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Home My WebLink About14-151 Authorization Number t — S— _ j (Office Use Only) --tea ► IIIoirilikit ATP go 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 c`r �}J � vA � t- `S 2. Mailing Address \ � er \\N� „�� \ 1 b 3. Telephone: Home (--5 b 3 S 7 - (0'7 Other: 4. Prior experience in transportation of passengers: --, <3 i > S 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? i\) Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Ni c, Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? (,O 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 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2014 I here certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 6 L Z � . 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) Signature of Applicant f. ' s" C 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. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by �r Y � a v On this 4-1 _ day of k . Notary Publi�in and for the State of low 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� /� � � Signaltn'e of ",alic�'Chief or designee Dte 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. gym /7Z Signat e of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81//" (width)and 5 1/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2014.doc 03/2014 • 4 SMARTERowe dot gem l SfMPLER I CUSTOM&R.DRIVEN'". ,._- _.- _,_,. - -.4. Office of Driver Services SPO Box 9204.I.Des Moines,IA.503015-9204 Phone:515-244-S124[800-532-1121 i Fax.:515=2394837 wvlvt.iowadot;gov Certified Abstract of Driving Record Inquiry Date: 7/2/2014 DL/ID#: 839228198(IA) Customer#: 1185591 Name: Edwards,Larry Wayne Class: D ID Status: None Address: 1805 F AVE Audit#: 7589769 DL Status: VAL Issue Date: 12/06/2013 CDL Status: None City/State: MUSCATINE,IA 527618954 Expiration Date: 11/13/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1805 F AVE Restrictions: Corrective Lenses Restriction None Date of Birth: 11/13/1940 Supplement: Mailing City/State: MUSCATINE,IA 527618954 sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 3tIR 08/02/2011 10/07/2011 jM7o :Improper Passing Muscatine !IA Name:Edwards,Larry Wayne DL/ID:839ZZ8198 Pursuant to Iowa Code g321.1D,I,Kim Snook,Director of Office of Driver Services,Iowa Department of Transportation,do hereby certify that I an,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: i‘ti t Dal 0�.••••••,..y..l fl 7/2/2014 4' IOWAof�; 9$002, dr IIII et of Diver Srvics t aflidf.Rs IowaOfficeDeparrtme leaf Transportation Name:Edwards,Larry Wayne DL/ID:839ZZ8198 Jul. 30; 2014 2:44PM CDiv of Criminal Investigation. No 5963 P. 1/3 ,'-TOWN STATIE OF IOWA -=Qi>pd. 6, tial 1\ Criminal IIistu ry RecoiS Cheek 9 ' -c' klqr �� / Request Form : • PCI Account Number; oa_- F itappllcable) To; Iowa Division of Criminal Investigation From: City oflowa Clty ' Support Operations Bureau,I"moor City Clerk's Office 215 E.7th Street 410 B.Washington Street Des Moines,Iowa 50319 . (515)725.6066 Towa City, IA 52240 • (515)725-6080 Fax Phone: 319-356-5041 , . Far; 319 356-5497 I am requesting an Iowa Criminal Histol Record Cheek on: . Last Name(mandatory) ' First Name(mandatory) Middle Name(recommended) ' 1.00044-rd S La C rt3 LOci-, h e_ Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) • • I l / 13 1) 1+0 �1'Iale ®female 4-85 4-fo 12-) ' Waiver IY(forltullion:Without a signed waiver from the subject of the request,a complete criminal history record may not • be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record Information;as allowed by law,always • obtain a waiver signature from the subject of the request. . • . . • WitiVer Rerease:l hefcby glop pennies:on for Ilio abovo requrning official to conduct an lova criminal hhmry record cheek with the Division of Criminal Investigation(DCI). Any Nimble'history dole conocming mo iltet ks raelniohied by the DU may bc released as allowed 6y law. • - Waiver Signature: ,0,_aa.,, nA✓. Is \ .a.k.&\ Jo w; Criminal Ristory Record Oteck Results, _ctchseu;rly) ••. As of 1 '30 -/v a search of the provided name and date of birth revealed: 0 No Iowa Criminal History Record found with DC .. • 4 Iowa Criminal History Record attached,DCI# ,O2 4/6 o • )DClinitials � Received Time7Jun8.T2014 12:44PM No. 5712 • J91. 30. 2014 2 :44PM Div of Criminal Investigation No. 5963 P. 2/3 IOWA CRIMINAL HISTORY DCI 00202460 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED- 2014/07/30 DCI:00202460 NAME: BDWARDS,LARRY WAYNE DOB SEX RAC HOT WGT EYE HAIR SKN POB 19401113 M W 509 130 HIV ERO IA 19401114 ADDITIONAL IDENTIFIERS SC L EAR SC L EYE CCH RECORD *** 01 ARRESTED 19740920 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 • DRIVE U/SUSP TRK#: L09257701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 DRIVE U/SUSP CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L09257701 SENTENCE DISP EFF DAT FINE $200 19750120 02 ARRESTED 19761006 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 DRIVING UNDER INFLUENCE LIQUOR- TRK#: L09257001 CHARGE NO- 02 DRIVE U/SUSP TRIO: L09259002 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 DRIVING UNDER INFLUENCE LIQUOR • - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L09257001 SENTENCE DISP EFF DAT FINE - $300 19761021 COURT COSTS DL RVKD 120D 19?61021 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 DRIVE U/SUSP CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L09257802 SENTENCE DISP EFF DAT . Ju1. 30. 2014 2:44PM Div of Criminal Investigation No. 5963 P. 3/3 • • DCI 00202460 PAGE 2 OF 2 FINE $100 19761221 COURT COSTS 19761221 03 ARRESTED 19790814 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 OMVUI TRK#: L09257901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 ONVUI 3RD CHARGE CLASS: FELONY CONVICTXON TRK#: L09257901 SENTENCE DISP EFF DAT COURT COSTS 19000110 PROBATION 3Y 19000110 SUSPENDED 5Y 19800118 04 ARRESTED 19790907 AGENCY; IA0520000 JOHNSON CO SO CHARGE NO- 01 HABITUAL OFFBNDER-DWLUS TRK#: L09258001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 HABITUAL OFFENDER-DWLUS • CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L09250001 SENTENCE PROBATION 2Y SUSPENDED 2Y AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTXGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEMENT AGENCIES BY THE DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD XS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION (61?.)O