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Home My WebLink About14-056 Authorization Number /24 — fJ 1 (Office Use Only) • III WI AIM lit ftt AMO On &Mr CITY OF IOWA CITY APPLICATION FOR TAXI 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 F-{(11110n ) l f tz Jay AR 2. Mailing Address 113 W �1 C 4QS 4- 'i L 3. Telephone: Home 311 -231 -2.<160 Other: I 3- 911 - V1 `17 4. Prior?xperiepr in transportation of passengers: 1 S y r t au ( Ar 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A) v Type of offense Where When 6. Have you bgen 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? /\/0 Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Y P $ T e of o ense Where When C I Suer; C�1Ic1 �o 2 o! 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Ii'J(o 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 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number, LS it' AH cm FLC . 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 I* /11 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A . mac- vim . On this 7- day of iUVrj(.jam --Di t{' . 4 a� Notary Public S1 forte Stat eof to J s, WENDY S MAYFR ry . T. Commission Number 729428 My Commission,Expires ow - 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). o ;�/... . .� 7— y Sign re of Po! -� - 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. ? -,t-e /-1x 7 -/v Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/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 clerkitaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation «. Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/12/2013 DL/ID#: 610AH9784 (IA) Customer#: 5876184 Name: Jackson,Anthony Dewayne Class: C ID Status: None Address: 735 SAVANNAH DR Audit#: 6109784 DL Status: VAL Issue Date: 07/10/2012 CDL Status: None City/State: NORTH LIBERTY, IA Expiration Date: 08/28/2017 CDL Cert Status: None 523179189 Endorsements: NONE CDL Med Status: None Mailing Address: 735 SAVANNAH DR Restrictions: NONE Restriction None Date of Birth: 8/28/1963 Supplement: Mailing City/State: NORTH LIBERTY, IA Sex: M 523179189 History Information . • Convictions Citation Date Conviction Date ACD Explanation County JUR 02/16/2012 W. 03/15/2012 ;820 Driving While Suspended, Denied,Cancelled, Revoked Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was,at fault or given a citation. Accident:D`te - Case Number;' I ' • JUR 05/25/2012 . . 688947 :IA Name:,Jackson, Anthony Dewayne DL/ID: 610AH9784 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Departmeht of Transportation; do•hereby certify that I am the custodian of the records heid,by.the Office of Driver Services, that this is a true and accurate copyof an official record currently In the custody of said office , and that I have been authorized by the Director of the Iowa Department of Transportatiorl;to socertify, In witness whereof;I Jave causedI My signature and the seal of the Department to be set upon this document,at Ankeny,Iowa this date: l-t• C 1.#41; 12/12/2013 Is OIOWA T. :o. At .. . ... . ... . ... .. aO. T..( . ii,�O,***** coes Office of Driver Services _.•' ' .' rnl,„..- •Iowa Department of,Transportation - ,Name:_Jackson,.Anthony.Dewayne DL/ID: 610AH9784 . . .. . ... ....._.. _ _ .... . .. _ . .. . . . . .l Mar, 4. 2014, 1 : 18PM Div of Criminal Investigation No. 4293 P. 1/1 r Cu. 10. GUI4 1 : 7U rlll city tiler ll - 1.1 fy el 1014 pity No. 4417 I. LI ;11 .1 • c STATE OF A®VYA ‘ 0 til.asT •. ") aCcn� nlm2ll History RecorcdCheek K•u la•4"; oN „„8¢ � � b®non trfi„ ` • DCI Account Number: 4°Ca—E (Itapplitabie) • Tot Iowa D1Vlslon ofcriminallnyestlgatton From: City of lova city support Operations Bureau,ft Floor City Clerk't office 215E.76 1 Street 410 JD.Washington Street Des Moines,Iowa 50319 (519)925-6066 . Iowa City, IA 52240 (515)725.6080 Fay Phone; 319-3564041 • Yam 319-3564491 • lain requesting an Iowa Criminal History Record cheek on; Last Name(mandatory) glint TTaIImm10(nuouloiory) Middle Name(rcconntatded) JaC1Sc�i fMer10(11 e •waY ne Dante of Birth(mandaloiy) Gender(mandaros) SocialSecurity " rityNumber(recommended) Auk (a• 2 611, I, I p 43 udMlsIa DFemaio 3 4 8” b a _ - 8 9 1 Waiverrtt 'orIM1611:Without a signed waiver'hut tjursubject of The request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,2.VpYMinnie(acriminalhistoryrecordinformation,usallowedbylaw,always obtain a waiver sigttaturefrom the subject of the request. Waiver Release;I114 6ygive permission farina aboverag acting official la•.:duet en ram terminal hrstorymmrd cheek 11fiili the Division of Criminal lwcitlgptlott(DCI). My cdmiaei history data concerning me l4n maintain,.b ea DCT may ba rcicased as altowad by law. Waiver Signature: — • - ' ' 1A • Iowa �xiiltaill�>1}6E$s l®n� 1”c coI___ Check]Rs n1tY . pause only) AS of 3 1� 1( 1 1 ^_ :: r, aseetchoftheprovidedrtameanddateof6irthxevealed: l- -R.; v;--il tx);.s c.r la No Iowa Criminal History Record found with DCI __i c: as ;n e,)r: -n cn ri U Iowa Criminal HistoryRecord attached,DCI# c:.7.1- - DCI initials , Received Time—Feb. 28. -2014— 1 :55PM—No. 4106 1