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Home My WebLink About13-056_02 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX � First 1. Name 2. Mailing Address Authorization Number 13 — 5 (o (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle 3. Telephone: Home 04 i 2l 9 2 t Z Other: 4. Prior experience in transportation of passengers: l A0rkuf. {,f ("&C c o' s -Cc1 l u e e.,t 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where V4 W, When 5 " r� t 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? fid u Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When 114 tz I B. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Type of offense Where When 9. Have you ever applied to bean 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) derrb�ddwadg 09/2012 I her@ certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number \ 1R L VR `1 . 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 Applicant Date -) - I V Yi#*i#H{4##H#S##HRRfHh###'#i#+'F#f+R%#RHH%ffffifHM###H+4#+{{#{{#%f%4ffHfffHfHHf1H1f##f####HH##%H#R##RR#4RRRRHYH*###+#H##R#4{## STATE OF IOWA COUNTY OF JOHNSON 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 of is hief or designee 7-l2 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 e Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update 3--7-13 Date Genvl dnvbadgeaW2010.d 09/2012 Iowa Department of Transportation (Toll Free) OW-M-1121Office of Driver Services Po Box 92U4, Des Maines, fA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 3/6/2013 Name: Davis, Jeremy Thomas Address: 1541 FOSTER RD City/State: IOWA CITY, IA 522451647 Mailing Address: 1541 FOSTER RD Mailing City/State: IOWA CITY, IA 522451647 Convictions Certified Abstract of Driving Record DL/ID #: 117AC4879 (IA) Customer #: 5207471 Class: D ID Status: EXP Audit #: 5804354 DL Status: VAL Issue Date: 02/17/2012 CDL Status: None Expiration Date: 05/28/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Supplement: Date of Birth: 5/28/1982 Sex: M History Information Page 1 of 1 Date Conviction Date ACD Explanation . __.. _ ,__.3 County .-�------- JUR — - - r08/3/2007,_. 10/08/2008 _ __ aA33 �DNg/Drug Rela[ed Conviction__112 Fall to Obey Traffic,Slgn/519na1..,__.,. ;SZ IA '12 1INDEFINITE j12/07/2012 iM14 _...... 'Speed l52 ;IA — - 112/30/2012 iS92 sanctions Type Effective End _ _, ACD,,,.. Revoked X11/27/2008 105/25/2009 ___ 'A33 Suspended 103/29/2013 1INDEFINITE _ D53 _ Suspended !04/09/2013iINDEFINITE D53 Name:. Davis, Jeremy Thomas DL/ID: 117AC4879 Related Conviction .nt of Iowa Fine ,._.,. ,...... ...�... nt of Iowa Fine occurrence JURJUR __._. ._ ..... !IA ... IA IA IA rIA Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that Vam the custodan of the records said offices and that I have been dauthorizethis Department by the Director of Transportation to so cert fy.l record currently In the custody of 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: Davis, Jeremy Thomas DL/ID: 117AC4879 3/6/2013 Office of Driver Services Iowa Department of Transportation 3' Mar. 5. 2013 3:57PM OP/27/2019 10.61 FAX Div of Criminal Investigation No.5362 P. 1/4 P DCI IOWA 2003/000 STATE OF IOWA q' Criminal History Record Check Request Form DClAwountNtanber Iy.eni arcs T� 1 llV skw�• D� 7m IowaDlvldni fZ ilKtotl lr vmnpdoa Supportopeetlnae Berle, V Fiver 318 IL 71 street "Mall", Iowa 5019 (516) 72544 (515)7766060 FAX Pvv} L` e Pkoret .