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Home My WebLink About14-090 Authorization Number ) 4— 90 r 1 (Office Use Only) .:III MlwIliaAr 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 La§t 3> 31°--/S /� � 9 1. Name 1 ,fit' ^ �M 1 /1 �-VI 1� S 2. Mailing Address 0 N �' S- • A)L 3. Telephone: Home 3\ 6 1 5 ) Other: 4. Prior experience in transportation of passengers: Cc h cA,r 3 C--It2-DO—J—Z. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? .) S Type of offense Where When 1 �I-e�� 1A-5 -1 �' 00 cs\r 2_66 4-05024002w, L1 I reC 744-+ Ups Ce) C ) C 9 9 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? S Type of offense Where When wr 3 (,,., CIA- 7 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? \"C.) 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) derk/taxidrivbadg 0 3/2 014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number —I 1 ; X X C. 7 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 o - 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public),,___ i /- / • Signature of Applicant r Date - P - ��'( 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. *********.*<;..************************x, ,k*********************************************************************************,.*,:**************** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1T \,Lfi 4 „v fk f-}; 1 1 5 . On this q-t,),� day of q to wENDY S.MAYER ll}}� 5 &.-4-0- -t- __ Notary Public f�1 and for the Staff of a z Commisslon.ss Ices ,t My Comm scion P 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). ,,A/------ SiSignature of Police Chief or designee //� 9 9 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. /),*?* -.7.,.3 T. �l-L t Lt/l Signature of City Clerk 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 clerk/taxidnvbadgeapp2074.doc 03/2014 1 /Apr• 7. 2014 2:24PM Div of Criminal Investigation -, DCT Ioll'�No. 4351 P. I/30o3 • O4l6-,/LVLY LV•JJ t:11\ `'• (if 1 Iy1-1 / 1 1 t . 1 1_ • t ' STATE OF IOWA /' ti Criminal History Record Check " "° Request Form r - DCI Account Nomber. 11365 (ihpckallo) To: Iowa Division of CriminalInverilgation From:. Mil lrfa 5-0.X1 .._ Support Operations Durnu,I"Floor 5ke,�,wy C)r.215 E.7°Street 1 r Q Ied,lowa,50319 _ • _ - - OUr.l_t. , Sa-yy_O_ .. _ _ (515)7256065 (51S)7254080 Fax • Phoaet L3w 338- 3.1111.Faxi• . o31i 561-8;99 I am requesting an Iowa Criminal Hide Recent Check one - , Middle Name(r:a aroMed) asstNameJmweorm First Name(nwe.wn) - • HMS -bus^h- h - R6.4.v" Date of Birth/ (1awd.by) Genderer(m.rd) demmi Social Security Number eaeouurcade ( 5 23 / -] 1 U'Male Cremate • tri S ')5-- V Z3 • al history record may ' eInr code oIowa,fIoChapter �Far oomnt k criminal historylocompleteect of the rogues;a ory record onustion,nu allowed by law,ilwryet breleasable, the obtain a waiver signature from the subject of the request. Waiver Releare:lhatby eve pandaalonfor e1edove reeat tegonieialtocoaeaet,"lovacintelbhtolymcodchalkwhtitDlvutonorettmieal Invaiigllan XII k•arlintal hrnory do el aoin:IOC datism.ilnimaby theDC1 sty b3.._.. • Ordby law. . Waiver :iw are _ ammam_oh.. — Tows Criminal History Record Check Results act use anyi r; As of 4-1-I 1_1l ,a search of the provided name and date of birth revealed; `-c ra -i ❑ No Iowa Criminal History Record found with DCI c)3%. '0 -0 ;o•17 Iowa Criminal III story Record attached,DCI M 5°1?-194 (-t N DCI initials J • DCI.77(08(25/10) Received Time Apr. 3. 2014 1: 51PM Na. 4064 Apr. 7. 2014 2:24PM Div of Criminal Investigation No. 4351 P. 2/3 IOWA CRIMINAL HISTORY DCI 00592134 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/04/07 DCI:00592134 • NAME: HILLS,DUSTIN ADAM DOB SEX RAC HGT WGT EYE HAIR SKR POB 19790523 M W 511 220 GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC LF ARM SC R FGR TAT L SHLD • TAT NECK • TAT R ARM CCH RECORD *•• • 01 ARRESTED 19990211 AGENCY: IA0160300 WEST BRANCH ED • CHARGE NO- 01 IA STATUTE TA713-1 BURGLARY 3RD DEGREE TRK#: 034086201 CHARGE NO- 02 IA STATUTE IA714-1 THEFT 3RD DEGREE TRK#: 034086202 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE IA713-6A BURGLARY 3RD DEGREE TRK#: 034086201 RESTITUTION SENTENCE DISP EFF DAT PLEAD GUILTY 19990430 DEFERRED JUDGEMENT 19990430 COURT COSTS 19990430 PROBATION 2Y 19990430 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 02 IA STATUTE IA714-2(3) THEFT' 3RD DEGRE$ CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 034086202 SENTENCE DISP EFF DAT PLEAD GUILTY 19990430 FINE $500 19990430 02 ARRESTED 20130816 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED- SUBSTANCE TRK#: 1AOOHDA01 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT Apr. 7. 2014 2:24PM Div of Criminal Investigation No. 4351 P. 3/3 DCI 00592134 PAGE 2 OF 2 COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID; 06521 SRCR102603 TRK#, 1A0ONDA01 SUBSTANCE ABUSE EVALUATION SENTENCE ?SSP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20131202 PROBATION lY 20131202 UNSUPERVISED PROBATION, INFORMAL PROBATION REVIEW 07/0.1/14 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 DE RELEASED TO WON-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. DIVISYON OF CRIMINAL INVESTIGATION Page 1 of 1 ., > www.towadot.go' SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver PO Box 9204 I Des Moines,IA 50; Phone:515-244-9124 1800-532-1121 I Fax:515-: www.ioW Certified Abstract of Driving Record Inquiry Date: 4/3/2014 DL/ID #: 713XX0776 (IA) Customer#: 3984225 Name: Hills, Dustin Adam Class: D ID Status: None Address: 1508 WASHINGTON ST Audit#: 4808413 DL Status: VAL Issue Date: 11/09/2010 CDL Status: None City/State: MUSCATINE, IA 52761 Expiration 05/23/2015 CDL Cert Status: None Date: Endorsements: 3 CDL Med Status: None Mailing Address: 1508 WASHINGTON ST Restrictions: NONE Restriction None Date of Birth: 5/23/1979 Supplement: Mailing City/State: MUSCATINE,IA 52761 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 05/07/2009 05/27/2009 M14 Fall to Obey Traffic Sign/Signal ':Johnson Name: Hills, Dustin Adam DL/ID: 713XX0776 Pursuant to Iowa Code §321.10, I, Klm Snook, Director of Office of Driver Services, Iowa Department of Transportation, do here 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 offic currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportal certify. In witness whereof,I have caused my signature and the seal of the Department to be set upon this document,at Ankeny, Iowa thi: J�oQNiEHICIf..4'I,� 4/3/2014 IOWA •2' _ t . .o: 1a: • ricof Driver Services ��OBIVt-- Iowa eDepartment ofTransportation Name: Hills, Dustin Adam DL/ID:713XX0776 4/3/2014