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Home My WebLink About13-015III cccccrz A,0O►�Il CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Address_ 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.) Middle Last '3-16 (Office Use Only) Other:_Z14_1)." sC "/_3) 00rIQ%ol 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 3n 6TA�' l "el,L70,%le 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? V _ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When Type of offense Where When 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? _ Zo d 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) ,A) d 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) dim dew g 09/2012 I hereby certify th t I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 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) / f Signature of Applican Date / �W STATE OF IOWA ) COUNTY OF JOHNSON ) Su"ed and sworn to before me by On this �7 Y� day of 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). gnatu of Police Chief or designee X15=/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. 6"/CLtGcG�r% 7� . 7��ry✓ Sig ture 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 /-mss-is Date aaama.ia vbaaeea WIOa 09/2012 Jan, 23. 2013 4:34PM Jan, 16, 2013 3:39PM Div of Criminal Investigation City Clerk - City of Iowa City To; XowaM031onOfCr1)-nJgpyXuva5dY9AtfM Support Oparattons payona, V-Vteor 2162, 914 Streot .b"xP1nc4,T01ya 50319 (file) lad ew (315) IM -6000 X dYe 0 No.2674 P. 2/3 No.3150 P. 2/2 { ACI P,.ccountNumhar; �� 1- ' Q epplkab e bkaw (,.w nA' TOGTA r1TjZ • CITY CTERK79 O ZI:cz 470E tYAAYtrnTryl'ON &TREY 'C T09A MTZ TWA 52$40 - h'axt '.L9-95fi—TG 47 Check on: - waive1 Wormailon,WithoutathesubjaeSofthorequat'?41camprefocyJhdnp(hfsforyrexordmnyliob iia Yelea9gbie, k er Carne oEXo}Vp, Chslptor69�,2 jEor corn'erlmtnaihistaxy recoYdJdCormptloq, gs eltpwed 6y lAvr, !t(Yrays J�stiveY.11el's(<Se; YnrcW9AffoA PO. AR 941 ver 'A etflnfnaJ 6lslory[ecordtherkvdYf,JAeDIDrsron 4fCrimfna( lejcelcd ptl IlrotYcd 6ylRtt: - r AOWii �AAIXIIXlJslIR751CUYYdeeL'Qt1), u�d1GCK eit3FlulLt3 NCJl000ntyj As of_��a 7J �� , a search dffio,prowlcw name And date of bil'tji-revea1cd; I1'o 75wa fowd WI&DCT u, Zo'a�nCrlminaTil'iatpryRecoXdattached,pGi#_ �� -t:_ =: - 1)Cila�itials�ll / Jan.23. 2013 4:35PM Div of Criminal Investigation No. 2614 P. 3/3 IOWA CRIMINAL HISTORY DCI 00916489 NON CONVICTION PAGE 1 OF I DATE PRI9TRD- DCI:00916489 2013/01/23 NAME: COLLINS,ANTHONY DOB SEX RAC NGT WGT EYE HAIR SRN POB 19721205 M B 605 260 BRO BLK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** O1 ARRESTED 20101130 AOENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK(): 1A0 0AOU01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSSORMS COURT CASE ID: 06521 SRCRO92689 CHARGE CLASS: NON CONVICTION TRK)(: 1A00AOU01 SENTENCE DISE EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20110330 PROBATION 1Y 20110330 UNSUPERVISED PROBATION TO DCS DISCHARGED FROM 20111110 DEFERRED JUDGEMENT AN ARREST WITHOUT D13POSITION 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 Iowa Department of Transportation Office of Driver Services (Toil Free) WO -532-1121 PO Box 9204, Des Moines,A 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/24/2013 DL/ID #: 28BAES480 (IA) Name: Collins, Anthony Class: D Address: 421 6TH AVE APT 3 Audit #: 2885769 Restriction None Issue Date: 01/02/2009 City/State: CORALVILLE, IA 522412325 Expiration Date: 12/05/2014 Endorsements: 3 Mailing Address: 421 6TH AVE APT 3 Restrictions: NONE Date of Birth: 12/5/1972 Mailing City/State: CORALVILLE, IA 522412325 Sex: M History Information Convictions Customer #: 5342369 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_ y County OUR 10/01/2011 _ 10/28/2011 -S92 ,Speed (10 mph & under in 35-55 mph zone) 52 IIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date _ Case Number _ 7UR 02/13/2009 494175 IA Name: Collins, Anthony DL/ID: 26BAE5480 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: +°""'•Z:1PA"' 1/24/2013 IOWA '? Ci .:Sr'). 0. T.....- . ...... ...... `Q---� Office of Driver Services �HIYtR„ Iowa Department partment of Transportation Name: Collins, Anthony DL/ID: 288AES480