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Home My WebLink About13-053.Ir , -4 �kr"III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 13 19) 356-5040 (319) 356-5497 FAX 1. Name Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday* 'p- 13 -S�6 (Office Use Only) 2. 2. Mailing Address X 5-2,2 2a' 3. Telephone: Home ?AZ L(2, y25-0 Other: 4. Prior experience in transportation of passengers: syr Clop- ce? /!3 /5�!41 51/115 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Oir��i 7-A415 T �T2v Type of offense Where SY e )""9 G F, �es r l -'� When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? NO Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? )/ Z�:�- Type of offense Where When When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /A/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) 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) c.a .id,wbadg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4Sz 7 Z (11 3 . 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--/� 4(/ Gf i ew-,e Date 3—i A4/ ;? FH##iR*FRR**RRRR*flRfiff*#F#4*RF***R*RR*H1RH1R11f###Y#######F#***R#*R**R**4RRf1RRf1R#fH#*#1f1H#Hi#'FFH*RR#*#*H#*RR*R**IHRf#fYf###4###k## STATE OF IOWA ) COUNTY OF JOHNSON ) cribed and � orn � before me by I f i��1� Olti-e fAs On this day of s'°►KELLIE K. TUTTLE 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). Signat a of 1,4e C ief 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 dean idrivbadgeapp2010dm 09/2012 CA Iowa Department of Transportation Office of Driver Services (Tall Free) OM -532-1121 PO Bot 9294, Des Moines, IA 50300-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 3/5/2013 Name: Owens, Theodore Wayne Address: 572 7TH AVE City/State: CONROY, IA 52220 Mailing Address: PO BOX 92 Mailing City/State: CONROY, IA 522200092 Convictions Certified Abstract of Driving Record DL/ID #: 854ZZ6223 (IA) Class: D Audit #: 6742932 Issue Date: 03/05/2013 Expiration 01/01/2018 Date: Endorsements: 3L Restrictions: Corrective Lenses Date of Birth: 1/1/1954 Sex: M History Information Customer M 3642021 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County IUR 05/15/2008 —OS/2 -2/2008 -592 Speed 53 IA 06/26/2008. _.__.k _ .. ... ...—. __ _1592 .. .{__... _ .. .._.. .. ., ;Speed.___- ., ._, .-, .,_ „ ._ _ _...__. ., 53 _ _ JA _ 11/06/2008 _ __„07/07/2008 112/61/2008 M14 ;Fall to Obey Traffic Sign/Signal 57 'IA 01/27/2011 02/22/2011 :S92 :Speed (10 mph & under In 35-55 mph zone) 48 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 11/06/2008 1471391 '1A Name: Owens, Theodore Wayne DL/ID: 854ZZ6223 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: oQ�F91Ci[0�P 4t IOWA tr; .trfy yiD. 0. T.;� 11",' all �e , Name: Owens, Theodore Wayne DL/ID: 854ZZ6223 3/5/2013 C4 Office of Driver Services Iowa Department of Transportation State of Iowa Division of Criminal Investigation 215E7'"St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal History Record Check Walk -In Request Your name �-.e W IyFk Address 57.2 77;910 WY a 1?L City/State/Zip YAre 5-2 2.2 d Phone# 9or- G4.t- q,95.O R PmiPMino an Tmun criminal histnry rrrnrd rhrrk nn' Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) �} w=ar -r-/ry�- 4vQ n Date of Birth Fecha Nacimienlo (mandatory) Gender Genero (mandatory) Social Security Number (recommended) /— /- / y,s.y Male ❑Female ql-:? / T — q6.2 Waiver Signature Firma (If the mqueessttiiss on yourself, please sign. If the request is on someone else, write N/A.) Results As of , a name and date of birth check revealed: ❑No record found lt, Record attached, DCI ff DCI initials Receipt 1 r� Number of requests \ x $15.00 per last name = Total amount $ 4 ✓ 'O� Method of payment: d2 a h ❑money order []check #. Cardholder's name DCI initials r ` OCIUSEON Y []MasterCard or Visa Last 4 digits of MC or Visa Credit Card Number # Exp. Date. IOWA CRIMINAL HISTORY DCI 00160864 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 6 DATE PRINTED - 2013/03/05 DCI:00160864 NAME: OWENS,TED OWENS,TEDDY OWENS,THEODORE OWENS,THEODORE W OWENS,THEODORE WAYNE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19540101 M W 504 175 HAZ BRO MED IA ADDITIONAL IDENTIFIERS MOLE NECK PROD L EAR SC ABDOM SC CHEST SC L ARM SC L WRIST SC LF ARM SC UL ARM CCH RECORD *** O1 ARRESTED 19671016 AGENCY: IA042015C ELDORA ITS FOR BOYS CHARGE NO- 01 ARREST DATA NOT RECEIVED TRK#: L04473001 COURT DISPOSITION AGENCY: COUNT NO- Ol DEL CHARGE CLASS: STATUS UNKNOWN TRK#: L04473001 SENTENCE ADJUDICATED DELINQUENT SENTENCE OF UNTIL 21 YRS OF AGE INDETERMINATE TO MAJORITY LENGTH CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS A 19671016 RECEIVED CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR B 19680310 PAROLED CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS C 19690218 PAROLE REVOKED CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR D 19690808 PAROLED CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS