The URL can be used to link to this page

Home My WebLink About14-113 Authorization Number (Office Use Only) �f=icz CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE 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 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name cp57- ii t` 2. Mailing Address Z �e L,-/i en 4i, S�,. �' ,Lt r R~_ �•'nS X, N 5"Z_ icy 3. Telephone: Home 34 = 3 i 3-242/ Other: 9 — 3g)7 —C 242 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ,VC' 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? •'; 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? • 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) clerkltaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license ntrmber . Q-,C.) I '2_,z-- U'q Le I . 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 Date , , • 7'y. 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 ci c_.1 C _ C o S-b.. L L o . On this / 6-}AA,. day of L�\n,u.--tdu aat of Io 3v- WENDY S.MAYER ( Notary Public and for the Staff of Iowa . Commtselon Number 7L 4[6 MY Com fission ExpaLik ires ow 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). i /f) r _ (// Siglt2ture oPoli ee hief 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. 1luet,� 4% • -„c/ _4-//5// ,/,/ Si naturof CityClerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2” (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 cler1 taxidrivbadgeapp2014.doc 03/2014 ,.lar. 25. 2014 10:50AM Div of Criminal Investigation No. 5815 P. 2/2 IOWA CRIMINAL HISTORY DCI 00167368 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2014/03/25 DCI:00167366 NAME: COCHRAN,JACK • COSTELLO,JACK , DOB SEX RAC HGT WGT EYE HAIR SKN POR 19420613 M W 601 195 RAZ BRO NED OK ADDITIONAL IDENTIFIERS MISS R FGR TAT LF ARM TAT RF ARM CCH RECORD +*+ • 01 ARRESTED 19691004 AGENCY: .IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 INTOX TRK#: L05412101 COURT DISPOSITION AGENCY: IA0570150. LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA123,46 CONSUMPTION / INTOXICATION - 1976 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L05412101 SENTENCE DISP- KKK' DAT FINE $26 7.9691010 02 ARRESTED 19020204 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 ' _ ASSAULT TRK#: L05412201 COURT DISPOSITION ' AGENCY: IA051015J LINN CO DIST COURT COUNT NO- 01 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION _ TRK#: L05412201 • • SENTENCE DISP EFF DAT PLEAD GUILTY 19820610 • FINE $100 19820610 COURT COSTS 19820610 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 0GERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORNAD2NISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD . COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION ivvw,�ovvadot,goy J Y NPTElt t SIMPLER ! CUSTOMER DRIVEPI.,-. -.== -r• : -. . z Office of Driver Services PO Box 9204 I Des Moirre3,LA 50306-9204 Phone:515-244-9124 1 80G-532412i fax:515-239-1837 writ) Certified Abstract of Driving Record Inquiry Date: 5/15/2014 DL/ID#: 8092Z6961 (IA) Customer#: 415986 Name: Costello,Jack Cochran Class: A ID Status: None Address: 280 WILSON AVE SW Audit#: 6854236 DL Status: VAL Issue Date: 04/11/2013 CDL Status: ELG City/State: CEDAR RAPIDS,IA Expiration 06/16/2015 CDL Cert Non-Excepted 524043678 Date: Status: Interstate Endorsements: NONE CDL Med Not Certified Status: Mailing Address: 280 WILSON AVE SW Restrictions: Left and Right Outside Restriction None Mirrors Supplement: Date of Birth: 6/16/1941 Mailing City/State: CEDAR RAPIDS, IA Sex: M 524043678 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name T Medical Examiner Last Name Alshouse Medical Examiner License Number _ _ 817 Medical Examiner Jurisdiction _ IA Medical Examiner Phone (319) 364-7730 Medical Certificate Issued Date 03/13/2013 Medical Certificate Expiration Date 03/14/2014 Date Added to CDLIS Driving Record 04/11/2013 CDL Downgrades Type Effective End ACD Issuing JUR Downgrade 05/13/2014 IA History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/06/2012 04/03/2012 Miscellaneous Buchanan IA Name: Costello, Jack Cochran DL/ID: 809ZZ6961 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