HomeMy WebLinkAbout14-051 Authorization Number ((-/--
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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
F,irs1. Name tL /I- Ni Middl� ' T_/-I
L11 S C)
2. Mailing Address ' PLu (s'7 Tv L /1 5 3 - -1 0
3. Telephone: Home Other: —3l ') 133 r — —7 3 Y «L(
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? '1
Type of offense WherreAA -- When 3W
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6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? /CA'
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? / 5
Type of offense
Where When
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /O
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)
of
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)
clerWtaxidrrvbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
ij I >< 1'1 y 2 . 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 ���r'""' -- Date 34 /1 Li
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by .4-)c--,,,., Y... LTi* CSO-v\ . On this `5 1- day of
0-\o, 6 Com. c�01 t4 .
J' WENDY S.MAYER Notary Public 4 band for the S to of Iowa
---L1 T.l.ommisawr,Nuu,t r 729$28
• My Com ission Expires
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).
Signatur f Po ice • ier or d~:nee Date
• ?—Z-7 V
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.
oma - ' 3 — - — /�
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'/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
clerkkaxidrivbadgeapp2010.doc 03/2013
. Jan. 31. 2014 3: 21PM (Div of Criminal Investigation NN2. 8301 P.P. ` 1/2
,0 ST.ATh *OF IOWA ��Ire-'.�ly,I.n
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vs ` 8¢tuefl Forme . ' `
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DCT AccountNumber: 1 .-—F—
(if eppiloablc)
Tot Iowa Division of Criminal Investigation Froml City ofrowa City
Support Operations Bureau,1"Floor City Clerk's Office
2131x.94h Street 410 E.Washington Street
Des Moines,Iowa 50319
(515)725.6066 Towa City, IA, 52240
(519)125-6080 Fax
Phone: 319-356-5041
Fax: 319-356-5499
I mn requesting an Iowa Criminal Hisror Record Check on:
LastName(mandatory) First Name(mendototy) Middle Name(rcconmrended)
1__.A13otV ItLAN I< ElTj4
Date of Birth ILrinndetory) Gender(mandatory) Social Security Number(oxeremendcd)
71)3 lS GI ' t61Ma1e ❑Female H -7 ? - 12 - 3 6 i O
WaiverInformalion:Without a signed waiver from the subJect of the request,a complete criminal history record may not
be releasable,per Code of Iowa,Chapter 692.2,Fpr complete criminal history record Information,as allowed bylaw,always
obtafas_walver signature from thesubfee(of the request, _ _______ __. . _____
Waiver Release;1hcreby give permission for the above requesting officrei to conduct an rows oAminel history record ohcck whit the Division ofcrtminwl
rnvestiltetIoll(DCD). Any criminal hlsloty dein conceivingme lemain lla/atned by theDelme&he released as allowed by few.
agn
Waiver Signature: (�Xu-•-. K. �ovi-a-0--,
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lava zCl. minas,J3['i�ao lite&he&&Result (�G1ta�duly) ti;;
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As of I' l V , a scorch of the provided name and date of birth revealed: }
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C.s.= r
® No Iowa Criminal History Record found with DCI -;r_> N D
r _
.0 Iowa Criminal History Record attached,DCI# SLo'13Zq
DClinitials 1 �
leceived Time—Jan, 28. -2014-12: 21PMr-No. 7849
DCI-77(08/25/10)
. Jan. 51. 2014 3: 21PM Div of Criminal Investigation No. 8301 P. 2/2
IOWA CRIMINAL HISTORY DCI 00567329
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
2014/01/31
• DCI;00567329
NAME: LARSON,ALAN KEITH
DOB SEX RRC HGT WGT EYE HAIR SEN, POB
19540713 M W 601 200 BLU BRO FAR IA
ADDITIONAL IDENTIFIERS
SC PHD
CCH RECORD +w+
01 ARRESTED 19980111
AGENCY: IA0850100 AMES Pb
CHARGE NO- 01 IA STATUTE IA124-401-5
POSSESS CONTROLLED SUBSTANCE
TRK#: 032094601.
COURT DISPOSITION
AGENCY: IA085015J STORY CO DIST COURT
COUNT NO- 01 IA STATUTE IA124-401(5)
POSSESS CONTROLLED SUBSTANCE
CHARGE CLASS: MISDEMEANOR CONVICTION
' TRK#: 032094601
SENTENCE DISP EFF DAT
FINE $250 19980331
COURT COSTS 19980331
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 SE 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
Dj
•
fIowa Department of Transportation
Office of Driver Services (fall Free)800-532-1121
PO Box 9204,Des Manes,IA 50306-9204 515-244-9124
FAX 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 1/28/2014 DL/ID 5; 431%X7942(IA) Customer is 900797
Name: Larson,Alan Keith Class: D ID Status: None
Address: 1540 PLUM ST Audit Sr 5423120 DL Status: VAL
Issue Date: 08/05/2011 CDL Status: None
City/State: IOWA CITY,IA 522402124 Expiration Date: 07/13/2016 CDL Cert Status: None
Endorsements: 3 CDL Med Status: None
Mailing Address: 1540 PLUM ST Restrictions: NONE Restriction None
Date of Birth: 7/13/1954 Supplement:
Mailing City/State: IOWA CITY,IA 522402124 Sex: M
History Information
Convictions
Citation Date Conviction Date ACD Explanation County IUR
03/25/2011 I04/0B/2011 1592 speed I,Johnson 1IA
03/26/2011 1,04/13/2011 M14 (Fall to Obey Traffic Sign/Signal ilohnson IA
Name;Larson,Alan Keith OL/ID:431)X7942
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:
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1eev •*`Ali 1/28/2014
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Services
Iowa Departme[of Transportation
Name:Larson,Alan Keith DL/ID:431%X7942