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HomeMy WebLinkAbout14-070 Authorization Number )t-t 1 (Office Use Only) EraArit 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 Last 1. Name t3 t S Lv.> f E'T'0/Pr), i IT 2. Mailing Address -4/87-` ��'/It r eekti (ANC S 74" C/ 1A- . Z`�/O 3. Telephone: HomeCj l 9) 87 3093 Other:(3) ) 35 9 - �yZ 3 r 4. Prior experience in transportation of passengers: Ge 1- -�Q 4 k Ir ©/0411, ,A/E-- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /&- Type of offense / Where When ree- Grvrnt.r\i-.I A ,syidly 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1JJ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Afi Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? (1h- Type of offense Where When 9. Haveffyou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Ail 3 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 Z5 ,'\/\/ r`t (14 . 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 time with all of the prov".ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) r"' 3 - r1 - 1Li C ,, 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 Devi IA t_ �- . �r.t, . On this 1 g LIN day of \.cASc L. ,t.-)1 _ % r A _ o 44,g, wENDY S.MAYER ! Nota Public in .' d for the State o"Iowa a 7 Commission Numher 72Sa2R( ry My Commission Expires ow —1—t S—1 Le ************************************************************************************************************************************************ 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). �.� /�/� Signat o Pol �e hie 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. • \ J . ` ` � 1`(\,1� Sig_.ture of City Clerk or designee ate Taxi cab businesses are tequired to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report _ State certified driving record Website update clerkltaxidrivbadgeapp2014.doc 03/2014 oo!_Ma•r_ 12. 2014) _1 : 30PM Div of Criminal Investigation No. 1771 P. 7/11 1 DCI INA 'P.IUoo • 1 b • STATE OF IOWA °; Criminal History Record Check Request Form 0;. .• • �u1aqPi:•,al, DCI Account Number: "1da pi�J-FL 'ren �—• (Vapptiablo) To: IOWA DlvtelonorCrirainllovanppdon Front Aftavte5 10.jY1 Support Operations Bureau,ie Floor • 215 E.t Street to 541,vews Or• Def Mainee,Ion $0519 (515)725.6066 - - • aA Oa sa)'{o... (515)725.6080 Fu ,(3'14 338" '�`�, Phone: Fe::._ (319) S5I'Sall I em requesting on Iowa Crimtml HistoryRecord Check on: - Last Name(ns aamry) First Na111e1mnaamry) Middle Name pacpmorca&d) �e- Tri-r , e.,J,d l 5 E0 OA t20 Date of Birth(meWararyi Gender(mwndamy) SocialoSecurity Number(,«oa,.,a,ma) Zz - 70tnfe ❑Female `7 8 Z ' 0 - Z.63 Waiver Information:wallow a signed waiter from We subject of the request,■complete criminal hbtoty record may not he relenabie,per Code glows.Chapter 692,2.For jomhete erotical binary record Information,as allowed by law,always obtain a walver tipaturc from the subject of the wont, Waiver Release;i hereby pvepeamWrna(be aLovo Valles ofOcid ra••+i(a*mtvws crl• • hlaary record check web the Dlvb1oe of Ohba! InvoalSnlen(DC)).My nimble)blMwy Isle img=Mei me)ntainod bymay... - .•u ollowed by l/w. ', vr�/!r/�i♦� Iowa Criminal History Record Check Results (ocrmeenly)_. crr Mot 3-12-19 ,a search oftho provided nem.and date of birth revealed; -c T= ut •;i . "r7' — 0 No Iowa Criminal history Record found with Da ;" ^ • o c, —O r/r• qat, Iowa Ct$ninal History Record attached,DCI ii L ti 455 a=r �. D DCI initials DCI-77(08125/10) Ieceived Time Mar. 11. 2014 1:46PM No. 1637 , Maj. 12. 2014 1 :31PM Div of Criminal Investigation No. 1771 P. 8/11 IOWA CRIMINAL HISTORY DCI 00434455 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED- 2014/03/12 DCI:00434455 NAME: PETTIT,DSNNIS EDWARD PETTIT,DENNIS EOCENE DOB SEX RAC HOT WOT EYE HAIR SKN POB 19700922 M W 600 175 RAZ BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ABDOM SC CHEST CCH RECORD *+• 01 ARRESTED 19920215 AGENCY: IA0160000 CEDAR CO SO CHARGE NO- 01 IA STATUTE IA3211-2 Owx TRKB: L41392601 • COURT DISPOSITION AGENCY: IA0160153 CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2 OWI TRIO: L41392601 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19920508 COURT COSTS SA EVAL 19920508 PROBATION lY 19920508 02 ARRESTED 19960729 AGENCY: 'IA0520100 CORALVILLE PD • CHARGE NO- 01 IA STATUTE IA708-7(1A2) HARASSMENT 1ST J DOMESTIC ABUSE HARASSMENT TRK((: 019233801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-7(2) HARASSMENT 3RD CHARGE CLASS£ MISDEMEANOR CONVICTION TRKN: 019233801 SENTENCE FISP EFF DAT FINE $75 19961121 03 ARRESTED 19970316 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA3211-2 OWI 2ND TRIO: 025662101 COURT DISPOSITION ' AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2 Mar. 12. 