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Home My WebLink About14-080 Authorization Number _ 1 (Office Use Only) sigozmifilr 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 52240-182() (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name M l 0-1\-1 Y1' j LZ—A-7N" �`yL-" 2. Mailing Address - Gv\l U 60 6007'S.— U Q (�L"�( `� C t i`� �4 �ZZ 3. Telephone: Home 3 7 --c•3`3(, - "--- 0U Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? NO 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? U Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? P" Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V Cj 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) NIO 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 a 1 3 Q r3 Z/, t . . 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 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 M,rlA., Q Ca.Sell� s. . On this 1 day of Apt- , ? 1c Wan=AL-dialir) Notary Public in and -or the State of to Commission Number 729428 My Commission Expires ***** 7y1 _ ..... *********** ************************************************************************************************•***** 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). ignature of Police 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. ef-tom�� e ti� "7 ignre 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 cleri taxidrivbadgeapp2o14.doc 03/2014 Mar. 12. 2014 1 :30PM Div of Criminal Investigation No. 1771 P. 6/I1 ca/liizula is:ou NAA , DCI TOlin a • • . STA'T'E OF IOWA :,,, Criminal History Record Check f Request Form . DCI ACeounl Number: i?e)-FG M T 1(apptk■Ne) To: lawaDh'Woq of Criminal iovesNg■tbo From, MACC.5 I ix1 Support Operations Bureau,V Floor : hit,�j,+-tvA+s Dr'• 215 E.76 Bind CL % Det)v7254,66— 50319 .. .._ .. tik `-BAIT I A 5". -,,V1 a U . • (51�7256066 (513)7256080 Fax Thom: l�i� 33g- ��I Fast, • 3191 551-11a99 I em requesting an Iowa Criminal Tstoty Record Check oni - .• Last Name fflsMaury) First Name(madam) ,Middle Name(mtpmm lal) C,-SCLL-Pf , a2 V1{ I CM 40�. . eerra 2 Date of Birth(nwanny) Gender(=Maim) Social Security Number(rvccWb nded) • 'tr. 71 - 195 0 / ale ' OFemate 33g -57`11"O7 _ waiver Dittlinot pi elimed waiver from the 'elect on, record may berelacrpeodeofIowa,Ctiptn69 .2.Foreomuktecrimin■blrtoryrecordlaformatinallowedbyaw,alwy Alibi twelve elgoature from the root Jett of the request. . Waiver Release:Denby bc.vty the pnm)ulue or the Abovereauorlier offiW to vara m Iowa aiming hirtaq cord thta with the v)vblonof edmtmd bretdpden(DC0.Any aimiod Maury dao oonomligi me mer u(mAIISMCN/4Jb unCI W Dmay I.leaud u alma/fwd by law. • --- waiverSlgRtlfflYE: •" • Iowa Criminal History Record CheckResults (bcrmeeM ) As of 347711 ,a s:tuah of the provided name and date of birth revealed: — r, r 77 .i� No Iowa Criminal History accord found with DCI rt• _ :':rn Tie, -pro ❑ Iowa Criminal History Record attached,DCl 11 ? 71: ' eft r 1,, ci:` Y: DCI initials W .4....,- — DCI-77(08(25/10) Received Time Mar. II, 2014 1 :46PM No. 1637 ADOT vrrvw,iowodot.gov SMARTER I SIMPLER I CUSTOMER DRIVES ..m,_.. Office of Driver Services PO Box 9204 I Des Moines, IA 59306-9204 Phone:515-244-9124 [890-532-1121 Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 4/1/2014 DL/ID #: 013882642 (IA) Customer#: 3959505 Name: Casella, Michael Peter Jr Class: D ID Status: None Address: 2110 N DUBUQUE ST Audit#: 6831235 DL Status: VAL Issue Date: 04/03/2013 CDL Status: None City/State: IOWA CITY, IA 522451624 Expiration Date: 12/27/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2110 N DUBUQUE ST Restrictions: NONE Restriction None Date of Birth: 12/27/1956 Supplement: Mailing CIty/State: IOWA CITY, IA 522451624 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 11/01/2009 11/30/2009 1592 '.Speed Johnson IIA 12/09/2010 01/02/2011 1S92 ;Speed (10 mph&under In 35-55 mph zone) Cedar IIA , Name: Casella, Michael Peter Jr DL/ID: 013682642 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: = v%Nc "`��a ,'tiOQ• L(7(Giyy 4/1/2014 trcs• IOWA to osD. O.T.::�s 040014* ,/I1��„a�A SeSf Office Iowa Department fDrServices Transportation Name: Casella, Michael Peter Jr DL/ID: 013882642