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Home My WebLink About14-108 Authorization Number r 1 (Office Use Only) �IIIi 'ft WI SO ir 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 Las 1. Name �a � 2. Mailing Address 6211Q0L 1t 6(.('66 40 3. Telephone: Home ,31q - X30`—foo-t 5 Other: 4. Prior experience in transportation of passengers: tD 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ab Type of offense Where When 6. Have you bmonvicted 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 k76JD � � �Z7 Li f t7/ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /vC) 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) AYD 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 hereby ertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7 A- ! f 2`-D . I understand that if I falsely answer any questions in this application, that this A 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 do uments relating to this application, and I further agree that, if a license is granted, to comply at all times with all of th- ::%sions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date _44 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 ) bscribed and sworn to before me by �om Sc�oev,tJ �r ao t �r q e `r On this day of •tary Pu. is in and for the State of Iowa 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). ./144 Sign re of Palic7Chief 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. At �c k4'4, 5 �' -// Signat re of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width)and 5'/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerkttaxidrivbadgeapp2014.doc 03/2014 c3tA DOT • SMARTER I SIMPLER I CUSTOMER DRIVEN www•lawadogov Office of Driver Services PO Box 9204 I Des Moines,FA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1831 www_iowadotgov Certified Abstract of Driving Record Inquiry Date: 5/2/2014 DL/ID it: 075AA1185 (IA) Customer#: 2545540 Name: Schoenberger, Roman Tim Class: D ID Status: None Address: 2100 S SCOTT BLVD TRLR Audit ft: 4398269 DL Status: VAL 40 Issue Date: 06/02/2010 CDL Status: None City/State: IOWA CITY,IA 522403032 Expiration Date: 05/11/2015 CDL Cert Status: None i Endorsements: 3 CDL Med Status: None • Mailing Address: 2100 S SCOTT BLVD TRLR Restrictions: NONE Restriction None i 40 Date of Birth: 5/11/1949 Supplement: Mailing City/State: IOWA CITY, IA 522403032 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County RIR 04/17/2010 05/03/2010 592 Speed Johnson 'IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR- _ 10/06/2009 - �- 531782 _ 'IA Name: Schoenberger, Roman Tim DL/ID: 075AA1185 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 4"" do .= e... /4 \ 5/2/2014 5a: eck et %FA,.D. O.T. ickli ciren2 eetioick 4L. B" Ne Office of Driver Services Iowa Departmentof Transportation Name: Schoenberger, Roman Tim DL/ID: 075AA1185 g. May, 7. 2014 4: 11PM Div, of Criminal Investigation K . 7889 P. 1/4 • v.v. L; zui't 9 ; )/1Y1 6i Ly t.; tra - b . Ly ui 'iiuwe i,i t>• AU. '-uMu � . nit ,• • y1brf/y • 1 1 t 1a STATIC O IOWA 'D"�`,r • , r . CkiddrAn>r 1 IEIICnstorry Recen°a� Check n�" . •:t; ' DCI Account Number: <-(Do r3-r (Ifappllcable To: Iowa Division of Criminal tnvost)gallon grow City of Iowa City Support Operationslaureau,141 Floor City Clerk's Office In 410 Y';.Washin ion Street' - . - 215 b;-9 rpt t— g— Des Moines,Yowa 00319 (515)725.6066 • Iowa City, IA 52240 • (515)725-6000 Fax Phone: 319356-5041 • Fax; 3193563497 ' I am requestinj an Iowa Criminal History Record Check on: Last Name(mandatory) _ 'First Name(mandatory) Middle Name(recommended) Date Of irtf(maanddatory) Gender(mandatory) Social Security Number(recommended) II r %ale D 'ernaIe 12%- (k0 %9O ' l •r c Wrtiv Pitt/tinge/ow Without a signed waiver from thdsubJect of the request,a complete criminal history record may hot ._ hare]easabierpenf ultatIovvn,_Chapte.i_692.2._Eor_comp)ataniminal htrttnit;y.flearnJnformatinn,ea allosvedhyJaw,.always__ obtain a waiver signature from the subject of the request.. Waiver Release:I:Indy give permission forth&obeys regllssriny al to conduct an Iowa criminalhistosymord cheek wit cBivifionofCriminal rntwtigellon(DCI). Any ulminolhistory data concerning m&that ..? UlncdbylhoACCmsyberclmscda WaiverSignatrrfe: / 1 1 — • i • Iowa Criminal'Blistery Record Check esiul>t0 •jDCIuseoyy) As of 5 7-Iy , a search of the provided name and date of birth revealed; ® No Iowa Criminal History Record found with ACI :-,. - no Er Iowa Criminal History Record attached,DCI ti L3 190(a nor:..:tin1nt.A) a ' Received Time May. 2. 2014 -4: 35PM3No. 7392 • May. 7. 2014 4: 11PM Div of Criminal Investigation No, 7889 P. 2/4 • - . IOWA CRIMINAL HISTORY DCI 00431906 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2014/05/07 DCI:00431906 NAME: SCHOENBBRGER,ROMAN TIM SCHOENBERGER,TIM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19490511 M W 601 190 BRO BRO NY ADDITIONAL IDENTIFIERS SC R THGH CCH RECORD vrr 01 ARRESTED 19920105 AGENCY: IAOB50000 STORY CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRKft: L41122601 COURT DISPOSITION AGENCY: IA085015J STORY CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRKN: L41122601 SENTENCE DISP EFF DAT JAIL 2D 19920318 FINE $500 19920318 COURT COSTS 19920318 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP CRIMINAL INVESTIGATION, BUREAU OP 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 THE SUBJECT OF YOUR ,INQUIRY. DIVISION OF CRIMINAL INVESTIGATION