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Home My WebLink About13-064III N ot CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX ilI11111110F1=11- IF� 2. Mailing Address �,y S y C) P L u 3. Telephone: Home -L-(-S-/ S-/ 3 - 3 4. Prior experience in transportation of passengers Authorization Number '18— (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) VV"\ Other: /TSI r+ 13---C-)90 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? y E 5 Type of offense rn Where When cy p 4— Cv'rkTv 0 C 2 dcw r2a h•'eQ S . S� d � 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? TMJ 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where A 8. Has your driver's Iibense or Type of offense k license been suspended or revoked in the last five years? Where When t $ , !2v10 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 'fes 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) derke dmb dg 03/2013 I hereby certify that I hav issued to me by the Iowa Department of Transportation a valid Chauffeur's license number. L4! \ )(y=7 L % . 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) _ _ p Signature of Applicant 1 Date — � 3 3 H######HHfHHlfHlHllHlf*HHHf!**fH*4H*H**fHH*HH+!*HIHHHHfIHlHH1Hf11fi4H1flH1HHf*lffff-f*Hi*off#1�1#***HHH*****HH COUNTY OF JOHNSON ) Su ¢ ed pdsycom to before me by fqlQ L1 �e� On this day of KELLIE K. TUTTLE D..tir, i., on,i fn, tK. Ctntc of Inun 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). Signature Police Chief or designee 3/ 3/i � 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. Signature of City Clerk or designee 3--i3,-ice Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 Y:" (width) and 5 1/2" (height) and prominently displayed to all passengers. HHHHHff1HH*****#4HH##*#######H##1ff#Hfif fiff4f HfH*H44H*HH*t*H*H#**tHtH##4flHfflff #t#f fffHff il4H*#*4tH**H#**tt4ktit*444 Office Use Only Approved application DCI report State certified driving record Website update da,wtewm dq.a 201 d - 0312013 Iowa Department of Transportation AO Office of Driver Services (To11 Faze) 800-632-1121 PO Box 9204, Des Manes, IA 50348-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 3/13/2013 Name: Larson, Alan Keith Address: 1540 PLUM ST City/State: IOWA CITY, IA 522402124 Mailing Address: 1540 PLUM ST Mailing City/State: IOWA CITY, IA 522402124 Convictions Certified Abstract of Driving Record DL/ID #: 431XX7942 (IA) Class: D Audit #: 5423120 Issue Date: 08/05/2011 Expiration Date: 07/13/2016 Endorsements: 3 Restrictions: NONE Date of Birth: 7/13/1954 Sex: M History Information Customer #: 900797 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Fail to Obey Traffic Sign/Signal Citation Date Conviction Date ACD Explanation County IUR 03/25/2011 04/08/2011 S92 :Speed 52 IA 03/26/2011 04/13/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA Name: Larson, Alan Keith DL/ID: 431XX7942 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: Name: Larson, Alan Keith DL/ID: 431XX7942 3/13/2013 s Office of Driver Services Iowa Department of Transportation -A State of Iowa Division of Criminal Investigation 215 E 7' St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal History Record Check Walk -In Request Your name LrArSo Address _ City/State/Z! D Phone# Reauestine an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apelfido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) �_A 2 s6NJ )qL-7�_t )fl Date of Birth Fecha Nacimtento (mandatory) Gender Genera (mandatory) Social Security Number (recommended) �7 / (—s / Male ❑Female y-7 g— 7 "L __3G) v d — Waiver Signature Firma (If the request is on oluself, Jesse sign. If the request is on someone else, write N/A.) al USE ONLY Results As of 3 - / 3 % a name and date of birth check revealed: ❑No record found Record attached, DCI #5 73A9 DCI initials Receipt Number of requests x $15.00 per last name = Total amount $ $ . 0 (� Method of payment: cash ❑money order ❑check # ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number # Exp. Date ." IOWA CRIMINAL HISTORY DCI 00567329 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2013/03/13 DCI:00567329 NAME: LARSON,ALAN KEITH DOB SEX RAC HGT WGT EYE HAIR SKN POB 19540713 M W 601 200 BLU BRO FAR IA ADDITIONAL IDENTIFIERS SC FHD CCH RECORD *** 01 ARRESTED 19980111 AGENCY: IA0850100 AMES PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE TRK#: 032094601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401(5) POSSESS CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 032094601 SENTENCE FINE $250 COURT COSTS DISP EFF DAT 19980331 19980331 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 �o