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Home My WebLink About13-060�r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 Ca) 1 7'Ztur$ 3�7 (319) 356-5497 FAX First 1. Name 2. Mailing Address Authorization Number Vs - vk� (. O (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) r'A4 Av-_ 3. Telephone: Home Y Other: 4. Prior experience in transportation of passengers: �� pe.1_6t1 COC aC �J�1 v ti IZ ,/Q V,, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ae, ' 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? IVO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 7V—(Z- Type %(ZT e of offense Where When s I" COVK+yy1/0W;-010 50ee�tilW CTL)k Sov`— 4- ao� 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 6429 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) daM .d,lW dg 09/2012 ejeby certify t17at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number All, Z �/ 6 I understand that if I falsely answer anv nuestinns in thin annlirntinn that thic 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 Applicant <� Date RRRR**f f f H*H+f+#++R*+FFF*HR#f H###I.##*HIFFHHHHHHH##%#*1Hf4*1*'*#f1HH1H*H#H##!**FF**Hf1f 11H*H*H##i##H#+HHH*F4f *f ###HH+# STATE OF IOWA ) COUNTY OF JOHNSON ) 7G��tb? ed nd sior�n xg before me by Z�ka � ��- On this z5' day of D r �(I"�_. TUTTLE �a1it s KELLIE K. �� P A f�� Ccrt',m s��°m ssio4� Ex i es p Notary Public in and for the State of Iowa Number 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). 4 /112, /� Signature's 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. Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update Date deWiaxiddvba gea,2010 as 09/2012 I A i owaDepartmentof Transportation difice of Drivw Ser ices (Tolt Free) IIDO-532.1121 PO 13=92N, des Moines, L4 5030&I}2G4 315-244-4124 APAX:516.239.18337 City/State: CORALVILLE, IA Expiration Date: 10/19/2014 522411733 Mailing Address: 812 12TH AVE Mailing City/State: Convictions CORALVILLE, IA 522411733 Endorsements: L Restrictions: NONE Date of Birth: 10/19/1986 Sex: M History Information CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Certified Abstract of Driving Record Explanation County Inquiry Date: 3/1/2013 DL/ID #: 644XX2016 (IA) Customer #: 758423 Name: Eash, Zachary Dean Class: C ID Status: None Address: 812 12TH AVE Audit #: 4690806 DL Status: VAL B20 Issue Date: 09/22/2010 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 10/19/2014 522411733 Mailing Address: 812 12TH AVE Mailing City/State: Convictions CORALVILLE, IA 522411733 Endorsements: L Restrictions: NONE Date of Birth: 10/19/1986 Sex: M History Information CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County IUR 01/27/2006 09/19/2006 B21 Driving While 79 IA Barred 06/15/2007 07/11/2007 B20 Driving While 96 IA Suspended, Denied, Cancelled Revoked- evoked03 03/14/2009 14 2009 .05/27/2009 S92 Seed 50 IA 08/11/2009 09/02/2009 S92 Speed (10 mph & 52 IA under in 35-55 mph zone 08/21/2009 09/29/2009 S92 Seed 52 IA 01/09/2010 02/12/2010 S92 Seed 52 IA Name: Eash, Zachary Dean DL/ID: 644XX2016 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: 3/1/2013 IOWA ` *� D. 0. T`� ...; Office of Driver Services Iowa Department of Transporation Name: Eash, Zachary Dean DL/ID: 644XX2016 Par. 7. 2013 4:04PM Div of Criminal Investigation dt. i. LV 1.) i:ItIrin City t,iere - t,ity of iovta t,ity TO; Iowa vQ1s(ott0(CrhntnalYrt�eat(�atf0h SapporE OperafCbns aUCenu, all Wool! �f5�`:7tbStreeC besh�yitl0.s,SowA 50319' (513) �a9•GQ66 (9.15) M-6000 140 9 woly9p,1 AlyeetrgatIOA 0 Ofydr Noo'j6655 zvq PP. L13/18 0 �" r r• I � � �� fid �'4��k Cheok on7 ch ar i pClAccountNtlmber: '��.-- F QPnpp)fieb J) Womp CITY 0E' TOWA. fxT_R'4- CS'L'X cun's OFFTox 410 'R YJA ¢HTIPGTOU MMA T Y0t7A MIT XOTTA 52242_ kvakl 3J9=3�.s4u-r -�. De 8 6 'Mazs [�X+a>1tale 17 Wphoutaefgaodw0yoritom•li<esabfedafthoyd(puh a rofiplo(6QVIdnAlhlsfo YWordttlaynoC tE7owA,Chaptcr692,a,ba�com ttaerint(naShistoryrecordialetmatloh,ava0otvedBylA>ri,A(ways 0•1YoltTtke.suGiaeCoStheYofast`i-- - -- grye petatfsffott lSrrhoahoYeregaeslingofAo/pl to tvnduolaptYotva otimin�(ldstoryLeeardcheektVlh lAebNslonoPCriminol IhtelolydnnYeQepcmin��nfatLatlafiotntelded6yiReD Wmpy6arc#sescd pv ellotrd6yl'aiv. 'oma chock Rosily ro I1 000 ) A6r of , a sedaoh oftho,provided name and doe, d1sSt't xwealod; Mo Bwa G4iuti1lct�Ixfstozyltecprd �ollnd withDCX Efl. TomG�iminaliiPAtoxyRecordaiCachcdpCY#P 6Tit 3 3 AC73uitlals R>rpivod Tlmp.`.Mar 1 —7011— 1•41PM—Mn KOgQ G Mar, 7. 2013 4:04PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00769133 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2013/03/07 DCI:00769133 NAME: BASH,ZACRARY DEAN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19861019 M W 511 155 BLU BLN IA ADOMONAL XDENTXFIERS CCH RECORD *** 01 ARRESTED 20060127 AGENCY: IA0790000 POWESHIRK CO SO CHARGE NO— 01' IA STATUTE IA921J-561 DRIVE WHILE BARRED TRK#: 075930001 COURT DISPOSITION AGENCY: IA079015J POWESHIEK CO DIST COURT COUNT NO— 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER — 1978 COURT CASE IDo 00791 AGIND11995 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 075930801 SENTENCE DISP EFF DAT SUSPENDED JAIL SO 20060919 JAIL 10D 20060919 SUSPENDED FINE . $500 20060919 UNSUPERVISED lY 20060919 PROBATION 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 EN CEMENT AGENCIES BY THE DCI. XM ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS. BA179MN INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 6655 P. 14/18