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HomeMy WebLinkAbout19-080I r l CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. jq -0'3� (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 Last First Middle 3. Contact Information (REQUIRED) Email:(/��iv� an C,Nr 77 ) ' J Cell Phone: fnn; ) ©(1�written communication sent via email) 4a. Driver's License expiration date ( b. Taxicab Business Name (REQUI 5. Prior experience in transportatior 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead ®Iq 97ther 7. Have you been arrested /charged with any traffic offenses in the last five years Type of offense W here it ��A A n 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? Y) -6 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 REQUIRED SIGNATURE AND NOTARY) 04/2018 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 here¢yirtifyal issued to me by the Iowa Department of Tran sportatio v li iver's license number I issued on expiring on understand that if I falsely answer any questions in this application, that this appli do ay be denied. I a ee t t In m ing 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 &-,-,LaCh— ___� Date" STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A mv% --T. on this L day of NtD')P"_a- 1'-19. 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 Dr r' cense 01 1 n- � Signatu of Police Chief or designee co 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. l(-5-19 Date Approved application Office Use Only DCI report State certified driving record Website update CIedVTAXIDRIVBADGEAPPL92018am nded.DOC 04/2018 10r2dizu1m Ib:5bYellow Cab fAA)319338Z7Q r.u02I002 STATE OF IOWA Criminal History Record Cbeck Request Form . 1, #1 DCI Account Number: 9967-F Of ♦ppHable) Mall or Fax completed forms to: Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E. r Street Dot Moto"$, Iowa $0319 (515) 725-6066 (515)725-6080 Far I am reauestwR an Iowa Criminal History Record Cbeck on: Sendrasttlts to: Name 'Yellow Cab of Iowa C1 Address P.O. Box 428 Iowa City, Iowa $2244 Phone (389)3 8-9777 _ Fax 319-359-4142 M'R °`a,RIOi ' n ..<i.� \r.A .:. • ..:1 `ll'y �•� W.Y. _ +�� ..r.. R W 1' 1"�.�� L �i illddd �',- QMale El Female - � �, ; ; ^aS a Rta+ap'pjlyt .. L e,4u Yr e !rOc6 �_ ,� 9 �f7.� L J`.l\U 1' 'i 'IW`M3l� { }..T� tLy^s } '�c_]"�.att' __.:__ ��! �o" •L -'ilfyVl�t \�4 Vit H 7 • ase+$n xoxe � ease.aa oiiaah`on:form�fr.fiJis e,.., �, >ti t '.- ri,.• � �ti 1".,. �S- y f Y 'sd ' y f y� t q 4 Y•'� ,-`- � ��y'""-�.•pi.ywi rs..� &X£`' :• < 5�`�i G'- au i^ -i ' '/fir y'i4ti 'QOM' -`�f L ' � �' r ,� ' 1' 1 •b �i w{i' 1a�4�`�A��'O"�9,�'S��1�Oduci,p�v3 eomsmat'bia �er3 xfi�%`wail'1,�,raTA�aWn a[. 5;� rw' �, h � �1 �� % d 14 W-1� I / 1 J IYy„ 1Y , L N U' �' ry I eV t` I..? xi�:'i.�K.a'�n `�•.��.«� .. '. 'k�T+��1_'_:. S_ ti ._.....� ... ._: � .. _ ....c.. o.e_ . - .e.n. � � l,• As of k �A 1 ` / , it search of the provided name and date rn lrth repealed. 0 r u( ' ❑ Iowa Criminal History Record attached, ICI # ° ° °''t° p h .gq:r6giluu tln•Np;J+P�� DCT initials DCI -77 (updated 06.26-2016) Received Time Oct, 28. 2019 3:45PM No. 6161 Page 1 oft a DISCLAIMER 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 W011110601, h oil, the Division 01 C14mine! Investigation. in order to request the r-Wease 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: http://www.fowasexoffender.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(18). N Q v^ cn w4, Y �i ^pt mmnma co �t� c )0A00fn 10WA00T li SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowedotgov Drhw & id4rNYkatlon SNviws PO Box 9204 I Des Mines. IA 60306-9204 Phone 515-744-9124 1 Fax 51 5-Z3B-1837 Certified Abstract of Driving Record Inquiry Date: 10/28/2019 DL/ID #: 831AA6031(IA) Customer #: 393832 Name: Anderson, Aaron Jay Class: C ID Status: None Address: 207 LAKE PARK Audit #: 1787780 DL Status: VAL BLVD STE 8 City/State: MUSCATINE, IA 527615406 Mailing Address: 207 LAKE PARK BLVD STE 8 Mailing City/State: Convictions MUSCATINE, IA 527615406 Issue Date: 05/03/2017 Expiration Date: 01/29/2022 Endorsements: NONE Restrictions: NONE Date of Birth: 01/29/1978 Sex: M History Information CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 0 Citation Date Conviction Date ACD I Explanation Co intv 3U ..�.. 03/25/2018 04/10/2018 S92 I Seed Washin ton n 41A Name: Anderson, Aaron Jay DL/ID: 831AA6031 G ^ CD Li O W 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: a�4pP4Y fNT OF rAi 9401 h 4 _b Z 10/28/2019 OL Driver & Identification Services Tnwa nonartmont of Tranennratinn Name: Anderson, Aaron )ay DL/ID: 831AA6031 N 0 .rte vl+ati c;1 o og w