!aa*Y*4++*++++++++++++++++4++aa+++++++++++a++++++++k+++++t+aa++++a+a+++a+++++e++++++++a+++++++++*+aa++4+++e+++++++++++++++t+*++ STATE OF IOWA ) COUNTY OF JOHNSON ) SuAcribed nd sworn t before me by 0--e ��06�_t LSC On this day of GommKEaion Number z° Co mis t ion fres Notary Public in and for the State of Iowa R****#Y##Y#}Yf4if4it4tti4###4k**ltlf}RRf#R114 k!}4ittkt**i**!R#tRattRRt4411143f44itt*t*tki****t*kRRa}41f4t4i44itt4t#llittkllR*t*}R#1141441tf441t* 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). I/ - Signaturif of Pblice Chief or designee , .�y.20/3 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 re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 1/2" (height) and prominently displayed to all passengers. 4tiit#tti*tiMR#tRf}ft4f4ttkifi*1f14*****###*Yf##Y#4fittltttitlY*tti****#**##4#R##H1tHitt4t4t*i*##*4MRtR#tHtfit4ffi*i#t#t*tttt*#tafr###ktt#k#t Office Use Only Approved application DCI report State certified driving record Website update u#n rwbadi; aWX)io. 03/2013 04,Apr. 4. 20133 4.: 21 PM Div of Criminal Investigation No.8950 P. 1/6 i DCI I0%n avuuy STATE OF IOWA Criminal History Record Check Request Form Tot Iowa Division of Criminal Investigation Support Operallone Bureau, l's Floor 215 E- 7" Street Des Moine$, Iowa 50319 (515) 725-6066 (515) 7256080 Fax I am reauestina an Iowa Criminal Histnry Reenrd Chaco nn - DCI AeeountNumbor-4383-FC Orapocatne) From., Marco's Taxi _ 1161lteveas Dr. ��• Iowa City, la 52240 (319) 337-8294 Phone. - Fall (319)3518294 Last Name manauury) First Name (mandawy) Middle Name (rc rncaded) 3 -YL N t4 A tz Lc batt of Birth mandelmy) Gender rntwu9ry) Social Security Number rarommwded 12--Z-)-SCP ale DFamwla 33 9 ' 5'0 — y o �Z trarverI JUM9110R: Witnout a signed waiver from the subject of the request, it complete criminal history record may not be releasable, per Cade of Iowa, Chapter 692.2, For am fete criminal blalary retard information, ae allowed by lawn always obtain a waiver slimature from the sublect of the renuact. Wa1V*P RPiMf lborebygivo paml&Inn fur she above sequc ting officid to conduct $n lora a1mWs hlJtoryo:rord ehoclr wlih 1A9 DWsluu of C imin&l Invs:stlgrtlon l )CO. Anycrimtru) MOM dunwn=0119 se dim is m$Int$inal by ft Wl in* DosclwW st Idlowed bylaw. Iowa Criminal History Record Check Results (I)Clusconly) As of y" t'�� 3 , a search of the provided name and date of birth revealed., ' No Iowa Criminal history Record found with DCI Iowa Criminal History Record attached, DCI #_ r.l - 00-77 (08/25/10) Received Time Apr. 1. 2013 11:12AM No. 8857 ryry Iowa Department of Transportation C Office of Driver Services (roil Free) 80U-532-11121 PO Box 92&i, Des Milnes, IA 50306-9294 595-244-9924 ttJJ4 NW FAX: 515-239-M7 Inquiry Date: 4/3/2013 Name: Casella, Michael Peter Jr Address: 114 W MAIN ST City/State: OXFORD, IA 523229026 Mailing Address: PO BOX 442 Mailing City/State: OXFORD, IA 523220442 Convictions Certified Abstract of Driving Record DL/ID #: 013BB2642 (IA) Customer #: 3959505 Class: D ID Status: None Audit #: 4912226 OL Status: VAL Issue Date: 12/29/2010 CDL Status: None Expiration Date: 12/27/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 12/27/1956 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County JUR 01/19/2009 02/17/2009 M14 Fail to Obey Traffic Sign/Signal 52 IA 02/15/2009 03/17/2009 Injurious Material on Highway 52 IA 11/01/2009 11/30/2009 592 Speed _ _ _ .52 IA 12/09/2010 01/02/2011 ;592 Speed (10 mph & under in 35-55 mph zone) 416 -IA Name: Casella, Michael Peter Jr DL/ID: 013BB2642 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: ;:'""•• 4/3/2013 IOWA '% D. 0. T f .""."SCJ Office of Driver Services '4�4410— Iowa Department of Transportation Name: Casella, Michael Peter Jr DL/ID: 013BB2642