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Home My WebLink About14-049 Authorization Number ) LI - y (Office Use Only) 614111,6 7rr III �� mit MIM®ogIl 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 /ey •36twiCS V 1111ut 1 2. Mailing Address y/�(oS �C��^nS`.n - /u.ce 4ec LL) S� L he,- / �� cz2X 3. Telephone: Home C S/7)cq Z/- Other: / 4. Prior experience in transportation of passengers: �L~l7 2 O 13 eove 47eK 2 e/3 ��✓l - / erCy e-///ca MN?S7nc C e��G,�as� Z,.t, �.�� rye, 4.,4 (0,CF i" /C)( AC/ elle'{;r t,- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? '' 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) clerMaxidrivbadg 03/2013 Authorization Number / LI / .r 1 (Office Use Only) II 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 �rEirst Middle Last 1. Name /y/e,— 'ncL wt-2.S V iitia.467- 2. Mailing Address I V .k S -3-okls on - /v/I c c&4;ne_ (,e%S� L �er� �/�� 5"--Z 2X 3. Telephone: Home 3/`!1 577 ?//-f ? Other: 4. Prior experience in transportation of passengers: r2O l 3 /14/644e,„--e,„-- 2 e/5 /I/c)✓ b.-767Th 7 ✓y,��ge_///,Ca( f ref��S/ `7 ' �/t "' Sck�G��aS� �.�, �rr�6/ FY-6' 2v �/ a,a i'> WG+C_el/C�tt�� VCt� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A' 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) 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) clerWtaxidrivbadg 03/2013 02feb. 28.- 2014212_05PM Div of Criminal Investigation • Bei IolNo. 4094 P._4/4. • STATE OF IOWA y ,-• };,. Criminal History Record Check '-� ('- Request Form `=.d • DCI Account Number: 9385-PC. �n� tet^ (IfgcaN pllel To: Iowa DlvblonofCriminal laveraganon Frandv'Ga5 I axl . Support operations Bureau,I"Moor $�6uewS Or. 215&7'Skeet ((�� ( j )7256066wa 50319 • VUs. Cix't, I A sl)H o (alb�254e66 / S� iL! (515)7254050 FaY Phone: ;1314 339- a'ty' - . • Pne:. - 3t 1 551-Sall _ • I am requesting an Iowa Criminal I�istoq Record Check on: Middle Name(roCommradc+� Last Name tray) ,First Name prmderoy) Orl/kms 7 - 50(wt5 Date of Birth 0n"demy) Gender(wnduey) Social/' Security4meu Number utendm) O ! /20/ / / 9-0 Male OFemale C--�'`r?4/ z?- • Waiver Information:Without a aped waiver from the subject of the request,a complete crhulmat hletory record may not be releasable,per Code of Iowa,Chapter 692.2.For Syaplra criminal history record infoundoneas allowed by law,always obtain a waiver signature from the subject of the request. WaiverRcIease:thrmbygive w,o4+imror,mdove regl ,d/aO toomduatnlo�wcriminal i ryooedW ddiedwm,meavhlmcrcdmwl tnvadszlbn(DCf.My gamine bluo,ydsta c000nnl/rat me h., nsMWeed 'a,o IMy falt�d • Waiver Signature; f��I,( - • Iowa Criminal// ' ton Record Check Results (DCL use only) As of 2.-o2& �# _ ,a search of the provided namo and date of birth revealed: No Iowa Criminal History Record found with DCI • 0 Iowa Criminal History Record attached,ACI IX — _t. DCI Initials 9.0 ri•--= 7" DC1-77(0825/10) c`ii �)`3 -n c/,-^ H kit e`i r t' NJ ;r. H _- Received Time Feb. 25. 2014 12: 30PM No, 0350 , 4 it, i t iiiisfl 130T SMARTER I SIMPLER I CUSTOMER DRIVE( ... -. VVWW ICiVUadat,gov Office of Driver Services PO Box 9204[Des Moines,IA 50306-9204 Phone:515-244-9124 1 800-532-1121 1 Fax:515-239-1837 WvrNJowadotgov Certified Abstract of Driving Record Inquiry Date: 2/25/2014 DL/ID#: 435AA8689(IA) Customer#: 4701572 Name: Villhauer,Tyler James Class: D ID Status: None Address: 801 WESTWINDS DR APT Audit It: 7097012 DL Status: VAL 3 Issue Date: 07/03/2013 COL Status: None City/State: IOWA CITY,IA 522464024 Expiration 04/20/2018 COL Cert Status: None Date: Endorsements: 3 CDL Med Status: None Mailing Address: 801 WESTWINDS DR APT Restrictions: NONE Restriction None 3 Date of Birth: 4/20/1990 Supplement: Mailing City/State: IOWA CITY,IA 522464024 Sex: M History Information CLEAR DRIVING RECORD Name:Villhauer,Tyler James DL/ID:435AA8689 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: .y VEAICIf p�v, soft.•• 4', 2/25/2014 (; ? ) • ael/,%OAv IowaOfficDepartment of DriverServices Serviiceansportation Name:Villhauer,Tyler James OL/ID:435AA8689