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Home My WebLink About13-0141. Name –I L A 2. Mailing Address ) 2 3. Telephone: Home —/ P70ther: �;V yi a 4. Prior experience in transportation of passengers: <:;;- � V'S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? &16 Tvoe of offense Where When 6. Have you b e convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?� Tvae of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?PS Type of offense I Where r l When / 8. Has your driver's/ license or chauffeur's license been suspended or revoked in the last five years? TVDe 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) d�d9 09/2012 Authorization Number 1 � `) 9 r i (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday – Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 -- (319) 356-5497 FAX r 1. Name –I L A 2. Mailing Address ) 2 3. Telephone: Home —/ P70ther: �;V yi a 4. Prior experience in transportation of passengers: <:;;- � V'S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? &16 Tvoe of offense Where When 6. Have you b e convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?� Tvae of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years?PS Type of offense I Where r l When / 8. Has your driver's/ license or chauffeur's license been suspended or revoked in the last five years? TVDe 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) d�d9 09/2012 I herebyf� that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbers h, (59,�=% . I understand that if I falsely answer any questions in this application, that this application may be denied. I u derstand 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) 1 Signature of Applicant s O LA Date_D L 2 3 1 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cribed and sworn to before me by VI -00- r�, tad ((SCm On this day of 2-o 13 )<�_e (rY L L KEwE K. TUrnE _ Notary 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). Signatu of Polic ief or designee /-� V /s 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. '1% ?� 9� 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 /---�q �, -1-3 Date d« .i�wad�W2010a 0912012 Jan.23. 2013 12:17PM Div of Criminal Investigation ! Jan. 15. 2013 10:36AM City Clerk — City of Iowa City 0 RequestIs . To: XarvaXllvlsfohUCrimMalXnverHgAtfou Support Operations Aursau, 1"Noor 2Y5 E, �'� SfreoE bes nraes, rolva 50319 (513) 9z5•sg66 (515) 7�•b0B0 kiax X Ohl requosting aaTOWA Cr1n(h0(H1'9ory Record Chook V50,0 0 No.0666 P. 7/15 No. 3145 P. 2/2 DCI tl,000unEl�Tatnhar. C�Oda-- QFapp�tagb e) ]1•omr QTZK OF TOVA CITY CTTi„RXIS On -Tog. 410 X- Sli 6l1ON TRat$T -10VA OXTZ IOWA 5v hyo Phono} '079,45F_SnG7 _ Ml,c (1 z 7 � A 19P Vlvlwa�'nsr; V�'dtAoutasigxerlpvaryerfromlhesubjootofthnreghesp,geotnylotecYlrainAlhistoryreaokd'ntay»ot AieasabXe,parCode....,C[tapfer69z3.JPol•oynnlara•orinlfna7blstoryreoord]Arormatlott,assllowodt3jhv,Always Wniverl2elanse: fAcrebyglve partntre(onforrhoaboverequeslrayor4oipi/o wndaaaen fovea odmfnel Fhtory(ecordcftecCwtdinc�nla's1on0PComfnof rnresltderToa(ne), Any erlmMeltlalorydmsMdcomfngmolhatlarnalnmlacdtyIWll0impybarelemadasWowed bylgw, Wnfver5Yglad�rrel I�(�P1 fn l.�Sc^/t `�T t�JC�\ , aGWU uxxrxxxxx A =arory Xecor a;rlecxR OS41t5 • (o�jnra ugly) A3 0f_ I a3- L3 �, a search of thoproviderl name triad dace o�biaihso�ealed: • ", �-I tdo xowa G'x»MJnal 11,1storrykecord found WitiibCZ Q X0,00Cr1rainaIVatozyRecord attaohcd,)DCX# 1XI a Iowa Department of Transportation Office of Driver Services (Toil Free) BM -532-1121 %1;01 PO Box 9204, Des Moines, lA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/23/2013 DL/ID #: 769YY0847 (IA) Customer #: 4292416 Name: Allison, Kevan Michael Class: D ID Status: None Address: 519 Church St Audit #: 3925101 DL Status: VAL Issue Date: 12/04/2009 Expiration Date: 11/29/2014 Endorsements: 3 Restrictions: NONE Date of Birth: 11/29/1961 Sex: M City/State: Iowa City, IA 52245 Mailing Address: 519 Church St Mailing City/State: Iowa City, IA 52245 Convictions History Information Citation Date Conviction Date ACD Explanation County 7UR 01/16/2012 02/06/2012 Improper Registration 52 IA Name: Allison, Kevan Michael DL/ID: 769YY0847 Pursuant to Iowa Code 4321.10, 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: .......... /R9°4 1/23/2013 IOWA 0. CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 7UR 01/16/2012 02/06/2012 Improper Registration 52 IA Name: Allison, Kevan Michael DL/ID: 769YY0847 Pursuant to Iowa Code 4321.10, 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: .......... /R9°4 1/23/2013 IOWA 0. D. 0. 0.T. � � S`= Ra�'� Office of Driver Services Iowa Department of Transportation Name: Allison, Kevan Michael DL/ID: 769YY0847