The URL can be used to link to this page

Home My WebLink About14-047 Authorization Number 1 — 111-1 L r, 1 (Office Use Only) 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 �ea 741da4-1-i eo/ _ 2. Mailing Address / 3 7)(27-1- --Pvv`ve C-eJa 3. Telephone: Home (3 i 9) ,iso - 73-7 I Other: /VA 4. Prior experience in transportation of passengers: /U07 0 p.SSU hg�r s b r, t �f l�v� ��7 prrop nc a// -714 -c riiv/�i /'��/ .S'7a-tp/-ess /4v v/6„.. V asT '- y-r 2 r_� dr,vim') 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When (),C9CG/vi,P c7"S/0„-Ct /99 ?)r;vrcAI,c l ate/ —ow� /99c 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A/0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? No Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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) clerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's licdnse number :.?y S4 67 . 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 Applicantj��` 1� �- Date ? - 3 - / / STATE OF IOWA COUNTY OF JOHNSON ) c Subscribed and sworn to before me by v�b�� t o\ . On this P day of \\ \C .`.. ... t—\ .113 Ili+ NOtarr Publi in and for the tate of Iowa 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). Signature of olid e hie Cf 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. 3/3 // Signat e of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 Y2" (height) and prominently displayed to all passengers. *****************ir:t**********************************************************************************************************************AA A AA Ak Office Use Only Approved application DCI report State certified driving record Website update clerkllaxidrivbadgeapp2010.doc 03/2013 LiA?ii iii) \faitai wWW.iawadot,goV SMARTER I SAMPLER I CUSTOMER DRIVEN,DOT _ __._..,--._—, Office of Driver Services PO Box 92041 Des Moines.IA 5030E-9204 Phone:515-244-9124 I,800-532-1121 I Fax:515-239-1837 www.iowadoigov Certified Abstract of Driving Record Inquiry Date: 2/20/2014 DL/ID#: 345AE5367(IA) Customer#: 3190100 Name: Boltz,Robert Adam Class: D ID Status: VAL Address: 13 DATA DR Audit#: 7809892 DL Status: VAL Issue Date: 02/20/2014 CDL Status: None City/State: IOWA CITY,IA 522403010 Expiration 07/15/2021 CDL Cert Status: None Date: Endorsements: 3L CDL Med Status: None Mailing Address: 13 DATA DR Restrictions: Corrective Lenses Restriction None Date of Birth: 7/15/1958 Supplement: Mailing City/State: IOWA CITY,IA 522403010 Sex: M History Information CLEAR DRIVING RECORD Name: Boltz,Robert Adam DL/ID:345AE5367 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: wy o�p.. .. 4"•,, 2/20/2014 I 'I�ly0fOgIVtO 's ' e of Dr Services Iowartmrtrviceansportation Name: Boltz,Robert Adam DL/ID:345AE5367 Feb. 28. 2014� 11; 55AN� Div of Criminal Investigation No. 4091 P. 1/7 ..I ., .. . , n v, ., vi AmvrtY NO. 44U/ r. L • v ' 7,! STATE®FIOWA .. -, fhl, m.1,6 `ai 'f' �� n i, Qirnnnnllq1-Estarry er®LLWChecky y i Rectinest Form DCI Account Number: Lignz—�F (itappneehre) To: Iowa bivlaion of Criminal Investigation From: City of Iowa City Support Operailons Bureau,Id Moor City Clerk's Office 215 E,714 Street 410 E.Washington Street Des Moines,Imre 50319 (515)729.6066 Iowa City, IA 52240 (515)725.6080 Pax phone: 319.356-5041 . Pax: 319-3S6-5491 t am requesting aniowa Criminal History Record Cheok on: Last Name(mmndeloey) First Name(mandetosy) Middle Name(acommnisuo BO/fz • `Ra /b- piA1 4Q"-7 Date of Birth(mandalor7') Gendd�er��(mondstory) Sochit Security Number(eecotnmegaed) -7 ` /Sr `-7 6 L�114daIo OF=ala / e7 " /6 —S-636 . waiver ormation;Without a signed waiver fromthesubJeetofthe request,a complete criminal history record may not be releasable,per Code oflowa,Chapter 692.2.For complete:criminal history record information,as allowed by law,always obtain A waiver signature from tho sub/act of the request. 