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Home My WebLink About19-013IDENTIFICATION NO. - 14 -0313 l 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)356-5040 (319)356-5497 FAX First Middle Last 1. Name (REQUIRED) Theodore Alexander Ballantyne 2. Address (REQUIRED) 4890 Orval Yoder Tpke 3. Contact Information (REQUIRED) Email: Ballantyne099(agmail.com Cell Phone: N/A (All written communication sent via email) 515 q'le1'jt}'�D 4a. Driver's License expiration date (REQUIRED) 09/05/2022 b. Taxicab Business Name (REQUIRED) Yellow Cab of Iowa City 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Simple Misdemeanor Iowa City, la 2013? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Guilty Plea/Paid Fine 7. Have you been arrested/ charged with any traffic offenses in the last five years? NO Type of offense Where When What happened to the charge? (Circle one) 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) NO 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 435ZZ 245 issued on 08/01/2014 expiring on 09/05/2022 . 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 Date ALIS/ I �i aaaaa+aaaa.a«aaa.aaaaa»«aa«eeaaw«a«aaaaa«aaaaamaaaa»aa>saaawaaaaaaaa«aaaaaaaaaaaaaaaaaaaaaaaaa«aaaamaaaaaaaaaraaaaaaa.aaaraaa«:a«a«a«aa STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by —11,ceke rt: Pr Z.)6tLEg on this S day of 701.x( SQA C%, M.111 L a �OSLCai /tai oar WENDY S. MaYER Notary Public in d for ie�e of lovffi 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 'ea of _0S Signature of Pe ice Chief or designee Date i 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. Ignat re of City Clerk or de nee / 1 Date =A ._,.,«,«aaaaaaaaaaaaaaaaaa«.a..a«aaaaaaaaraaaaaaaaaaeaaaaaaaaaaa.aaaaaaaaaa«aa+aa.aaaaa+«.aaa.a»,..,««.»_«.••»a.«.�*•»•••......••••» Office Use Only Approved application DCI report State certified driving record Website update Cl.h AXIDRIVMDGEAPPL92014a MW DOC 07/2016 C � I Cl.h AXIDRIVMDGEAPPL92014a MW DOC 07/2016 Q4191 4610WAI)OT MA www.iowadot o� SMARTER I SIMPLER I CUSTOMER DRIVEN DdNer & Wentiftatlon 7 woo PO Box M i Des Moines, IA 50WD M Ph" 516?44-91241Fax -5162991&77 Certified Abstract of Driving Record Inquiry Date: 1/15/2019 DL/ID #: 435ZZ2245(IA) Customer #: 2956512 Name: Ballantyne, Class: C ID Status: None Theodore Alexander Address: 4890 ORVAL YODER Audit #: 8314432 DL Status: VAL TPKE SW Issue Date: 08/01/2014 CDL Status: None city/State: KALONA, IA Expiration Date: 09/05/2022 CDL Cert Status: None 522479234 Endorsements: NONE CDL Med Status: None Mailing Address: 4890 ORVAL YODER Restrictions: NONE Restriction TPKE SW Supplement: None Date of Birth: 09/05/1971 Mailing KALONA IA Sex: N City/State: 522479234 History Information CLEAR DRIVING RECORD Name: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 Pursuant to Iowa Code §321.10, I, 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: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 1/15/2019 d-92--4-121 Driver & Identification Services Iowa Department of Transporation 011Jan_30_201.9j;-1:_56PMCab DCI IOWA 0:40183182No.2130 P- . 1/3,1002 17 1 r: STATE OF IOWA Criminal History Record Check '' . Request Form To; Iowa Division of Criminal Investlffation Support Operations Bureau, Jr.)' poor 215 8.7, Street Des Moines, Iowa 50319 (515) 775-6066 y (515) 72-54090 Fax Iam requestingan Iowa Criminal His Jtocord Check on: Y _ . 1T- - bCI Aocount Number: _9967-F (ifapylleebls) From:yellow Cab of low& City $.O. Boz 428 fowa City, YA. 52244 (319) 338-9777 Phone: Fax. Q19) 339-7302 a,aac isarue 'First Name (m.nd.e y) Middle Name (r.eomrn.ii . Date of Birth .nda[ery) Gender (menduory) 'Social•Securi Number rewauoso C1 Is 1q-1 Male Elremale _ _0 Waiver 1%formation: Without a atoned waiver from the subject of the request, a Eomplete criminal history record spay not be relemable, per Coda of lows, Chapter 692..2.For comGleta criminal histoly.reeord informsW on, aq allowed by taw, simys obtain a waiver si afore from the sub dctwfthe request Wiz ver Release: i hereby 0c pvmission fur the'ibove.requesting official to conduct an lows crimimd hint q. record check with the Division of InvesGa.tivn (DCI), CriminalMY �m6W hlrmry data eanrxmin'me nut is malnnined by fho DO may be ralesaW aYallowA by Imv. ' WafverSlgnaturrr (DCT on only) As of 1�3 per, a search of the piovitded name and date of birth rev taled: ❑ No Iowa Criminal History Record found with DCT STAT OF IOWAIDPS J N 24 2019 -Iowa Criminal Mstory I.eeord attached, DCI # Q 3 DIV OF CRIMINAL_ INVEST DCI iz idala� � DCI -77 (06/25/10)' Received Time Jan.24, 2019 10:15AM No, 1089 Jan.30.2019 1:56PM DCI IOWA No.2130 P. 3/3 IOWA CRIMINAL HISTORY DCI:00400312 DCI 00400312 PAGE 1 OF 1 DATE PRINTED - 2019/01/30 NAME: BALLANTYNE,ALEX BALLANTYNE,ALEXANDER THEODORE DOE SEX RAC HGT WGT EYE HAIR SKN POB 19710905 M W 600 240 BRO BLK MED IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRBSTED/TAKEN INTO CUSTODY 19900121 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321A-17 DRIVING U/SUSP TRK#: L37421401 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 DRIV UNDER SUSP TRK#: L37421401 SENTENCE FINE JOHNSON CO DIST COURT IA STATUTE: IA321A-17 $150 PAID SURCHO DISP EFF DAT 19900423 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. This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(15), Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowasexoffender.com/ . However, even though some information is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(15). 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 Jan.30.2019 1:56PM DCI IOWA Kim Reynolds Governor Adam Gregg Ll. Govemor To Whom It May Concern: No. 2130 P. 2/3 Department of Public Safety Stephan K. Bayens Commissioner The Iowa Division of Criminal Investigation believes the attached record is the same individual as the subject of your request. If you feel that these results are in error, you may provide fingerprints for positive identification. Please contact our office at 515-725-6066, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday with any questions or concerns. Thank you, Iowa Division of Criminal Investigation OMSION OF CRIMINAL INVESTIGATION • 215 EAST 2' STREET a DES MOINES IOWA 50319.0041 •515-7 6010 Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service