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Home My WebLink About13-046CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number /5-44, APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) (Office Use Only) 1. First Middle Name XX)S;--1 Y-) c1G Last m 1�1 I S 2. Mailing Address �6))AwobA '101Vl �Chti L( SG 3. 4. Telephone: Home Prior experience in transportation of passengers: Other: a I G In 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? �O v Tvpeofoffense (r Where ((G [When CIGfir. 1 `1 j'Z�Lrt,C t� �P( Co R1 � L e Cn np,�n�A I I Scwc 11Zn )_002— -7 03 ? 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? vin Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When �c l -4-o orx S G 5 / 610 c.0, 5 /Z 71 Dr1 >e_Q P 8. Has your drivers license or chauffeur's license been suspende Tvoe of offense Where or revoked in the last five years? D 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) clerMA idriv adg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license ndtnbe� J12 x () i 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 A Signature of Applicant fl� ( �( Date 4}}f ##4##+}444#i}#4N+4+#4+####}i4ii4##44#Hf##f+#i4+4#4#+#H#+####44#H4##H}#44##4#H##Hf#4+#iffHHf#ffflR+f4Hf1f fRIfRHHR4RRM4Rf fHfRRRf STATE OF IOWA ) COUNTY OF JOHNSON ) I l u ribed and sworn to before me by J JL,tS 1 r\ �S On this 2�day of �b1--�) // TU �,, o ublic in and for the State of Iowa 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). A N! Signatur of Police Chief or designee .Z�� 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. '7�TaA"T� e . -ea"Ly Signature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Date ««+««+++++++#+}++++4++#++#+++++++++++x+#+##w+x+x+++##4+#++##xx##+++++f+++H+++4}++f+++««ffHRRfxR«Hwxwwxwxxx«wx««xxHxx«x«xxwxxxxwxHwwwxxxxxxx Office Use Only Approved application DCI report State certified driving record Website update der wi@ivb dgea,2010d 09/2012 N Iowa Department of Transportation Office of Driver Services (Toll Free) OM -532-1121 FO Bost 9204, Des Maines, IA 51130&92{)4 515-244-9124 FAX: 515-239-1837 Inquiry Date: 2/28/2013 Name: Hills, Dustin Adam Address: 1508 WASHINGTON ST City/State: MUSCATINE, IA 52761 Mailing Address: 1508 WASHINGTON ST Mailing City/State: MUSCATINE, IA 52761 Convictions Certified Abstract of Driving Record DL/ID #: 713XX0776 (IA) Class: D Audit #: 4808413 Issue Date: 11/09/2010 Expiration Date: 05/23/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 5/23/1979 Sex: M History Information Customer #: 3984225 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: iSpeed _.. Citation Date Conviction Date ACD Explanation County IUR 04/02/2008 .05/06/2008 -M14T to oa Obey Traffic Sign/Signal 152• IIA _.,. 04/23/2008 .06/02/2008 592 iSpeed _.. •• .. vm 5 IA 05/07/2009 .05/27/2009 {M 14 -Fail to Obey Traffic Sign/Signal iS2 IA Name: Hills, Dustin Adam DL/ID: 713XX0776 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 2/28/2013 IOWA *.to ).01 0.T.rr4 C44V e4oillir-=4 .11" r '••••' $_= Office of Driver Services p4a�� Iowa Department of Transportation Name: Hills, Dustin Adam DL/ID: 713XX0776 02JPeb_21. 2013811; :26 AM Div of Criminal Investigation No.4066 P. 9/10 4 DCI IOWA U007 ( '�D STATE OF IOWA � Criminal History Record Check Request Form To: lavra Wisloa of Ctla lbal lavattlaalloa SupportOpcmtt=a Bureau, le Floor 711 IL 76 street onldotaee,loaw 10719 (sfsl77s.coa6 (OIb) 72"ose. Fat I ntn rwumdlno an Inwa Cdrninal fllstnry A,rd Cheek nn., Lot Name r� •{F�.S�.. DO Account Number: µ t l\s u -S >1 11rLWkstic) ' Frotgt �ayC.s T�xl Gender ma,ano 4 Skevcws Qr.. owe , I iY 534 0 casae ,(31a 33p�a�y• nm8un. Wnbout &aimed waiver f vat the subject oral rqua t, a mmplNe criminal ebtery Mord mtyaot Faa:. - 319 551-W-11 t to 6= tke subject of the wL Lot Name OWN e ( ]Middle Name µ t l\s u -S >1 /' Ar'vv\ Date of Hirth LgMLsoW Gender ma,ano SoeM Seca NOmbor tEmeMieg ®Male chremale 4`iZ Is-g1Z3 nm8un. Wnbout &aimed waiver f vat the subject oral rqua t, a mmplNe criminal ebtery Mord mtyaot er Code of Iowa, Ckaptor 6971. For complete crfie WI hloory record toformadoo, a allowed byrerw, ahnyt t to 6= tke subject of the wL setibo on"mdnwno dw a�F6rryoortr Wmw relovtrAmWhYremdcb*wahtedvbsmarComlW FWjalyejr�'�X�e Aq'plPoorl Aimo,YdN�eaoanl�M MpQW4 1 YYLe reladuNaxed b�hw. Walmsignaturer—� h Io Matoa Record Check Reay ioc, enly> As of a e search of the provided name and date of birth revealed: n No Iowa Criminal History Record found with DO " Iowa Criminal History Record BMwhhA DCI a 6`1-a 13`4 IV DCI Inlllals 1� r .– Received Time Feb. B. 2013 B:07?M No, 4110 Feb.21. 2013 11:27AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00592134 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - DCI :00592139 2013/02/21 NAME: HILLS,DUSTIN ADAM DOB SEX RAC HGT WGT EYE HAIR SKN FOE 19790523 M W 511 210 GRN HRO MED IA ADDITIONAL IDENTIFIERS SC LP ARM SC R FGR CCH RECORD *- 01 ARRESTED 19990211 AGENCY: IA0150300 WEST BRANCH PD CHARGE NO- 01 IA STATUTE IA713-1 BURGLARY 3RD DEGREE TRK#: 034086201 CHARGE NO- 02 IA STATUTE IA714-1 THEFT 3RD DEGREE TRK#: 034086202 COURT DISPOSITION AGENCY: IA0160159 CEDAR CO DIST COURT COUNT NO- 01 TA STATUTE IA713-6A BURGLARY 3RD DEGREE TRK#; 014086201 RESTITUTION SENTENCE DISP EFF DAT PLEAD GUILTY 19990430 DEFERRED JUDGEMENT 19990430 COURT COSTS 19990430 PROBATION 2Y 19990430 COURT DISPOSITION AGENCY: IAD16015J CEDAR CO DIST COURT COUNT NO- 02 IA STATUTE IA714-2(3) THEFT 3RD DEGREE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 034056202 SENTENCE DISP EFF DAT PLEAD GUILTY 19990430 FINE $500 19990430 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAI ED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDEN ICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFO MENT 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 No.4066 P. 10/10