13 alver Release;IhetebygWo Patrols-don for rhe dove requesting official to conduct en Iowa crindnet Alstosy record eherkrwilh thcDtvlsion of Criminal IrweeligetIon(DCA, Any cumin Of history do la concemin);nto that is maintained 6y tho bet may 6ore Mooed as allowed by few. Waiver Signature; / de-., 2 o-/- t 4 _ - Iowa Criminal HiStiory Record Cheek Re ultil. 4— ": ti`�elUr��) -; Cn, , N I."-iii AS of d2-a260 /y , a search of the provided name and date of birth revealed: r.� r ;z:3 ® No Iowa CriminalllistoryRecordfoundwithDCI = C • Iowa Criminal History Record attached,DCX# 4" / 7/(o • DCIJnitlals tRaceived Time-Fah. 94. -9014- I .44PNr6ln. 06 Feb. 28. 2014 11 : 56AM Div of Criminal Investigation No. 4091 P. 2/7 IOWA CRIMINAL HISTORY DCI 00421716 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED- 2014/02/26 DCI:00421716 NAME:• HOLTZ,ROBERT BOLTZ,ROBERT ADAM DOB SEX RAC HOT WGT EYE HAIR SRN POB 19580715 M - W 510 190 BLU BRO FAR PA ADDITIONAL IDENTIFIERS TAT L SHLD TAT UL ARM CCH RECORD **t 01 ARRESTED 19910629 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA236-2-2A ASSLT CAUSE INJ DOMESTIC TRK#: L39988701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA236-12 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988701 RESTITUTION SENTENCE DISP EVE DAT JAIL 45D 19911011 PROBATION lY 19911011 SUSPENDED 225D 19911011 BATTERERS AND SUSS ABUSE TRTMNT 02 ARRESTED 19911018 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-11 VIOL NO CONTACT ORDER TRK#: L39988801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST'COURT • COUNT NO- 01 IA STATUTE IA236-11 VIOLATION NO CONTACT ORDER CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988801 SENTENCE DISP EPP DAT JAIL 35D 19911022 COURT COSTS 5D CREDIT POR TIME 19911022 03 ARRESTED 19911122 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 1ST TRK#: L39988901 Feb. 28. 2014 11 : 56AM Div of Criminal Investigation No. 4091 P. 3/7 DCI 00421716 PAGE 2 OF 3 • COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2 OWI-2ND OFF CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39988901 SENTENCE DISP EFF DAT JAIL 360D 19920508 DL BARRED 6Y-PAID SURCHRG FINE $750 19920508 04 ARRESTED 19920116 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 02 IA STATUTE IA908-2-2 -2-ASSAULT CAUSE INJURY TRK#: L39989002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-2-2 ASSAULT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39989001 SENTENCE DISP EFF DAT JAIL 1200 19920508 1150 CREDIT 05 ARRESTED 19920116 A AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA702-18 WILLFUL INJURY . TRK#: L39989101 COURT DISPOSITION AGENCY: 1A052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708-2 ASSAULT WITH INT TO INFLICT SERIOUS INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39989101 SENTENCE DISP SF? DAT PLEAD GUILTY 1150 CREDIT 19920508 JAIL 3600 19920508 06 ARRESTED 19920705 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321A-32 DRIVE W/REVOKED TRK#: L39989201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT Feb. 28. 2014 11 : 56AM Div of Criminal Investigation No. 4091 P. 4/7 DCX 00421716 PAGE 3 OF 3 COUNT NO- 01 IA STATUTE IA321-210 DRIVING WHILE RVKD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L39989201 SENTENCE DISP EFF DAT FINE $50 19921007 PAY SURCHRG 07 ARRESTED 19971007 • AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 POSE SCREE) I TRK#: 037284301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE 1A124-401(5) POSS CONTR SUBS-SCH I-MARIJ CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 037284301 SENTENCE DISP EFF DAT PINE $300 19980114 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OP 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. NE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION