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Home My WebLink About14-103 Authorization Number I g- I (i 3 � - 1 (Office Use Only) ;=.2.....;. 4:11111 43;tali ,141 fmr�1l 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 1. Name <---./. -✓� V" vy( 4.-oellit- 2. Mailing Address ("f/3 ,02/1 S (* -L(V, ! 1e ...1----<- e , X( / 3. Telephone: Home Other: .31 3,25-• c7-5—S-y 4. Prior experience in transportation of passengers: /0 `!-e,--15 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? e. Type of offense Where When frr 6 I_ (". t .=. U/i 6. Have you I)er}convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? f UU T .e of Offense Where When - p _- 7. Have you been convicted of any traffic offenses in the last five years? ?(Y T e of offense Where / When (--.?" tj , ( ,71,i L/ / (, 'IT 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A.,10 Type of offense Where When 9. Have you ever applied to be an Iowa Cityta�ci fiver using a different name? If yes, please provide the name(s) A. 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) clerkttaxidrivbadg 03/2014 hereby c ifj_that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7 y y - 77 . 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 an• ocuments relating to this application, and I further agree that, if a license is granted, to comply at all time with all of the p •v' ions of Title Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) . � I Signature of Applicant Date CI 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 ) ubscrib d and sworn to before me by S t . S.Q 1A \-Qt. On this 9 5 E day of ./-1") D) 1-1 . I mil �t � ( WENDY S.MAYER Notary Public in -1d for the State oVlowa Commission Number/29425 My Co mis Expires ow ** * iso *********** 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). 1 Its Signature of Poli Chief or designee �� c / es gnee 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:?-/-42_5t/p7/ Signature of City Clerk or designee Dae Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/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 derk/taxidrivbadgeapp2014.doc 03/2014 c A ■ i U -, r-4,i '4,•' 0 lAiww.iowa diptgay SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 92041 Des Moines,IA 56306-9204 Phone:515-244-9124[800-532-1121 I Fax 515-2391837 www.[owadot.gov Certified Abstract of Driving Record Inquiry Date: 4/23/2014 DL/ID#: 775YY2579 (IA) Customer#: 5041372 Name: Bennett, Steven William Class: D ID Status: None Address: 1483 2ND ST Audit#: 5800063 DL Status: VAL Issue Date: 02/15/2012 CDL Status: None City/State: CORALVILLE, IA 522411829 Expiration Date: 06/03/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1483 2ND ST Restrictions: Corrective Lenses Restriction None Date of Birth: 6/3/1976 Supplement: Mailing City/State: CORALVILLE,IA 522411829 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/13/2013 ,04/08/2013 (S93 Speed Johnson IA , Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/13/2013 1730226 IA Name: Bennett,Steven William DL/ID: 775YY2579 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: li to >� C 214 .. 44 4/23/2014 P IOWA tr1, ,. 1,,,,‘D. O.T.. ,,lf,• _ A,e""• SsSs Office of Driver Services �r �R C- Iowa Department of Transportation Name: Bennett, Steven William DL/ID: 775YY2579 og,Feb. 21. 2014a 2:41PM Div of Criminal Investigation -, pc/ Io)No. 3541 P._2/4 3 Jr `al y y STATE OF IOWA ,;;,r:;,•.„•, •'''• -. Criminal History Record Check '` Request Form r. DC1 Account Number: 1385—PC- (if • Tot Iowa DlvblonofCriminallovestlgatlou Item: MAresT9I - Support Operalion,Bureau,l^Floor , 21SL7aStrad! kip Dr• Des Was,Iown SOUP • /� A, (515)7ZS6066. 01.)A 1.ki, /1 S at{o (515)725.6880 ray • Phone: (3110 338-bilq. Fun,- (319) 551-8?19 • I am requesting an Iowa Criminal Nieto Record Chink oni - LnsI Mame(undelo.y) FirstName imams) Middle Name(reaa.wleed) it'llil et / Date of Birth(oundamy) Gender pasn ) ,SoeM SecuritylNumber(r000mmattod) Jv/i t 3 i-L 76 _Male OFemale i-tD O`V R- 05-05 WaiverInjnnmuilo4:Without a tinned waiver from the sublets of the request,a wmplete criminal binary retard may nor be releasable,per Code of Iowa,Chapter 692.2,For midi,er(minel hbtory retold Ioformatloa,se allowed by law,always obtain a waiver signature from the subject of the retlua4 • Wafter Release:ItWsIvtpmlU1on agvetequetle cid to unmlova cdtlhinoymold chock nit deeDlvbloeofcdrSl Investigation(OM.Any Stasi hWuyd.n ere ebetlr laid by Del my bored o allowed by law, -- :- Waiver Signature.- –161411 -- . - -. - i lowa Criminal History Record Check Results (DCI meanly) • �1 L\ . As of ' ,a search of the provided name and date of birth revealed: 0 No Iowa Criminal History Record found with DCI —c' sr 4()K2-, < ) IL n< try7r \,,E1--- Iowa Criminal History Record attached,MI N rn C° ” -4r l Cr)it v=' --o ti —11 DCI initials • `> OCI-77(08/25/10) I=T A r _ Received Time Feb, 19. 2014 1: 10PM No. 9872 Feb. 21. 2014 2:41PM Div of Criminal Investigation No. 3541 P. 3/4 IOWA CRIMINAL HISTORY DCI 00499264 NON CONVICTION PAGE 1 OF 2 DATE PRINTED- 2014/02/21 DC1:004,1264 NAME: BENNETT,STEVE WILLIAM BENNETT,STEVEN WILLIAM DOB SEX RAC HGT WGT BYE HAIR SRN POE 19760603 M W 511 180 BLU BLN IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD CCH RECORD *** 01 ARRESTED 19950421 • AGENCY: IA0520100 CORALVXLLE PD CHARGE NO- 02 IA STATUTE IA155A.24 PRESCRIPTION DRUG VIOLATION TRKO: 018246802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA155A.24 PRESC. DRUG VIOL (C.S,), 204,401(16) - 1909 COURT CASE ID: 06521 FECR37975 CHARGE CLASS: NON CONVICTION TRU: 016246802 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19951026 PROBATION 365D 19951026 DISCHARGED FROM 20121024 DEFERRED JUDGEMENT 02 ARRESTED 20111226 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA706.2A(2) (A) DOMESTIC ABUSE ASSAULT ' TRK#: 1A00DF202 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA70B.2A(2) (A) DOMESTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSMO88236 • CHARGE CLASS: NON CONVICTION TRKI: 1Ao0DP202 RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20120403 COURT COSTS $100 20120403 PROBATION 1Y 20120403 20130101 DISCHARGED FROM 20130214 DEFERRED JUDGEMENT Feb. 21. 2014 2:41PM Div of Criminal Investigation No. 3541 P. 4/4 Dcx 00499264 PAGE 2 OF 2 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP 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 OP 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 . . Feb. 21. 2014 2:41PM Div of Criminal Investigation No. 3541 P. 4/4 DCX 00499264 PAGE 2 OF 2 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 THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION