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Home My WebLink About14-048 • Authorization Number PI-- q 5 - 1 (Office Use Only) Ill 11 ww®I�� APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 Ifl a:WI - O Zr-1 CFI 2. Mailing Address ' (' rno de-4-r1 Lk-kt 3. Telephone: Home 311- 333- 657(/ Other: 4. Prior experience in transportation of passengers: 1 Dro1/41 School a u s -Por 3 y�C�r3 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 rt.')Q 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When fPrjd;n L o wa c;1-y a a- b rniorvRex- 17%et;s0a c►!-y (� ��- ►� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense/ Where When v /() 9. 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) clerk/taxidrivbadg 03/2013 I hereby certify t at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number rn ctJdhe .o J , p 12)r-e l2 . 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) �7 � 1�/ Signature of Applicant gO2C-(‘-et Date 0:eil �. / STATE OF IOWA ) COUNTY OF JOHNSON ) ,,Subscribed and sworn to before me by I V I.C�`f'>L .-C C t BY v ..._ On this day of i 4(0 vC\ CA , a0 IH . 1� 11 / __- / < KELLIE K.TUTTLE - �(� /� ! t f l �Y, ST Commission Number 221819 Notary Public in and for the State of Iowa My[,omtusat ti� 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). (A, S nature 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. Signature of City Clerk or designee / . Datb Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5 '/z" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerWtaxidrivbadgeapp201 O.doc 03/2013 .. C31th1i' OOT www.lowedot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124(800-532-11211 Fax:515-239-1837 www.iovradot.gov Certified Abstract of Driving Record Inquiry Date: 2/25/2014 DL/ID#: 614AH7688(IA) Customer#: 5996600 Name: O'Brien,Matthew Joseph Class: B ID Status: None Address: 77 MODERN WAY Audit#: 6147688 DL Status: VAL Issue Date: 07/24/2012 CDL Status: VAL City/State: IOWA CITY,IA 522403070 Expiration 07/09/2017 CDL Cert Status: Excepted Intrastate Date: Endorsements: PS CDL Med Status: None Mailing Address: 77 MODERN WAY Restrictions: Vehicle without air brakes Restriction None Date of Birth: 7/9/1984 Supplement: Mailing City/State: IOWA CITY,IA 522403070 Sex: M . History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 12/06/2012 '01/08/2013 __ ___ __ S_92____ ;Speed _'Johnson_ IIA i 12/08/2012 103/01/2013 a 'Improper Registration Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended ,01/23/2004 106/07/2005 ,D38 Fail to Post Security for an Accident f IL Suspended ;09/15/2007 01/27/2009 ,D39 ,Judgment I SIL 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: SOOQV(alClf***** 2/25/2014 t. IOWA ', ci• D O.T.iS' =echo, eterea • II iI'CN�F D91Y@S owaeDepartme Department Par. 3_ 2014 1 .12PM319.)Div of Criminal Invest igat ioJF IC LEGAL No. 4167 P.� 3/3ez/e2 41- :bar S1AAi OF IOWA r: k •Crnnnnaunn ibistory Brcgd Chock t a 4 r ` : e: I:Lk t �CqM� fC ®CA "' • � . ` , r i3iricl • DCI Account Number: r Ud —f Ofapplicablc) To: Iowa Division of Criminal Iavestlgation 1Fran: City of Iowa City Support Operations(Bureau,l'iMFioor City Clerk's Office 213 E.7th Street 410)+.Washington Street Des Motncs,Iowa 50319 (515)725-6066 Iowa City= IA 52240 (515)72,5-608D Fox phone: 319.356-5041 Fax 319-856-5497 I amrequasting an Iowa Criminal History Record Check on: Lest Nome(mandatory) First Namt:(mandatory) Middle Name(nommended) CYOri 2vl _ 1"ti'1 CLU41 asv Jo sh Date of Birth(mcdewly) - Gender(mandatory) Soeial Seel/lel Numabex ecommandcd) - _ O-1- 0 9 - 1 t1 ®J UTIMalo . OFemaNe • 33 7` 7 /-4i.5"76 waiver Irtfofrtfntiolvt Without a signed waiver from fhe subject of the request,a complete criminal history record may not ht.■eloseablfi-per ccYe-etYown nu;pier 692.2.For comnle(o criminal history record informatlo0,Ell allowed by law,always obtain a waiver signature from the subject of the request. Waiver n( gconcerning tnncriminaled to conduct mit Iowa Word kwih de Division of Criminal Investigation Any eimb Wstory data nma d Ie maiieledby the DCT may be nllntwdby Waiver Signature: r - F ►- s • Iowa C ' lite ]U1i ton Record Chick Resnik' Goa ass only) a --!y ,a search of the provided name and date of birth revealed: v As of . -7' OD FP --IrV `-%i'' 0 No Iowa Criminal History Record found with D CI m--, Cl u O) G')7:: ...a ,c-TI AI —- ^t 0 9 Iowa Criminal History Record attached,DCI# 021 7� ._ r— N ACI Initials • Received Time_Feb. 25. _2014— 4: 27PM-No. 0412