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Home My WebLink About14-177 , Authorization Number/ -1 1 � - 1 (Office Use Only) ,r-mtil IMIP•.:.®aft, i .:111111` N APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name tt c,/r/ loc{i'.0 l)Ow,vr `- 2. Mailing Address P a 130v ea 4fi/,,..L,to a 1:7vw.4 5-',1:-)..) d 3. Telephone: Home Other: Y06- .2)'/ - 3 cc-6 4. Prior experience in transportation of passengers: /1/Cl 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?yt,( Type of offense Where When /Doh^i sL:C M T o2 O f" ye,47I 13 U( .7-77- 7f we-s- 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? l'- 9 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ,.7''i,J Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? yam. ./ 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) iVO DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW -f apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) V" 0 N M O 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 51D- YY . 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) l Signature of Applicant — Date (Y/ A 1/ YOU ARE NOT VALID TO DRI E 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. STATE OF IOWA COUNTY OF JOHNSON ) gbscribed and sworn to before me by \\\<\-1'r L • sK)o�;; e. Y. . On this 2- 'k, day of <s) a�tIA . • No - -• Pu•lic in and for the State o lUwa 13�y� 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). F/t7t,i/L/ Signa re olice Chief 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. e .14fA F/02...2_ 9z Signa ure of City Clerk or designee to Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2"(width)and 5'/z" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update cler Wtaxidrivbadgeapp2014.doc , ----,46. .18. 2414 12:49PM (Div of Criminal Investigation NNo, 7633 P ). 3/4 • aairon STATE OF KOWA i„! t. .ni , � r ' -',',- Criminal Histor� ,;ecoid Check n� I Si , _�� kk /foRequest Form 111 -:1it nw, \ • I)CI Account Number: 9(7t7,•-� • Of applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City . • Support Operations Bureau,1”Floor City Clerk's Office 215 E.71k Street 410 S.Washington Street ' Des Moines,Iowa 50319 (515)125.6066 Iowa Clty) IA, 52240 • (515)725-6000 Fax . Phone: 319456-5041 • Fax 319.356-5497 I ant requesting an Iowa 0:1111111A1 TTietnizRncnrd Check oil: leastNAM& (mondetoiy) First Name(mends(my) _ Middle Name(recommended) Akar 0OWrty i-lAvey . 1 . Date of Birth (maMatoy) Gender(mandmory) Social Security Number(recommended) • 7/r;_7/1 37J) iMaie DBemale 911/'Pg^5 0i J Waiverlit/ormalion.Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Towa, Chapter 692.2.For complete criminal history record information,n allowed by law,always . obtain a waiver signature from the subject of the request, • Walper Release;I hereby give permission for the ab ova rcquesiing oftlold to conduct an Iowa criminal history retard check with the Division°Miltinal Investigation Mu). Any criminal history data&onccominngg�mee/t`hat is/, v 4 by the=Camay be released as allowed by law. Wa!ver,SYgnature:�'b' A "Y . . t�t�h�rA y l/V l 1R--- • Iowa Criminal History Record Check Results (DGtuteanry> As of g-(8—( , a search of the provided name and date of birth revealed: 0 No Iowa Criminal History Record found with DCT • 011e Iowa Criminal History Record attached,DCT# V DCT initials aCP • • nri_77 rotsl2.54o1 Received Time Aug. 13. 2014 10:50AM No. 6911 _, POug. 18. 2014 12:49PM Div of Criminal Investigation No. 7633 P. 4/4 IOWA CRIMINAL HISTORY DCI 00580918 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2014/08/18 DCI:00500918 NAME: DOWNEY,HARRY LOUTS DOB SEX RAC HGT WGT EYE HAIR SRN POB 19680727 M W 509 150 GRN BRO MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19980814 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESSION OF MARIJUANA TRK8: 034066601 COURT DISPOSITION AGENCY: IA01G015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-5 POSSESSION OF MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 034066601 SENTENCE DISP EFF DAT PLEAD GUILTS! SUBS ABUSE EVAL; DL REVOKED 19980814 180D FINE $500 19980814 COURT COSTS 19980814 PROBATION 1Y 19980814 SUSPENDED 30D 19980814 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 DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE •IDENTIFICATION THIS RECORD IS EASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, 1� DIVISION OF CRIMINAL INVESTIGATION�-p r vim V Yvv v iu adotl.gov SMARTER l SIM P!fF I CUSTOMF_P, DRIVEN Office of Oriver Services PO Box 9204 l Des Moines,iA 503055-9204 Phone:515-244-9124 1800-532-1121 I Fax:5155-239-1837 ve w iowadotgov Certified Abstract of Driving Record Inquiry Date: 8/13/2014 DL/ID It: 432Yy4298 (IA) Customer It: 4131512 Name: Downey, Harry Louis Class: A ID Status: EXP Address: 214 RAILROAD ST Audit if: 8347507 DL Status: VAL Issue Date: 08/12/2014 CDL Status: VAL City/State: ATALISSA,IA 527207746 Expiration Date: 07/27/2022 CDL Cert Status: Non-Excepted Interstate Endorsements: NT CDL Med Status: Certified Mailing Address: PO BOX 82 Restrictions: NONE Restriction None Date of Birth: 7/27/1968 Supplement: Mailing City/State: ATALISSA,IA 527200082 Sex: M CDL Medical Examiner's Certificate Certificate Specifics Explanations 5 _ .. Medical Examiner First Name Edward _ 5555 5555 ... ...__�._..._................__ Medical Examiner Middle Name �L _555,5_ .. 5555 Medical Examiner Last Name Quick 55_5_5 ... _.___.._..._ ..._ ...._.__.._� Medical Examiner License Number 4519 _..._..._. . __._...... Medical Examiner Jurisdiction „ MT _._ _...�_.._. .. .__. . _.T Medical Examiner Phone (406)728-6559 Medical Certificate Issued Date :12/16/2013 5555._ . . . e Medical Certificate Expiration Date .12/16/2015 _...__ ...... .... ... _..___. .._ Date Added to CDLIS Driving Record 08/12/2014 History Information CLEAR DRIVING RECORD Name: Downey, Harry Louis DL/ID:432YY4298 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: elielf 57-4%. .4....... § 8/13/2014 f ; IOWA Olt kvi ,r tD. O.T. 1i�f04091'uEt+��a\� Office ofreof Services Transportation Iowa Department Name: Downey, Harry Louis DL/ID:432YY4298