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Home My WebLink About19-059IDENTIFICATION NO. 1 9 —0�Oj— r 1 (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) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (3 19) 356-5040 Last First Middle (319) 356-5497 PAX 1. Name (REQUIRED) un - 2. Address (REQUIRED) 2-1 10 til b u b oeoc 57- 3. %3. Contact Information (REQUIRED) Email: QIG MIIIX� CC*t Cell Phone:31`)-S36 a'0 -7r (All written communication sent via email) 4a. Drivers License expiration date (REQUIRED) O) 3 3 6 zto L b. Taxicab Business Name (REQUIRED) 4L^Lt-0v✓ 0046 d7-- :. C 5. Prior experience in transportation of passengers: M►Y +R -d -c>5 (A1,Z I O `1`044 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? O Type of offense Where When What happened to the charge? (Circle one) a 0 Convicted Dismissed Deferred Suspended Plead Guiltyo_ Othet° 7. Have you been arrested/ charged with any traffic offenses in the last five years? 3>0d c Type of offense Where = -<enm r— M v What happened to the charge? (Circle one) cin 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? N 6 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 PAGE FOR 04/2018 4 • Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 epart ent of Transportation a valid Driver's license number d13h 3 Z(s��--- issued on 1076 expiring on /2•Z7 -2o Z6 . 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 55, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican/ c��a( Date O !f xf1+*lNet##'k*#+111t11r1111f!!!f flY1fllYfxx!!!f f!!H!HlrlfYxl4llHlx+Yflxtl x!!M!l1x111`!H!N!fllYflfllYflH1Mt11x'##!!!x!f!!!!H!!fx!!Y!!!l111f STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me IASHLEY A JAY-PIATZ Commission No. 785030 on this o day of 1eR1e##########ik######4f#t#####rfexfef#Rfefe#fete#R##RR*R#*xftRferle#feR#*R#1eRRR1MfeR#feRR##Ne#R/e###Rfe#RRR#tRfeR1[#Rl1e1t1e#RR##xRH##i###1e*#RRR###x+####R#RIe##R#fex 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). Expiratio7�ae nve Inse IZ-Z7-�ZG lcJ Signa of Police 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. rm #+r+++r!lr+++f++++++rxxrxxrrrrrrrrrrrrrrrrrrrrrrrrrxrxxxx##rxxxrxxrrr:v:xxxx+xxx+xxx+x«x+�xxxxxxxxxx�xxxxxxx�#�xx� rrrx�+� Office Use Only - 00 Approved application �rrri n m DCI report a State certified driving record Website update r cn aerkrrAX10RNBADGEAPPL92018ame ded.DDC 04/2018 J 1.24.2019 4 16P DCI IOWA Ohtoeaet7 t4:ar tanvwCab STATE OF IOWA U y CriminalHistoryRecord 1 1 rye..Request1 a To: IoWs bivision of Criminal Invesilgation Support Operations Bureau, 11,Floor 215 E- 7'e Street Des Moines, Iowa 30319 t (315)723.6066 ? (51S) 725.6080 jFax I am requesting an Iowa Criminal History ,Record Chenk rer TAM19 338 I./UG 4 3 9 P r.vv2/002 DCT Account Number: 9967-F (it applloable) : B'lt8t •NAme (taandetoM 'Ml file Namr (reeonunonded) . From: Yellow Cab of 7e'wa Cita P.O. Boz 428 � n ✓ — C7 Iowa Clty, kA tst 7 UI `i e1e ❑Female rJ 4 In r-- � (319) 338-9777 _ m Phone: Fax: (319) 339-7302:--1 —� o o � 13 Iowa Criminal Rigkory.Reoord attached,'DCI j,.a9t Naut0 mandato : B'lt8t •NAme (taandetoM 'Ml file Namr (reeonunonded) . AS of - ! l/ `i/` n search.- theprovided name and date of birth revealed: 0 R Date of Birth (mandatory :Gender mandeio 'Social-SecurityNumber recommended Z% '" l 1 `i e1e ❑Female rJ 4 Wa1verlKformatiolr: 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 by law, always obtain a waiver signature from the suWeet'of the ro uest. M2Ly6r ReLease; I hoteby Alva patrnluloa for thahbovo mquenlne otllolal to eonduq an lttwa criminal historynaafi chink with the Dlvbim of Ctlminsl lAyostl ation (DCh. Any odmlwl hlsmry data aonaem6ns me that Is maintainaadd by the DC7 may be M)ewsd as alioweq by law, Waiver .Signature; �rTy" VAAAAAAALNL XXIMLV1 r A\ UJU %-AAc1:ll x%.cjIAAt`J - (DCI un only) AS of - ! l/ `i/` n search.- theprovided name and date of birth revealed: 0 R to :. o C No Iowa Criminal Histo y Record found with ACT o Z r —� o o � 13 Iowa Criminal Rigkory.Reoord attached,'DCI � m onon DCT initials C__ 7TC to DCI.77 (08/25/10) Received Time Jul, 16. 2019 2;27PM No.9911 Jcl.24.2019 4:16PM DCI IOWA DISCLAIMER No.1439 P. 2/2 This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenlle 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(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. hti ://www.iowasexoffender.com/. However, even though some information is available on this site, the actual records forJuveniles 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(18). N 0 >n D- _O �O a � .,� C r r �m i M o� D� r M D�-�v�'� A0J10WA00 www.iowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN 0" & Idomft tsort solvim PO Box 92011 Des Moines, IA 503064204 Pyrone: $15344-41241 F3x: 515.239.1637 Certified Abstract of Driving Record Inquiry Date: 8/8/2019 DL/ID #: 013BB2642 (IA) CDL Permit Class: None Customer #: 3959505 Class: D CDL Permit Issue None Date: Name: Casella, Michael Peter )r Audit #: 9563241 CDL Permit None Expiration Date: Address: 2110 N DUBUQUE ST Issue Date: 11/10/2015 CDL Permit None Endorsements: Expiration Date: 12/27/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522451624 Endorsements: Chauffeur 3 ID Status: None Mailing 2110 N DUBUQUE ST Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522451624 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 12/27/1956 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 11/01/2009 11/30/2009 S92 .Speed IA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 10/07/2018 IA 1071728 Name: Casella, Michael Peter Jr DL/ID: 013BB2642 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do fteleby 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 recor urrently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certiflt- --{ G-) In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at �1,51lkkny, 19wa this�j�e: --i n CD �f— -L7 I r 1 _m 3 8/8/2019 F d9o"71�)L 'ems C -n Driver & Identification Services Iowa Department of Transportation Name: Casella, Michael Peter Jr DL/ID: 013BB2642 (IA)