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Home My WebLink About19-085CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. I q -0 O'S (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 1. Name (REQUIRED) Flay'KKSSe* y6wry 1984n 2. Address (REQUIRED) LE I+ �aF�f 5fi, Zoz✓x 641,,, R 522�t 3. Contact Information (REQUIRED) Email: ms -ho 21Ca q= a1Lc� Cell Phone: 304-375=3460 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) I?' l8'-ao2.2 b. Taxicab Business Name (REQUIRED) Yell&u, CA d1 ,0= a4r 5. Prior experience in transportation of passengers:23 yea,I- cine. rka -Anxis , 54, , +J&or i t„ ewk�n Yn&w (�, /'9ar u;s -r" i 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? ho Tyne of offense Where W hen NOV 18 2019 City Clerk Iowa City, Iowa 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? no Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /?0 Type of offense Where When 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) no (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 J 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 Department of Transportation a valid Driver's license number Lh30 www -55? issued on /0-29-20/'expiring on 12-!8'-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 Applicantaxd �- Date 1— i8 -2o jQ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to Qcvek��\vae r 2 o l 9 I have reviewed this application, DCI report, and the State certified driving record of this 4mtf,t crape ., terminad that there is no information which would indicate that the issuance would be detrimental to th s hef � * flare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Drive ' 11 e NOV '- 8 2019 City Clerk i� Iowa City, Iowa it /e i9 Signature 015olice 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. Office Use Only Approved application DCI report State certified driving record Website update 0eA IDRTVa DGE�9201Bamen ,DOC —ig-1 Date 04/2018 v,o,Nov.14,2019 10;43AMc,a„,DCI IOWA 319 3665497 r 11/07/2019 11:04N0. 8337.3 P. 112/002 To: Iowa Division of Criminal Investigation Support Operations Bureau, 1” Floor 215 L 7" Street Des Molnes, low& 50519 (515)725-6066 (515)725-6000 Fax am requesting all IR'�LS M t{S'.f" 12-1 e-- c 4 60 �t:rri DCI Account Number: C17a (iiapplicable) From: CJQ ofIowa Ci City Clerh's Offfee 410 E, Washington Street Iowa Ci Y, IA 52240 phone: 319-356-5041 Far: 319-356-5497 MbTele ❑Femaje NOV 18 1019 1811 Qh �f ?s— 40—Vf71 rrarver [njormation; without a Rigged walver from the subject of the request, a complete crlmiaal history record may not be releasable, per Cade of Iowa, Chapter 692.2. For coaR ete criminal history record information, as allowed by law, always obtain a waiver signature koro the subject of the request Waiver .Rejea"..1 boroby give pamisrion for d,c above requesting oaiolol to conduct no Iowa c imine) Nstory rewrd cher with ae Division ofCalminal fnvaetiwrion (DCI). My atimi,ul Idcmcy gam wnmmine me mel Is metntained by Iha DCi may be mleued as allowed by law, Waiver Sirmature: vP a - n _ _.b_ . _ ., Iowa Criminal His Dry Record Check Results f�S Of �� 9"') ONa.... nnln............. N, „(DCi case only) 0 a search of the provided name and date of birth rrca a(di}?t at to"I ""'o,,. P--Mrfowa Criminal History Record found with DCI = d = u . L, a Uu $_ sr Iowa Criminal History Record attached, DCI # go +� N DCTinitieds ry;ggr glnipuugUl\\PO DCI -77 (08/25/10) Received Time Nov. 7. 2019 9;48AM No -7560 Nov.14.2019 10:44AM DCI IOWA No. 8331 P. 2 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 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), 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(18). FILE® NOV 18 2019 City Clerk Iowa City, Iowa . � wiowadotgoy SWRtER I SIMFLER I CUSEC7,kAEr, JF ,: DmW & 101094 ation Satviars POScxT44sDes Wilm IAf,`Y40& Ply,ne 5+5-743-91241Fall SUC73n-I837 Certified Abstract of Driving Record Inquiry Date: 11/18/2019 DL/ID #: 430WW8558 (IA) Customer #: 1306832 Name: Rasmussen, Perry Class: D ID Status: None Allan Address: 414 Pleasant St Audit #: 8571396 DL Status: VAL Issue Date: 10/29/2014 CDL Status: None City/State: Iowa City, IA 52245 Expiration Date: 12/18/2022 CDL Cert Status: None Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 414 Pleasant St Restrictions: NONE Restriction None Supplement: Date of Birth: 12/18/1960 Mailing Iowa City, IA 52245 Sex: M City/State: rr� History Information CLEAR DRIVING RECORD NOV 18 2019 Name: Rasmussen, Perry Allan DL/ID: 430WW8558 City Clerk Iowa City, Iowa 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 setupon this document, at Ankeny, Iowa this date: Name: Rasmussen, Perry Allan DL/ID: 430WW8558 11/18/2019 Driver & Identification Services Iowa Department of Transporation AcTe"Z-4