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Home My WebLink About18-111r I r 1 QP.- =®64 ftlu;�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX L t IDENTIFICATION NO. /L- L I I (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application First Middle 1. Name (REQUIRED) 6'e-r7^y Alla;' 2. Address (REQUIRED) 'i L( sttnt s ', Zy wTc c n7,:r 3. Contact Information (REQUIRED) Email: i^cts La 21@ Q=ma - 6&� Cell Phone: 30-22!5--3'I'60 (All written communi tion sent via 4a. Driver's License expiration date (REQUIRED) h- l A(l2 D22 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: . e l A= d"'V -da_ Yax !s , sti uj#(V_0 ya.,rff 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere /lo Type of offense Where When v. -,1 i4l What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other ` 7. Have you been arrested / charged with any traffic offenses in the last five years? 1 `1O Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 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) (SECOND 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Drivers license number *30 WW8SSB' issued on 1,4-29-20Pf expiring on /2-/! I understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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 A. � Date 11-2 2 7 STATE OF IOWA ) COUNTY OF JOHNSON ) SSu)Dbsccribeedd Can�torn to before me by _P4fr l Ac_ _1cc,6VLA �ci� „,� on this ;2 day of I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's I' rise /7 -/1, L z 7 Signature ,,gW6lice Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Clerk or Office Use Only Approved application DCI report State certified driving record Website update -7 Date CIeWJTAXIDRNBADGEAPPL92018ame ded DOC 04/2018 Nov, 16. 2018 9:15AM DCI IOWA Fram:Oity of Iowa CITY Clark 0114100 STATE OF IOWA Criminal history Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7"' Street Des Moines, Iowa 50319 (515)725-6066 (515) 725.6090 Fas I am renue"tintr an inwa rriminal Wistniv Rennrd Cheek nn• DCI Account Number: U oCto7 F _... (ifepplfuble) -.--i From: City of Iowa City " ...s City Clerk's Office '�� 410 E. Washington Street T lows City, IA $2240 Phone: 319.356-5041 Fal: 319-356.5497 Last Name (mandatory) First Name (mandatory) Middle Name (recommended) No. 1480 P. 1 319 9866697 11/13/2010 10:20 *7M P.002/002 STATE OF IOWA Criminal history Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7"' Street Des Moines, Iowa 50319 (515)725-6066 (515) 725.6090 Fas I am renue"tintr an inwa rriminal Wistniv Rennrd Cheek nn• DCI Account Number: U oCto7 F _... (ifepplfuble) -.--i From: City of Iowa City " ...s City Clerk's Office '�� 410 E. Washington Street T lows City, IA $2240 Phone: 319.356-5041 Fal: 319-356.5497 Last Name (mandatory) First Name (mandatory) Middle Name (recommended) R4-srnks'ret7, fell-ey M14i) Date of Birth (mendaory) Gender (mandatory) Social SecurityNumber (reconuralded) I a— I S-- 6o 9(Male ❑Female `j' -S' q0 — 61(71 Waiver Information. Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed bylaw, always obtain re waiver signature from the subject of the request. Walter ReleaSe: t hereby give permission for the above Toilmdog official 10 oondou an Iowa "hAnal history record Cheek oft the Division of Criminal Invaligation (DCO. Any alminil history data coaceming me that is maintained by the DCI may be released as allowed by law. Waiver Signature: aa&,S+-- I Iovtra Criminal History Record Check Results (Da utya,ty> As of I 1. 1. to - I a search of the provided name and date of birth revealed:: ; c u y�liJ i1fJ /p(`I No Iowa Criminal History Record foutul with DCI <•�:' ❑ Iowa Criminal History Record attached, DCI # DCIiuitials I/ r " DCI -77 (06/25/10) Received Time Nov. 13. 2010 8:52AM No -0779 -f WWWkwadat.gov SlIVIRiEP4 I Sirrii-LEtt1 IUS10MER DRIVEK Drhw & eaaistidrcatlon Swvidas 11v E cz Y4%1; Des frfcines•. IA Yj&i6 . T,4 Fgt:.ne S5-251 9 4 74 �F�: 51w?",9-b$3? Certified Abstract of Driving Record Inquiry Date: 11/26/2018 DL/ID #: Name: Rasmussen, Perry Class: CDL Cert Status: Allan Address: 414 Pleasant St Audit #: NorK- —,fit t Issue Date: City/State: Iowa City, IA 52245 Expiration Date: Endorsements: Mailing Address: 414 Pleasant St Restrictions Date of Birth: Mailing Iowa City, IA 52245 Sex: City/State: 430WW8558 (IA) Customer #: 1306832 D ID Status: None 8571396 10/29/2014 12/18/2022 Chauffeur 3 NONE 12/18/1960 M History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 430WW8558 DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: NoRg Restriction NorK- —,fit t Supplement: 6 Pursuant to Iowa Code §321.10, 1, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: Name: Rasmussen, Perry Allan DL/ID: 430WW8558 11/26/2018 Driver & Identification Services Iowa Department of Transporation