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Home My WebLink About14-081 ! IJL;, r Authorization Number i " C-) r � _ 1 (Office Use Only) 4.7:1172Witha..t1 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 Mid I Last 1. Name C_I-'U/�, OVy\cC.� ��-L`l\ 2. Mailing Address \O\(JP cLvt fit. S k uk1 0. C l (� ) �2 2�( r 3. Telephone: Home (3 I `'1 - Sci Lk \S t� .$ Other: 4. Prior experience in transpo ation of passengers: 4.1 .- A.40../c o 'y 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? L ( .'D Type of offense Where When Eris S A bT `i ,'P 0? 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? L' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? U. 5 Type of offense Where When «�,.v..) fA 1 • •. c-_) II 1171lZ "Fc,k1 66 LMf 9 / s-./ /t 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? tie r\_. Type of offense Where When I (\`1V\ 1�,,a,c,A,La,a F 1,A�.c ;'1 3 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) clerk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number K 1 1 1 4 C''1rci . 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 Applica ��i .�� Date l� — ) — ► Li _ 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 se m "I-. �� L, S . On this / 't day of �., I �l� 1 ,011.1,. llJ 0-A-AA flPIA 0 t _ WEND Notary Public irf' nd for the Stat of Iowa M e y mis&"- 161:1 .'779428 — - p'res 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,,I 9-0/11Si ature ..'P; ice Chief 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. Signatof 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 derk/taxidnvbadgeapp2014.doc 03/2014 03/Mar. Z/. LU14( 9:7/AM , UP/ oT briminai investigation -, DCI );Ottwu• )""..._1(.2. IN' • , STATE OF IOWA $-. Criminal History Record Check _r. r . r. lm Request Form - DCI Account Numb= 93S)r C. I OfsepiiwHo) To: Iowa Division ofCriminal laveetlyetlon • Fromi Vacce5 t ry—AXI Support Operations bureau,V1 Floor • ` w Si-evene Or. 1 216 E.7th Strobl /� p, ----DsM25-606lows 60319 .. .. .—'- - '-1,03.0& GAM 1 A-5W9a ..----.. (313)7156066 (313)725-6080 Fax nine; e(3141 338- aq�J- • Far:, . (3(q 551-Sail • I am requesting an Iowa Criminal Hlstory Record Check ons Middle Name(raomro dod> Last Name(rrwd.w First Nemo twain:, Middle Date of Birth lasindstoq) Gender(min T ` Social Security Numberommmd (moed) o :z i ge Male °Female S 't-3. - f -1 'fruitier In opnwrba:Without a signed waiver from the eubJect of the request,a compete eNba■l binary record may not be releasable,per Code of Iowa,Chapter 692.2.Fornaatoleit edmlaal Story record 1nloemstton,ee allowed by law,tdeaya _obtain a waiersliatare from(be subleot of the request. Waiver Release:sMmbtAratambiIonforoestoromqrashmWcalci&tocondtctofowluhahslhietmyr oidthskwiththCDtrisieoMMCrinwul Inyeaigtlon(DCI).Any criminal hbmy den wean •.. Is meassleedby the DCI nay b Washed m . • ~ Waiver Signature: - S — --_S1 r — ---- Iowa Criminal HIstort Record Cb,fe •sults (DD,use only). As of_ 3 7.11y a search of the provided name and date of birth revealed: . .: ::,` 0 No Iowa Criminal History Record found with DCI - . �.. Iowa Criminal History Record attached,DCI IIh. SI UC• (}J F DCI Initials DC1.77(08/25/10) • Received Time Mar. 26. 2014 5:58PM No. 3224 Mar. 27. 2014 9:58AM Div of Criminal Investigation No. 3250 P. 3/5 IONA CRIMINAL HISTORY DCI 00811609 FELONY CONVICTION PAGE 1 OF 3 DATE PRINTED- 2014/03/27 DCI:00811609 NAME; DAVIS.OERENY THOMAS DOB SEX RAC HGT WGT EYE HAIR SKN POB 19820528 M W 605 160 HA2 BRO MED FL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L SHLD TAT R SHLD CCH RECORD •** 01 ARRESTED 20070813 AGENCY: 1A0520100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRKU; 1A0023R02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE XA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE • COURT CASE ID: 06521 FECR080455 CHARGE CLASS: MISDEMEANOR