2014 1 : 31PM Div of Criminal Investigation No. 1771 P. 9/II DCI 00434455 PAGE 2 OF 4 OWI 2ND COURT CASE ID: 06521 OWCR043979 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: 025662101 SENTENCE DISP EFF DAT JAIL 7D 19970708 FINE $750 19970708 PROBATION 1Y 19970708 SUSPENDED 53D 19970700 8/27/98-CONTEMPT-10 DAYS JAIL 04 ARRESTED 20000912 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-1 ASLT CAUSING INJURY DOMESTIC ABUSE 2ND TRK#: 100018301 COURT DISPOSITXON AGENCY: IA052015.7 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(3) (B) DOMESTIC ABUSE ASSAULT - 2ND OFFENSE - AG CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100018301 SENTENCE DISP EFF DAT JAIL 1800 20010124 FINE $500 20010124 PROBATION 2Y 20010124 SUSPENDED 170D 20010124 500 OF FINE SUSP 05 ARRESTED 20010008 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321-561 DRIVING WHILE BARRED TRK#: 033751001 COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06481 AGCR007517 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 033753001 SENTENCE pl$P EFF DAT SAIL 5b 20020301 5 DYS JL/CRD TM SERVD/F,SC.CC & CT APP ATTY Mar. 12. 2014 1 :31PM Div of Criminal Investigation No. I771 P. 10/I1 DCI 00434455 PAGE 3 OF 4 FEE FINE 20020301 06 ARRBOTBD 20011027 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321-560 DRIVING WHILE BARRED TRK$: 100380601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 FECR060306 CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: 100380601 SENTENCE DISP EFF DAT JAIL 60D 20020221 FINE $500 20020221 PROBATION 1Y 20020221 SUSPENDED 45D 20020221 07 ARRESTED 20061006 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA706.2A DOMESTIC ABUSE ASSAULT TRKO: 101998501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2) (A) DQMBSTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSM066930 CHARGE CLASS; MISDEMEANOR CONVICTION TRIO: 101998501 SENTENCE DISP Et DAT :TAIL 30D 20061220 COURT DISPOSITION AGENCY: YA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA664A.7(4) VIOLATION OF NO CONTACT OR PROTECTIVE ORDER COURT CASE ID: 06521 SMSM066930 CHARGE CLASS: MISDEMEANOR CONVICTION TRK{(: 101990502 SENTENCE DISP EFF DAT JAIL 7b 20080711 08 ARRESTED 20060528 Mar. 12. 2014 1 ; 31PM Div of Criminal Investigation No. 1771 P. 11/11 DCI 00434455 PAGE 4 OF 4 • AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A0049V01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR083530 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 1A0049V01 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 2D 20060820 DL REVOKED 100 DAYS FINE $315 20080820 09 ARRESTED 20060528 A AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA708.7(2) HARASSMENT / 1ST DEG. - 1909 TRK#: 1A0049W01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.7(2) HARASSMENT / 1ST DEG. - 1969 COURT CASE ID: 06521 AGCR082336 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 1A0049W01 SENTENCE DISP EFF DAT FINE $625 20081017 SUSPENDED PRISON 2Y 20081017 PROBATION 2Y 20081017 SUPERVISED PROBATION W/ DCS. PRISON 2Y 20081017 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 TUE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION ARTS Page 1 of 2 • r7, ' Ul "Sa tes 4 ,... SMARTER I SIMPLER I CUSTOMER DRIVEN VrillVttll,iow dC1�,C�o3 Office of Driver PO Box 9204 1 Des Moines, IA 50: Phone:515-244-9124 1800-532-11211 Fax:515-: www.iow Certified Abstract of Driving Record Inquiry Date: 3/18/2014 DL/ID#: 556YY0404(IA) Customer#: 3588195 Name: Pettit, Dennis Edward Class: D ID Status: None Address: 2824 TRIPLE CROWN LN Audit#: 7895115 DL Status: VAL UNIT 1 Issue Date: 03/18/2014 CDL Status: None City/State: IOWA CITY, IA 522407237 Expiration 09/22/2018 CDL Cert Status: None Date: Endorsements: 3L CDL Med Status: None Mailing Address: 2824 TRIPLE CROWN LN Restrictions: NONE Restriction None UNIT 1 Date of Birth: 9/22/1970 Supplement: Mailing City/State: IOWA CITY, IA 522407237 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County 05/28/2008 08/20/2008 1A33 Drug/Drug Related Conviction (Johnson Sanctions Type Effective End ACD Explanation Occurrence JUR Revoked ;09/30/2008 103/28/2009 !A33 €Drug/Drug Related Conviction 1IA Name: Pettit, Dennis Edward DL/ID: 556YY0404 Pursuant to Iowa Code §321.10, I, Kim 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 this w�.y 4t.. .•4i4 3/18/2014 czyreLe 111 IOWA :y% :D. O. T. �r dr ,I'1j�u4eIt2'8 face of Driver r DepartmentServices