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Home My WebLink About14-116 Authorization Number_ �/ r 1 (Office Use Only) UZI772%; Mig AMMO II 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 Fest Middle Last 1. Name Cay giA14;g_�1. �� 2. Mailing Address . rJ . r: A, �,0 3. Telephone: Home 3 l ! - Other: 4. Prior experience in transportation of passengers: Sj c 6.r v` .L (-)1 ^Cv 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? LI Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? (it t , Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? LACY h 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) (/\ v 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/laxidrivbadg 03/2014 , I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number CI 5 ct 7._:2_ --1 t1 —7 . 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 ,6-• tit,, ,,-----,' Date (q - 151 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. k******************************************************AA*AAk*********************************************************************************** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed�` and sworn to before me by J t✓ -_«, t A. 15,--ba . On this )Q }2,L day of IVA t 4-01 I t:(r) Ls. pC <_,I (1 � t � � .,►04, WENDY S.MAYER Notary Public in ar ,i for e State opowa`,- commissiorndumb.,P 942 • My Commission Expires =I/ --1 -) '1 —) LP ************************************************************************************************************************************************ 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). Signa re of P.rcelhief 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. Signatu'e of City Clerk or designee Date Taxi cab businesses are row(' to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displ ed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Uef1v axidrivbadgeapp2014.doc 03/2014 • Iowa Department of Transportation iirtiN Office of Omer Services (Toll Free)800-532.1121 PO Box U204,Des Memos,IA 50306-9204 515-244-9124 FAX:515.239.1837 Certified Abstract of Driving Record Inquiry Date: 5/5/2014 DL/ID#: 959ZZ3747 (IA) Customer#: 3363878 Name: Ulstad,Jeffrey Alan Class: D ID Status: None Address: 1131 3RD AVE APT Audit if: 7274554 DL Status: VAL 48 Issue Date: 08/23/2013 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 09/23/2018 CDL Cert Status: None 522402013 Endorsements: 3 CDL Med Status: None Mailing Address: PO BOX 810 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 9/23/1954 Mailing IOWA CITY, IA Sex: M City/State: 522440810 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/14/2010 549670 IA Name:Ulstad,Jeffrey Alan DL/ID: 959ZZ3747 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: —a ilasiANr 5/5/2014 IOWA` * cloKinip g e t, .h o Office of Driver Services mffiemax Iowa Department of Transporation May. 8. 2014 9:50AM Div of Criminal Investigation • OS/.:. /2014 10:15fal low C b of Iola Cit; No, 9522 P. I 5, s '. (Fax)31�33o47uJ N.u02/p02 , .. • STATE OF IOWA '"" aa' ' �� ' Criminal Histo Record Check �_: town t;:,y i, • History '�• A ,.: Request Form • �, , .....r: • , �•rm DCX Account Number: 9967-F (If applicable) Tot Iowa Division of Criminal Inveitlgatlon Prom: Yellow Cab oflowa City Support Operations Bureau,I"Floor P.O.Box 428 ' 215E.7'h Street • Des Moines,Iowa 50310 • Iowa City,IA. 52244 (515)725.6066 (515)725.6060t Fo• 338-9777 , __ • Phone: • • Faxi (319)3394302 • I urn requesting an Iowa Criminal history Record Check on: • Last Name(mandelory) First Name(mandatory) • Middle Name(rceommcnded) ' ILL 1S -4-'ad •, c-Q-C, c.. 1 ,1, vti Date of Birth(mandatory) Gender(mendarory) , Social Security Number(recommended) / -- _ • C -. IYJMaIe °Female \._ i ._ a Waiver Information,Without a signed waiver from the subject of the request;o complete criminal history reeord'may not ho releasable,per Code of Iowa.Chapter 692.2.For complete criminal hlitoryrecord Information,as allowed by law,always obtain a waiver signature from the au bleat of the request. . Waiver Release:I heroby give permlasjon far Ike above regneStina of(foial to conduct an lows criminal history record check with the Dlvlclen Of Criminal !mitigation(DCI). My etlmfnal hinny dam conceminty tna duet is maintained by the Da may bo calmed as allowed by law, , ' Iowa Criminal History Record Check Results (Dctacaonly) As of 5"8-N. , a search of the provided name and date of birth revealed: _ 3 `' ❑ No.Iowa Criminal History Record found with DCI —, len J1 It Iowa Criminal History Raoord attached,DCI if 5(11 foo '7‘''.:>" N 'r DCI Initials .f w DCI.77(08125/10) • • 0... ;..A t:M. II,.. g 1111/. ,n•IIRoM tie 7417 • May. 8. 2014 9:50AM Div of Criminal Investigation No. 9522 P. 2 IOWA CRIMINAL HISTORY DCI 00517960 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- DCI:00517960 2019/05/08 NAME: ULSTAD,JEFF ULSTAD,JEFFREY ALAN DOB SEX RAC HGT WGT EYE HAIR SKN POB 19540923 M W 603 210 BLU GRY FAR IA ADDITIONAL IDENTIFIERS SC R KNEE CCH RECORD •** 01 ARRESTED 19960220 AGENCY: XA0520200 IOWA CITY PD CHARGE NO- 01 _ IA STATUTE IA708-1 ASSAULT CAUSING INJURY TRK#: 022590301 COURT DISPOSITION . AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-1 ASSAULT CHARGE CLASS: NON CONVICTION TRIO: 022590301 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960815 DISCHARGED FROM 19970506 DEFERRED JUDGEMENT 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 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS TEE SUBJECT OF YOUR INQUIRY. ` DIVISION OF CRIMINAL INVESTIGATION N