(31x) 338-1 Fe:,. • 319 351 V �(, f'tann ✓l id'e'r (m:w�nni to �Femele r hvm the eub)eet or me reqs W.I. Few, Wal ver Relerve: I Mmby 10 b pwakeja ror ac .twe FV*Mbe edkm w a>rkX t„ ,.00ptioaMM. A9W0indW WKM Ad 9WMIPSew OAT w T11AhW rdty& PC[ walwi,steaalara K7 ux0m,a � C —S U cttmlo.ihistogreeerd mayao Adna, as anowedby low, elw•Ys bA law. [ow r 'stolljItecor e k Re Its As` f 3' S' 3 , a VANh of the provided name• iLnd date orbinh toveaiedt ❑ N_$low& Criminal history itoUnd with DCI , NI Iowa Criminal History ROcord etteeh , DCI # B 6 Oi y >; DCI inllfals n. .. :...J T:... r.l III 'Inie 1A.CtAAA U. CLIA Mar. 5. 2013 3:57PM Div of Criminal Investigation DCI:00811609 NAME: DAVI8,JERENY THOMAS DOB SEX RAC 19820526 M W IOWA CRIMINAL HISTORY DCI 00811609 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED - 2013/03/05 HGT WGT EYE HAIR SKN POE 605 160 HAZ BRO MED FL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD TAT R SHLD CCN RECORD *** 01 ARRESTED 20070813 AGENCY: IA0520100 CORALVILLE PO CHARGE NO- 02 IA STATUTE IA124.401(5)' POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A0023RO2 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 FECROB0455 CHARGE CLASS: MISDEMEANOR CONVICTION TRK(!: 1AO0231102 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL lot 20081008 FINE $315 200BLOOS 02 ARRESTED 20071105 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK((: 5AO043501 COURT DISPOSITION AGENCY: IA057010 LINK CO DIST COURT COUNT NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG COURT CASE ID: 06571. SRCR074931 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#r 5AO043501 SENTENCE DISP EFF DAT FINE $315 20050425 03 ARRESTED 2DO71213 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE TRK#: 1A0030Y02 COURT DISPOSITION AGENCY: lAOS2015J yOHNSON CO DIST COURT COUNT NO- No.5381 P. 2/4 Mar. 5. 2013 3:58PM Div of Criminal Investigation DCI 00011609 PAGE 2 OF 3 01 IA STATUTE IA713.6A(l) BURGLARY 3RD DEGREE COURT CASE ID: 06521 PECROS1761 CHARGE CLASS: FELONY CONVICTION ' TRK#: 1A0030Y01 SUBSTANCE ABUSE EVALUATION RESTITUTION ' SENTENCE DISP EFF DAT FINE $750 20080919 PROBATION 3Y 20080919 PRISON 5Y 20080919 REVOKED 20090204 04 ARRESTED 20080424 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124.213 PHARMACY PURCHASE >7500MG PSSUDOSPHEDRINE TRK#: 1A003Z301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.213 PHARMACY PORCH >7500MG PSEUD08PHEDRIN6 COURT CASE ID: 06521 SRCROB1795 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A003Z301 RESTITUTION SENTENCE DISP EFF DAT JAIL 101) 20081008 FINE $315 20081008 05 RECEIVED 20090206 AGENCY; IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA713,6A(1) BURGLARY 3RD DEGREE TRK#: CB005WB01 INMATE Ni 6747211 COURT DISPOSIWI014 AGENCY: IA0520159 JOHNSON CO DIST COURT COUNT NO- O1 IA STATUTE - IA713.6A(1) BURGLARY 3RD DEGREE CHARGE CLASS; FELONY CONVICTION TRK#: CB005WB0l SENTENCE PRISON 5Y CUSTODY AGENCY! IA0770150 ADULT PAROLE SVC A 20100824 PAROLED No.5382 P. 3/4 Mar. 5. 2013 3:58PM Div of Criminal Investigation DCI 00011609 PAGE 3 OF 3 CUSTODY AGENCY; XA077015G ADULT PAROLE SVC B 20110506 DISCHARGED 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 POSITXVE 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 INV85TIGATION No.5382 P. 4/4. M