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Home My WebLink About13-032r , ® 4* 111 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name ��l ✓l/1 2. Mailing Address j 3. Telephone: Home Authorization Number / 3 - 3 Z APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 1 r Middle - `15-51 Other: 4. Prior experience in transportation of passengers: (Office Use Only) 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type qj offense Where When (� �e rr`eS7tG � GttG � I I � • �1�� 6. Have yo en Convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? u e Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's 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) clerWta drivbadg 09/2012 I hereby certify that I haveissued to m by the Iowa Department of Transportation a valid Chauffeur's license number J S I understand that if I falsely answer any questions in this application, that this application M# be'deni d. I understand th t 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 ti m ith all of the pr 6gions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) — l Signature of Applica Date +i#++##i*##*##**#***#*f **4#**Rf+*444*R4%RH%##1f#1f%f4fflHHHff%#fHH#ffH4Hifff4%#fHfff f #fflf#flHfHlffflfflHflfHflfHff f #iflf iff#ff lff STATE OF IOWA ) COUNTY OF JOHNSON ) cribed and sworn_ to before me by Q �f11 h S -f e 1 L '"'n e On this 2 Sf day of Ke,e EK TUTTLE— otary Public 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). Signatp e ofPolrfhief 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. Signatu?e 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 c1wM .imivbaaeeacc2oio.mo 09/2012 Iowa Department of Transportation Office of driver Services (Toll Free) ODO-532-1121 PO Box 9204, Des Manes, IA 5030&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/14/2013 DL/ID #: 775YY2579 (IA) Customer #: 5041372 Name: Bennett, Steven William Class: D ID Status: None Address: 1483 2ND ST Audit #: 5800063 DL Status: VAL Issue Date: 02/15/2012 CDL Status: None City/State: CORALVILLE, IA Expiration 06/03/2014 CDL Cert None 522411829 Date: Status: Endorsements: 3 - CDL Med None Status: Mailing Address: 1483 2ND ST Restrictions: Corrective Lenses Restriction None Date of Birth: 6/3/1976 Supplement: Mailing City/State: CORALVILLE, IA Sex: M 522411829 History Information CLEAR DRIVING RECORD Name: Bennett, Steven William DL/ID: 775YY2579 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: """•%'el"I 2/14/2013 IOWA ' -v C4 Q" D: 0. T.;*W°, ,�S 7f .fl� S`= Office of Driver Services ' Iowa Department of Transportation Name: Bennett, Steven William DL/ID: 775YY2579 02Fab.21_.20191EI1:26AM Div of Criminal Investigation No.4066 P. 5/10 + DCI IOWA 0005 STATE OF IOWA Criminal History Record Check ,p Request Form To. low@ V Woo ofCriminel Invo"lpfla BURM opentUou eares■,10 Floor zles,raan«f >bMolumlow. SWIP (s,sl t1UM (sls)no60f0 Fax I am ronuesline an Iowa Criminal Iifrtory Itecerd Me& ane DC[AcoountNumber. t{• 3K 0 Wot�a) Frog1 MA TOO V 5+wa+s or. 1,600, P( a Phsaec :131q 339' �:� Feet.. 911 351- it9' Lan Name t FlratName Middle N me � � �� ✓v f �� pi.hrl GJZ DafeofBllb nada. Gender(ow*w Swurity Number mmmM v✓ e. - DFem.rel%• 9o2 -0s- $ Watwrlr(/bnnation: WigooeaAllied WehWMOM 64lobjedof the RQ11M0empLfeertmlmdItUbryrsoordmay got be ra[sssable, per Code at Ivni Chapter ML Farms erf atssl hhtary record 4ratsudonp u slowed by taw, ohrsys hl a WAIVer'fifflotarli from I lowbiontortharsagat WahwMean; ibarberpamlalanfpre■abmemrmGfto!HWmbao� [OWNeatehckdwuhk>tAVaDiWbnof6mad rldandr.a Im rIvnim MO. Moln4"d0 IS maoapmaacyo `ayCl WalterS/gnalar, M ��. ... .saws ...anon � .cocoa u �aaGa:n iwoulaa (aCil�Ont�._ r.) Aa of 2L\ a search of the provided tutme and dere of blah revealed; ❑ No Iowa Criminal Hietory Record found with DCI Iowa Criminal HieWry RCrd ettac�DCI DCI initials. Received Time Feb, 8, 2013 8:07PM No. 4110 i Feb.21. 2013 11:26AM Div of Criminal Investigation IOWA CRIMINAL HISTORY COURT DISPOSITION PENDING STATUS UNKNOWN DCI 00499264 PAGE 1 OF 2 DATE PRINTED - 2013/02/21 DCI:00499264 NAME: BENNSTT,STSVE WILLIAM BENNETT,STEVEN WILLIAM DOB SEX RAC HGT WGT . EYE RAIR SKN POB 19760603 M W 511 100 BLU ELM IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y ....TAT.-L-SHLD-__.- CCR RECORD •'�• 01 ARRESTED 19950421 AGENCY; IA0520100 CORALVILLE PD CRARGE NO- 02 IA STATUTE IA155A.24 PRESCRIPTION.DRUG VIOLATION TRK#: 018246802 COURT DISPOSITION AGENCY: IA052D15J _ JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA155A.24 PH93CRIPTION DRUG VIOLATION (C.S.), 204.401(1B) - 1989 COURT CASE ID: 06521 FECR37975 CHARGE CLASS: NON CONVICTION TRK#: 018246002 RE6TITOTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19951025 PROBATION 365D 19951026 DISCRARGED FROM 20121024 DEFERRED JUDGEMENT 02 ARRESTED 20111226 No.4066 P. 6/10 AGENCY: 1AGS20100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA708.2A(2)(A) DOMESTIC ABUSE ASSAULT TRK#: IAOUDV202 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2)(A) DOMESTIC ABUSE A09AULT COURT CASE ID: 06521 SMSM088236 TRKN: 1AOODP202 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUOGEMENT 20120403 COURT COSTS $100 20120403 PROBATION lY 20120403 20130301 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF I ICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW E FORCEMENT AGENCIES BY THE DCI. Feb.21. 2013 11:26AM Div of Criminal Investigation .IN THE ABSENCE OF FINGERPRINTS FOR POSXTIVE IDENTIFICATION THIS RECORD IS BASEb ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SU)onCT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.4066 P. 7/10