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Home My WebLink About13-0301 r ®4 -•..arm CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52 240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Address �Jt y / 3. Telephone: Home/ 4. Prior experience in transportation of passengers: Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Other: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AA Type of offense Where . L When /3 -30 (Office Use Only) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? /V 0 Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? G 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) derMn idn badg - 09/2012 I hereby M that ha e id to me by the Iowa Department of Transportation a valid Chauffeurs license number �� OA . 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) q 7— Signature of Applicantt� ll/ Date_�� STATE OF IOWA ) COUNTY OF JOHNSON ) Subs�ibed and sworn to before me by exp C,. r S�ra� On this S� day of �c r��.v.,, dolma. Kv a ublic in and fort the State of Iowa -713 I� +++++++++++++++++++++++++++++++++++e###4###*##*##**##fx###4Y###*f*f#*##*###4###4#Y4###44#44#########4##«#Y4«+#Y4#+++++++++++++++++++++++++++++++ 1 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). &-/I Signaty a of Po`y ief or designee 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. Sig re 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 - gl-13 Date dWWM*&MMd mo.doo 09/2012 Iowa Department of Transportation Office of Driyer Services (Tall Free) 800-532-1121 PO Box 9284, Des Maines, to 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/20/2013 DL/ID #: 435AA5012 (IA) Customer #: 224854 Name: Shrock, Steven Warner Class: D ID Status: None Address: 4487 490TH ST SE Audit #: 6581207 DL Status: VAL Issue Date: 01/02/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 01/17/2018 COL Cert None 522408288 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 4487 490TH ST SE Restrictions: NONE Restriction None Date of Birth: 1/17/1946 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522408288 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 02/17/2012 ,673587 IA Name: Shrock, Steven Warner DL/ID: 43SAA5012 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: ;••••••.: vV'v1 2/20/2013 IOWA :; D. 0.T c4VIV acen--=A yf '••••'•5� Office of Driver Services Iowa Department of Transportation Name: Shrock, Steven Warner DL/ID: 43SAA5012 Feb.20. 2013 4:51PM Div of Criminal Investigation No.4013 P. 1/3 Feb, 11. 2013 9:23AM City Clerk — City of lolva City No. 3213 P. 2 e `,�qifOrx'14UgVe, • T blmingfY,Watory Record Check i k\FyYh�'^�ting Request Yorm x'o: xo\YabivlsJoNpfCz+tnin9lXYNaSrlgdtrch " ' . SupporEOpeYatlon9a41au�,A'Ik�"fao>' 2X5E• 7+hSireet ll9�14SolOos,Iowq dH9f9 (91s) 7Z3 6066 (3�B)925-60H0 �afc CJieok on: DCTAccoua�A7um�ei,—7-Wa-•�� peeppri+a5rc> Vrom! V,3FTY Ow fOw,& ci= CZTX Cbmn's OBFTCA u.1n x zrAs�1'�GTd2AT s•C._ TOVA CT -TY 109A 5=f) 119x1 g7�Rti-K4n7 �ltdVef'.rf{fOlHla11017;}Yllthautasfgned�t�sYe1'lYomtfiosu6fcctaY.thereriztoaP q epmpJcf9oY((v(RAlhfstoYy r®9oxd:nnyno� b6yafoa9nbio,porCadoafX6ryp, Chapfor OM, Y+orcomu_letq'Orifi(nalJOB foxy recordinfox) nnflo11,asatlovis4 t3fIn,21(vgy9 --abf8lri atvoref uaWYOA' P1fha•6rtb oC�oY7lyprp gb9C; '— - ' - --- -' �(tjVBf+•�BrB(IJ'6; lflorcEyglva pumru(ere fardtaa6overaquasl[agoni'oiPl m conducl9nYowa crlminaJ hletdry[eroldofieok With lAaAllvlon pPCriminol Ynrasgflerlon(p�U-Mrar/mMaf>fsmlydaiacpacmfn nto+haUssnzrnwlnedgykon0[mgy6arorcasldO& 6y► WpryerSYgsladtdt'e; .. �� dope'?. eximill11 gto)r,vReemr� (6b)uroOhl � As oPZ. 1 ` aaeuct 6ithaprowldedname pizd date Q9bfx&,meaIed: -- No lbws Gk;ininalHistory2teeord kouud wlch J7Cx k _.:: �" YOM CaminabklisfOgReMdatcached,DCS# bCZiaaiflnls�� + r i 1. nn.1 .11 11 .1/11 - - Feb.20. 2013 4:51PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00186530 FELONY CONVICTION PAGE I OF 2 DATE PRINTED - 2013/02/20 DCI:00186530 NAME: SHROCK,STRVE SHROCX,STEVEN WARNER DOB SEX RAC MGT WGT EYE HAIR SKU POB 19460117 M W 508 180 GRN BRO MED IA ADDITIONAL IDENTIFIERS SC L CHK CCH RECORD *** 01 ARRESTED 19721124 AGENCY: XA0770000 POLK CO $O CHARGE No- 01 DANGEROUS DRUGS/POSSESSION OF CONTROLLED SUBSTANCE TRK#: L07373601 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 DANGEROUS DRUGS/ POSSESSION/CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L07373601 SENTENCE PLEAD GUILTY JAIL 1801) 02 ARRESTED 19740430 AGENCY; IA0070300 WATERLOO PD CHARGE NO- 01 IA STATUTE IA204-401 DANGEROUS DRUGS/POSSESSION/CONTROLLED SUB/INTENT TO DELIVER TRK#: L07373701 COURT DISPOSITION AGENCY: IA007015J BLACK HAWK CO DIST COURT COUNT NO- 01 POSSESSION/CONTROLLED SUBSTANCE WITH INTENT TO DELIVER CHARGE CLASS: FELONY CONVICTION TRK#: L07373701 SENTENCE DISP EFF DAT SUSPENDED PRISON 5Y 19751025 PROBATION 19751025 03 ARRESTED 19900722 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-12-2 ASSAULT/CAUSING INJURY/ DOMESTIC ABUSE TRK#: L07373801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA236-12-2 ASSAULT CAUSING INJURY No.4013 P, 2/3 Fe b. 20. 2013 4:51PM Div of Criminal Investigation DCI 00186530 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#! L07373801 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT PROBATION IY 19901212 SUSPENDED 30D 19901212 BATTERER'S $DU PROD 19901212 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 DCT, IN THE ABSEPtE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON IXTION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION No. 4013 P. 3/3