E 19700630 PAROLE REVOKED CUSTODY AGENCY: IA077025G FAMILY CHILD SVC BUR F 19710210 PAROLED CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS G 19710610 PAROLE REVOKED CUSTODY AGENCY: IA042015C ELDORA ITS FOR BOYS H 19710903 . DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 02 ARRESTED 19730504 AGENCY: IA0500100 NEWTON PD CHARGE NO- 01 IA STATUTE IA124-20 -3- MAKING BEER AVAILABLE TRK#: L04473101 COURT DISPOSITION AGENCY: IA050015J JASPER CO DIST COURT COUNT NO- 01 PUBLIC INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L04473101 SENTENCE FINE $100 03 ARRESTED 19790529 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA716-6 CRIM MISCH 4TH DEG TRK#: L04473201 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA716-6 CRIMINAL MISCHIEF 4TH DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L04473201 SENTENCE PLEAD GUILTY JAIL 04 ARRESTED 19810423 AGENCY: IA0610000 CHARGE NO- 01 THEFT 5TH TRK#: L04473301 COURT DISPOSITION 77 MADISON CO SO IA STATUTE IA714-1 DCI 00160864 PAGE 2 OF '6 DISP EFF DAT 19790529 19790529 DCI 00160864 PAGE 3 OF 6 AGENCY: IA061015J MADISON CO DIST COURT COUNT NO- 01 IA STATUTE IA714-1 -3-THEFT 5TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L04473301 SENTENCE DISP EFF DAT PLEAD GUILTY 29 DOLL COSTS 19510501 FINE $150 19810501 05 ARRESTED 19930408 AGENCY: IA0770400 URBANDALE PD CHARGE NO- 01 THEFT STH DEG TRK#: 000590701 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 THEFT 5TH DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 000590701 SENTENCE FINE $25 COURT COSTS PAY SURCHG 06 ARRESTED 19930910 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA714-2-3 THEFT 3RD DEGREE HABITUAL VIOLATOR TRK#: 009423501 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-3 THEFT 3RD DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 009423501 SENTENCE PLEAD GUILTY JAIL PROBATION SUSPENDED 07 ARRESTED 19941003 AGENCY: IA0770400 CHARGE NO- 01 THEFT -3RD DEGREE TRK#: 014853301 COURT DISPOSITION 70H COMM SERV WORK 28D 2Y 2Y URBANDALE PD IA STATUTE IA714-2-3 DISP EFF DAT 19930428 19930428 DISP EFF DAT 19931119 19931119 19931119 19931119 DCI 00160864 PAGE 4 OF 6 AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-3 THEFT 3RD DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014853301 SENTENCE DISP EFF DAT PLEAD GUILTY 70H COMM SERV WORK 19941116 COURT COSTS 19941116 PROBATION 2Y 19941116 SUSPENDED 2Y 19941116 08 ARRESTED 19950905 AGENCY: IA0770000 POLK CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIV LIC U/REVOCATION TRK#: 017687201 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA321-174 NO DRIVERS LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 017687201 SENTENCE DISP EFF DAT PLEAD GUILTY 19950908 JAIL 2D 19950908 09 ARRESTED 19960105 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION SCHEDULE II CONTROLLED SUBSTANCE TRK#: 024138301 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401(3)-2 POSSESSION CONTROLLED SUBSTANCE -MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024138301 SENTENCE DISP EFF DAT PLEAD GUILTY 19960423 COURT COSTS 19960423 PROBATION 2Y 19960423 SUSPENDED lY 19960423 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT ' COUNT NO- 02 IA STATUTE IA124-401(3)-1 POSSESS CONTROLLED SUB -NO VALID PRESCRIPTION CHARGE CLASS: MISDEMEANOR CONVICTION DCI 00160864 PAGE 5 OF 6 TRK#: 024138302 SENTENCE POLK CO DIST COURT DISP EFF DAT PLEAD GUILTY THEFT 3RD 19960423 COURT COSTS CHARGE CLASS: MISDEMEANOR CONVICTION 19960423 PROBATION 2Y SENTENCE 19960423 SUSPENDED lY 19960423 10 ARRESTED 19971123 19980728 PROBATION AGENCY: IA0770000 POLK CO SO SUSPENDED 60D CHARGE NO- 01 IA STATUTE IA124-401-3 POSS CONT SUBSTANCE POLK CO SO CHARGE NO- 01 TRK#: 036659201 DRIVING BARRED , COURT DISPOSITION TRK#: 044780801 AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401(5) POSS CONTR SUBS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 036659201 SENTENCE DISP EFF DAT PLEAD GUILTY LIC REVKD 180 DAYS 19980123 JAIL 30D 19980123 COURT COSTS _ 19980123 CREDIT W/TIME SERVED 19980123 11 ARRESTED 19980402 AGENCY: IA0770400 URBANDALE PD CHARGE NO- 01 IA STATUTE IA714-2-3 THEFT 3RD DEGREE TRK#: 037178301 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-3 THEFT 3RD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037178301 SENTENCE DISP EFF DAT PLEAD GUILTY 19980728 COURT COSTS 19980728 PROBATION lY 19980728 SUSPENDED 60D 19980728 12 ARRESTED 19981217 AGENCY: IA0770000 POLK CO SO CHARGE NO- 01 IA STATUTE IA321-561 DRIVING BARRED TRK#: 044780801 DCI 00160864 PAGE 6 OF 6 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE IA321-561 DRIVING WHILE BARRED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 044780801 SENTENCE DISP EFF DAT PLEAD GUILTY FOR 11 DAYS 19990106 JAIL 11D 19990106 COURT COSTS 19990106 PROBATION lY 19990106 SUSPENDED 19D 19990106 CREDIT W/TIME SERVED 19990106 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 � Y!/