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Home My WebLink About14-019 Authorization Number I r 1 (Office Use Only) 'AMPZ.®r -�► MMM IZE qr. 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 irst rjr. fle f Last AI eXAName � y( r t 2. Mailing Address � 1 rlS b7�/1`JV� C- 522 S 3. Telephone: Home 3/ ��6 -/ q77 Other: 4. Prior experience in transportation of passengers: 5- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ! v Q 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? ki C Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense ' Where When Qkks 1 cti 026 4 /2 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Nit) 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) N 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 7l Y Q kl( 7 . I understand that if I falsely answer any questions in this application, that this application may be defied. 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 k\--U4_,O VI A LUS(N1 Date Cl 1 2 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by V.e UQ VL- A i `I S cm, . On this ,:.)--q--1-6\-- day of __j //_ , (,-e__ ,L' /LA. {{(e IE K.TUTTLE Notary Public in and for the State of Iowa Dn,lumber Llitsi5 Cc, ..•r iso n Expires _L._ 5 1� ************************************************ ** * * ************************************************************************************ 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). - 4,-,_• 25 ,2, ,/ Signa re of P•. Ice Chi- "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. :_F��\. .....,-,f ,...,-._.,9,\,,) \ VD-.4-Alc) Li\ Si9n ofCItY Clerk\or'designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerknaxidnvbadgeapp2010.doc 03/2013 Jan. 21. 20144 9: 59AM,AI Div of Criminal Investigation J No. 1005 P. 1/1 V II. 1). G V 14 L. V T,I/I VI l ) VI VICIA VI .7 IJI ,v n o vii y NU. T L O'f r. L • is STATE OF IOWA *04 ;sr m1, Criminal History Record Check ',i _.. l!d' r, l Request Form• DCIAccountNumber: LiOD,1'F • ((1opplleeble) To: Iowa Division of Criminal Investigation From: City of Iowa City • Support Operations Bureau,i'IFlo or City Cleric's Office 215 E.7th Street . 410 E,Washington Street Des Moines,Iowa 50319 (515)125-6066 Iowa City, IA. 52240 • (515)725-6000 FaX Phone:. 319.356.5041 , Fax:• • 319.356-5 3T �� • lam requesting an Tows Criminal History_Record Check our Last Name(mandatory) First Name(nlendelory) Middle N a(runmmeaded) • AL l�so 11.‘ i<Q h _ MiGQ1 Date of Birth(mandetoryl Gender(menaawrr) Social Security Number(recommended) I Ifa/ Sl la‘a-Io QFemala 4244 74[ DR /v Waiverltlformolleft:Without a signed waiver from the subject of the request,a complete criminal history record may not I be releasable,per Code.of Iowa,Chapter 6912.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. _ Wuiver.Releifse;I hereby give permission for the aboverequasdng official to conduct in Iowa criminal history record cheek with the Division ores:m1nel investigation(DCI). Any criminal history dale A conccminngt k g ma that N minlalned by the C may be released ae allowed by law. WaiverSYguature: -eA_r -mCI Iowa Criminal History Record Check Results (Dcreeeohty, As of 1 \t\\ 1 , a search of the provided name and date of birth revealed: • c' C v, No Iowa Criminal History Record found with DCl . b x in r Cm i cm 0 Iowa Criminal History Record attached,DCI# 0 71 -o c DIM x • o cr — -5 DCI initials r N v Receiverfirni7Jan:-15.))2014 2:03PM No. 0724 r Iowa Department of Transportation C83 i Office of Driver Services (Toll Free)800-532-1121 PO Box 9204. Des Manes, IA 50306 9204 515-244-9124 NIIIIIP FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/24/2014 DL/ID #: 769YY0847 (IA) Customer #: 4292418 Name: Allison, Kevan Michael Class: D ID Status: None Address: 621 1/2 BROWN Audit #: 3925101 DL Status: VAL Issue Date: 12/04/2009 CDL Status: None City/State: IOWA CITY, IA 52245 Expiration Date: 11/29/2014 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 621 1/2 BROWN Restrictions: NONE Restriction None Date of Birth: 11/29/1961 Supplement: Mailing City/State: IOWA CITY, IA 52245 Sex: M History Information Convictions Cit7'-H" ! to ronv.cticn DP ACD Explanation County JUR 01/16/2012 02/06/2012 Improper Registration Johnson IA Name: Allison, Kevan Michael DL/ID: 769YY0847 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: `�ENICLf,p`a .1,e..• �....... %i,l/ 1/24/2014 s4.:' IOWA • ', , * : : 17: clir.e.i.017.r oeseiessick; �..D. O. T.::�% '4,fof.......'. Office of Driver Services �-,,,,�„ Iowa Department of Transportation Name: Allison, Kevan Michael DL/ID: 769YY0847