CONVICTION TRKU: 1A0023R02 • LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 10D 20081006 FINE $315 20081008 02 ARRESTED 20071105 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK#: 5A0043501 COURT DISPOSITION AGENCY: IA0570153' LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG COURT CASE ID: 06571 SRCR074931 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 5A0043501 SENTENCE DISP EFF DAT FINE $315 20080425 03 ARRESTED 20071213 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE TRK4: 1A0030Y02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- Mar. Ll. 2014 9; 7BAM Uiv oT Criminal Investigation Ivo. MU r. 4L) • DCI 00811609 PAGE 2 OF 3 • • 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE ID: 06521 FECR081761 CHARGE CLASS: FELONY CONVICTION TRIO: 1A0030Y01 SUBSTANCE ABUSE EVALUATION RESTITUTION SENTENCE DISP EFF DAT FINE $750 20000919 PROBATION 3Y 20000919 PRISON 5Y 20080919 REVOKED 20090204 04 ARRESTED 20080424 AGENCY; IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124.213 PHARMACY PURCHASE >7500MG PSEUDOEPHEDRINE TRK#: 1A0032301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT ND- 01 IA STATUTE IA124.213 PHARMACY PURCH >7500MG PSEUDOEPHEDRINE COURT CASE ID: 06521 SRCR081795 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 1A0032301 RESTITUTION SENTENCE DISP EFF DAT JAIL 10D 20081008 FXNE $315 20061008 05 RECEIVED 20090206 AGENCY; IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA713.6A(1) BURGLARY 3RD DEGREE TRK#: C3005W801 INMATE #: 6747211 COURT DISPOSITION AGENCY: IA05Z015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA711.6A(1) BURGLARY 3RD CROREE CHARGE CLASS: FELONY CONVICTION TRK#: CB005WB01 SENTENCE PRISON 5Y CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 20100824 PAROLED Mar. 2]. 2014 9:58AM Div of Criminal Investigation No. 3250 F. 5/5 DCX OOBII609 PAGE 3 OP 3 • CUSTODY AGENCY: IA077015G ADULT PAROLE SVC B 20110506 DISCHARGED AN ARREST WITHOUT DISPOSITION YS NOT AN INDICATION OF GUILT. TUTS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFXCATION IS A PUBLIC RECORD HUT 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 0 . . v MIowadot,go\ SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver! PO Bax 9204 I Des Moines,IA 502 Phones 515-244-91241800-532-1121 1 Fax 5154 www_iow Certified Abstract of Driving Record Inquiry Date: 4/1/2014 DL/ID#: 117AC4879(IA) Customer#: 5207471 Name: Davis,Jeremy Thomas Class: D ID Status: EXP Address: 1016 DIANA ST Audit#: 7828478 DL Status: VAL Issue Date: 02/26/2014 CDL Status: None City/State: IOWA CITY,IA 522404627 Expiration Date: 05/28/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1016 DIANA ST Restrictions: NONE Restriction None Date of Birth: 5/28/1982 Supplement: Mailing City/State: IOWA CITY,IA 522404627 Sex: M History Information Convictions Citation Date Conviction Date ACO Explanation County 08/13/2007 110/08/2008 A33 Drug/Drug Related Conviction Johnson 09/05/2012 .._j12/07/2012 'M14 Fall to Obey Traffic Sign/Signal Johnson �M_�._�. 11/18/2012 112/30/2012 ;592 [Speed bohnson Sanctions Type Effective End ACD Explanation Occurrence JUR Revoked 11/27/2008 105/25/2009 A33 Drug/Drug Related Conviction ]A Suspendetl 103/29/2013 __._. 105/?7/2013 LL LL053 _ Non Payment of Iowa Fine _ _4IA Suspended ;04/09/2013 106/04/2013 053 Non-Payment of Iowa Fine —.— 1IA Name:Davis,Jeremy Thomas DL/ID:117AC4879 Pursuant to Iowa Code 4321.10, I, Kim Snook, Director of Office of Driver Services,Iowa Department of Transportation, do hereby certify that I am the Gust( 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 at 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: B � EHIf .' '.$: $ s 4/1/2014 4. s . IOWA #'a D. O. T. ' s. t ��F l'thDBI — Driver Services kVE1.," IowaD artmentofTranspo Transportation Name:Davis,Jeremy Thomas DL/ID:117AC4879