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Home My WebLink About18-037�► VIIItam," CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. t -- (Office Me Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application D 3. Contact Information (REQUIRED) Email: _ ) q I. V, Q-� ,� A �� u �IyCell Phone: O III 16�4G Ut �1 (All written communication tent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pai 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �,/ ? 5 Type of offense W here When What happened to the charge? (Circle one) Convicted Dismissed Deferre Suspended Plead Guilty Other Have you been arrested/ charged with any traffic offenses in the last five years? V 5 Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty he 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? \1Sd 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STARV"ED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICEF REWIEW_,p �;r� You must apply for an individual Department of Criminal Investigation Report (form ave upI on re est). rn 0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARR3 w y .. N 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Deparl7ent of Transportation valid Driver's license number �� \� 5 % (/ issued on , / t expiring on I understand that if I falsely answer an estions in this application, that this applica ion may be denied. 1 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 authorization to be a taxicab driver is granted, to comply at all times with all of the pr^ ^-Jyy�^II^�'ts"/�j//J pter 2, o the �ty C e. Needs to be signed in front of a Notary Public) Signature of Applican._ ��dG% Date VV V (f� 1111111'fHlfflHlftlffffflHlf!lllflfllf 1f11ff1ffflf!lllfHff4lf f1f hf lfllll11f1f1111N1f1f 111fflN1ff11ff ffflfft1f11111111ffHfY11ft111tlMfffM STATE OF IOWA ) COUNTY OF JOHNSON ) Subscriped and sworn to A. r-. 1 7ruPA before me by µi I;A�uaL �_ . S t:7g fQ &e,)4— on this y day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiratio date river' license // Signature o Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signal re of City Clerk o designee Date 1.!1111111R1f1..f411f.,1111N1ff11./ffiff4!!11!!11«flfl11f1iff.fl4#llflf 1f1.1f1f.1ffffYlflffHllf!!f lflf ff 1111111111!!!.1l11f1ffifl..1f41.I..11f Office Use Only N O_ Approved application o ::E,C-) W q DCI report , � State certified driving record c-)-< r Website update r- tI 'n M rn � = 0 �x w n N 0&*MA IDRN64DGEAPPL9201CenWnOetl.DDC 07/2018 inp I -t7• cv I II. J In111 VIv u v Intl ndl 1nveSllgdtlon NO, Ijbd V. 1 1 Mrom:Clly o1 10-6 C11y Clerk Orfl90 319 3665497 03/27/2018 13:24 0469 P.002/002 To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7"' Stredl Des Moines, Iowa 50319 (515)726.6066 (515)725.6090 Fax 1 am re nesting an Iowa Criminal F Last Name (mondetory) Date of I3i1'th (mandatory) Check DCI Account Number 4'902. (itaypticnblej From: City of Iowa City _4 City Cleric's Office 410 E. washintston Street �.._��. lows City, IA 52240 Phone: 319-356.5041 Psx; 319-356-5497 P MMale ❑Female I 4 �)//q dl� 40 rratver injorrttortonr Wilh tuI a signed waiver from the subjeel of the request, a complete criminal history record may not be releasable, per Code *flows, Chapter 692.2. For complete criminal history record fltforntstion, as allowed by law, always obtain a waiver signsturc from the subiect of the renuecl Waiver .Release: I hereby tive pen.ission for the ob?vue"stin�eial 10 conduct an Iowa criminal history record elmck sritli the Division oFCri,,innl L1vuligaliml (DCI). Myaimilul history data eon��/nf/ltfm llp(4 l>lj ioed -..."ie DQ may be released as allowed by law. Wnivu Sl_Pnarerrll s Iowa Criminal History Record Check Results 2 Q Q As "2_1 ' � u (t�iee only) of J a search of the provided nerve and date of birth revealed - � —3ao ❑ No Iowa Criminal Histot7, Record found with DCI C_.) � tv r - M M m Iowa Criminal History Record site hed, DCI # 5 2 i tiC � =rw 0 r DCI initials N DCI -77 (09/25/10) —� 0..,. �,,„A TIS,„ hl,. 17 1610 11. Ag oil il„ 4109 0 WI,; 1. L7. LVI0 11l 3Lnnl MY UI VIIIIIIIIdI IflVeSL16dltUll IOWA CRIMINAL HISTORY DCI 00521404 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2018/03/29 DCI:00521404 NAME: STEPANEK,MICHARL RAY STEPHANEK,MICHAEL RAY DOE SEX RAC MGT WGT EYE HAIR EKN POB 19750408 M W 602 140 BLU SRO MED IA ADDITIONAL IDENTIFIERS vo. 000 SUSPENDED 24D 19971023 O AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD D::q MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF C)-< IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY SE RELEASED TO NON -LAW ::Cn ENFORCEMENT AGENCIES BY THE DCI. �r rn IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD ISC3� BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD D COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION r. rn 0 CCH RECORD +w+ 01 ARRESTED/TAKEN INTO CUSTODY 19960409 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-3 FOSS BCH I TRK#• 024157501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSE BCH I MARIJ CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 024157501 SENTENCE DISP EPP DAT FINE $30D 19960731 02 ARRESTED/TAKEN INTO CUSTODY 19970920 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 FOSS BCH I TRK#: 037272401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401 FOSS BCH I MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037272401 SENTENCE DISP EFF DAT JAIL 6D 19971023 FINE $250 19971023 COURT COSTS PAY SURCHG; 073196-PROB 19971023 REVK'D: 14 DAYS JAIL PROBATION lY 19971023 vo. 000 SUSPENDED 24D 19971023 O AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD D::q MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF C)-< IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY SE RELEASED TO NON -LAW ::Cn ENFORCEMENT AGENCIES BY THE DCI. �r rn IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD ISC3� BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD D COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION r. rn 0 Pagel of 2 Clil WADOT Driver & Identification Service P.O. Box 9204, Des Moines, [A 50306-9204 Inquiry Date: Customer Name: Address: 3/27/2018 4198905 Certified Abstract of Driving Record DL/ID #: 606yy5716 (IA) CDL Permit Class: None Class: C Stepanek, Michael Ray Audit #: 1817719 2715 WAYNE AVE Issue Date: 05/17/2017 City/State: IOWA CITY, IA Convictions Expiration 04/08/2022 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 522402528 Mailing 2715 WAYNE AVE Address: None Mailing IOWA CIN, IA City/State: 522402528 Date of 4/8/1975 Birth: None Sex: M Convictions Expiration 04/08/2022 Date: Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County 02/07/2016 03/21/2016 S92 Speed IA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number D6/22/2014 IA 805008 Name: Stepanek, Michael Ray DL/ID: 606yy5716 (IA) N 0 Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department',„yf Tranawntation, do hereby certify that I am the custodian of the records held by the Driver & Identification Services, that thiS'�!p*rumWcl acr-rat copy of an official record currently in the custody of said office, and that I have been authorized by the Diretlic tI1E owa Dej4tment of Transportation to so certify. 7-< I �►• .-ln N I— In witness whereof, I have caused my signature and the seal of the Department to be set upon >iOdocumeOnt, at a4p ny, Iowa this date: CD �'j -� w n •• MENt^O[ ,q• w 7117MAIO