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Home My WebLink About14-014 - Authorization Number / 1 (Office Use Only) tel, ww®eRir 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 hdlrl/�/ - /fes' 7 2. Mailing Address 02/ 3. Telephone: Home Other: (QZL 694 )9O 7c 2r 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? yoS 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? /t Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? IA Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? it,/ 1 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) /fV�� 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 w I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ,,2 5 8 A 5L-1 3 . 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 ,.2___ Date //S/26/17 ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,>, A 1,.-r-„t ti C c'11., %is . On this r,Q day of it"ui4a ,r,4 -,IL1 Li t\')LL il A S 1/1--/1 �---,—_ aTAIA`'� WENOY S.MAYER Notary Public in And for the State of I a ICommission Number !L'34Lb 4My Commission Expires low *******,,,.,.x mirw�xxx*�G *#**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). v;greiww.y. 4 ‘d#1k o7X 0Z/17 Signature of Po Chie 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. 2 (ze--1---e",-4%'..4z.-- k�� /-a- 3 - /L'I Signare of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width) and 5'/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerdtaxidrivbadgeapp2010.doc 03/2013 Page 1 of 2 fl Iowa Department of Transportation Office of Driver Servites (Toll Free)X-532-1121 PO Bax 9264,Des Moines,iA 563ISfi-9264 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/14/2014 DL/ID #: 288AE5480 (IA) Customer#: 5342369 Name: Collins,Anthony Class: D ID Status: None Address: 421 6TH AVE APT 3 Audit#: 2885769 DL Status: VAL Issue Date: 01/02/2009 CDL Status: None City/State: CORALVILLE, IA Expiration 12/05/2014 CDL Cert None 522412325 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 421 6TH AVE APT 3 Restrictions: NONE Restriction None Date of Birth: 12/5/1972 Supplement: Mailing City/State: CORALVILLE, IA Sex: M 522412325 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/01/2011 10/28/2011 S92 Speed (10 mph&under in 35-55 mph zone) Johnson IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 02/13/2009 494175 IA Name: Collins, Anthony DL/ID: 288AE5480 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: `1E...... p'�4� $4.wc: 1/14/2014 /*: IOWA *"' ',,fit D. 0. T. 1/44 nbR� Offowlaeof Driver Departme tServices of Transportation 1/14/2014 Page 2 of Z Name: Collins,Anthony DL/ID: 288AE5480 1/14/2014 Jan. 17. 2014 11 : 56AM Div of Criminal Investigation No. 0920 P. 2 . on. 14. [014 1 :4Lr'vi city leierk - Lily oT Iowa city No. 4251 Y. 2 -;ir,r in--.., STATE OF IOWA `��lo Iif? Ir k"\ Criminal !•!istory Record Check ' ••:;t•;': i '' IOWA.,1 \. .6 Request Form '% ' ;..,,; ,, r biro)':°. tit\ ACI Account Number: t4C704G- ,`1 (tfapplitOle) To: Towa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau,1.'`Floor City Clerk's Office 215D.7d'Street 410 la.'Washington Street Dere Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725.6000 Fax Phone: 319-356-5041 • • Fax; 319.366.5497 I atnrequesting an Iowa Criminal Histo Record Check on: Last( / " Name e (mendaloty) first Name� (mnandatory) Middle Name(recommended)Date of Birth (mandato ) • Gendderr(nand) iy) Social Security Number(recommended)rei 177f. 7 Malo °Female �� 20 �/ _ 2,.2aion: Withoutusignedwaiverfromthesubjectoftheroguest,acompletecriminalhistoryrecordmaynot ber Coda of Iowa,Chapter 692,2.For corplotq criminal history record information,as allowed by law,always obsignoturo from the subject of the request. Waiver Release:thc:chy giVo permisslon foe rhe oho we requesting offiebl to conduct an Iowa criminal history record cheek Oh rho Division of crint/nal Investigation(DCI). Any celminathbiory data concerningmethiti oinlainedbylhaDClmay 6ereleased asallowed bylaw. Waiver Signature., . <a ._ --- ' r . Iowa Crimin istory Record Check Result! (Musa only) As of, \\\ \ 1'-{ , a search of the providednatno•and date ofbirthrevealed: ci { 0 No Iowa Criminal History Record found with DCI in-II -- n 'i n 'L' '..:;d5 (� G'2' —0 VSA lea' Iowa Criminal History Record attached,DCT#" I4 �--•i-'_ c� O a- r 7 N A DCIlnlllals 07 Received Time7Jan. 14. 1)2014 1 :41PM No. 0615 • Jan. 17. 2014 11 : 56AM Div of Criminal Investigation No. 0920 P. 3 IOWA CRIMINAL HISTORY DCI 00916489 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2014/01/17 OCT:00916489 NAME: COLLINS,ANTHONY DOB SEX RAC HGT WGT EYE HAIR SRN POB 19721205 M B 605 280 BRO ELK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y CCH RECORD *** 01 ARRESTED 20101130 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#: 1A00AOU01 COURT DISPOSITION AGENCY; XA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.2A(2) (B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSE(SRMB COURT CASE ID: 06521 SRCR0926B9 CHARGE CLASS: NON CONVICTION TRIO: 1AOOAOU01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20110330 PROBATION lY 20110330 UNSUPERVISED PROBATION TO DCS DISCHARGED FROM 20111110 DEFERRED JUDGEMENT • 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 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. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Vt