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HomeMy WebLinkAbout20-001IDENTIFICATION NO. 20 -6n 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) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will resuk in denial of the application Iowa City. Iowa 52240-1826 319 356 5040 ( ) Last First Middle (319) 356-5497 FAX 1. Name (REQUIRED)�gG �CTNcNk2� 2. Address (REQUIRED) FRO I IC»Ai`xh1 1;pta;lS,l 5Z2-77 3. Contact Information (REQUIRED) Email:t �$ Cell Phone: 34-ni-2ir (AD written nication sent via email) 4a. Driver's License expiration date (REQUIRED) 0007/100 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this Type of offense What happened to the charge? (Circle one) Where —1 hen 1 m M Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? Tyne of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ad Gui Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 04/2018 f 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 55SXK3581 issued on 00idloM expiring on OW011TW I understand that if 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-r04� Date i jpholo1 Hf#*fM'Ff4*#4i1ff1kile}fffff l4i'klHklf}fff11f11f11111fN1f111fH11Hff11NffffYff111tMfyif}}11fyf f 11f 1f11f11f'NeMl}}fffffryflffff1f1111f!/rif i}4ff STATE OF IOWA ) COUNTY OF JOHNSON ) f f �� ubscribed and swom to before me by t1 �%i C ti S on this �) S� day of /QtMl�ov 2) 19 - 4 n n � ASHLEY AJAY-PLATZ ' Notary Public i an the My Comm scion Expires I µ r I have reviewed this application, DCI report, and the State certified driving record of this applicint_ri�d h -1e de irlined that there is no information which would indicate that the issuance would be detrimental to the safety, _iealt^or welfarq of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). ,-n Expiration date of Driver's ' ense u 0 L Lp 20 Si re of Police Chief or designee Z-7vZ0 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 aerkrrnxiDRMLADGEnPPL9MII �.DOC 04/2018 rere„Dec, 27, 2019 1:29PMCto,k DCI IOWA 319 38e6A97 12/20/ 2019 09:12No. 341027 P. 1/3.002 STATE OF IOWA Criminal History Recoid Check Request Form To: Iowa Division of Criminal Investig&tion Support Operations Bureau, l" Floor 215 E. 7a Street Der Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax an Check L"JMale DCI Account Number: 4r t�o (ilepplicable) 1`rooi: Cil of IowaCEl City Clerk's Ofllce 41013. Wp9hingicut Street Iowa CIC IA 52240 Phone: 319356.5041 Fal: 319356-5497 r_.- ❑Female n raavcr iryormarson: Without a signed waiver from the ruNcet of the request, a complete erlmina! history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as &Bowed by law, always obtain a waiver signature from the subject of the reauer_ Witiver Release: t Aucby glyc permission for the above rcqucs int oaicid to conduct en lows climinel hinory record chcel, with d„ pivisim n� im'eaugadon (DCO. My eriminel hislory date wnc ing me that is mebnpincd by the DO nuy be mimed m allowed by law. erCrjmi WaiverSienature: ,0 D .....,.,,�._ r e As of 1 e =� a search of the provided name and ❑ No Iowa Criminal History Record found with DCT -E/-Iowa Criminal History Record attached, DCI # 01 DC1 initialsZ.— DCI -77 (09/25/10) Received Time Dec.20, 2019 6:27AM No. 2771 (DC) use only) ^P 9 'P��f d�• (~4�, 0 2019 NALINVEST Dec.27.2019 1,29PM DCI IOWA IOWA CRIMINAL HISTORY DCX 00671923 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - DCT :00671923 2019/12/27 NAME: NEESE,SSTH RICHARD DOB SER RAC HGT WGT EYE HAIR SKN POB 19830607 M W 601 190 BLU BRO FAR XA ADDITIONAL IDENTIFIERS TAT L LEG CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20020526 AGENCY: IA0520200 IOWA CITY PD CHARGE N0- 01 IA STATUTE IA124.401 POSE SCR I TRK#: 100562801 COURT DISPOSITION AGENCY: IAOS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SMSM044101 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100562802 SENTENCE FINE $100 02 ARRESTED/TAKEN INTO CUSTODY 20020902 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 02 IA STATUTE IA713-6A BURGLARY 3RD TRK#: 100647202 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA713.6A(1) BURGLARY 3RD DEGREE COURT CASE XD: 06521 FECR062866 CHARGE CLASS: NON CONVICTION TRK#: 100647202 RESTITUTION SENTENCE DEFERRED JUDGEMENT - PROBATION 3Y PROBATION EXTENDED 1Y DISCHARGED FROM DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA712.5 RECKLESS USE FIRE/EXPLOSIVES - 1978. COURT CASE ID: 06521 FECRO62866 DISP EFF DAT 20030423 DISP.EFF DAT 20030418 20030418 20060418 20061004, No, 3410 P. 2/3 O ti N c A� -i b rn s::0 3 m y� N U1 LO Dec. 21. 2019 1;30PM DCI IOWA No. 3410 P. 3/3 DCI 00671923 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 100647203 SENTENCE DISP EFF DAT JAIL 228D 20030418 FINE $250 20030418 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 -_'w Investigation. In order to request the release of confidential juvenile %3_i records, if any, an application must be filed pursuant to Iowa Code sectioR-< 232.147(18). C-) Additionally, criminal history data concerning convictions for certain 3: juvenile sex offenses can be found on the Iowa Sex offender Registry; http;//www.jowasexoffender.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). 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 N O 0 t_ m Z -a a N Cil ARTS Page 1 of 2 C 00" 10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN wvvw•iowadot.gov Dnvar s Nlanfifieation $011 as PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515.244-91241 Fal, 515239.1837 Certified Abstract of Driving Record Inquiry 1/2/2020 DL/ID #: 555XX5584 (IA) CDL Permit Class: None Date: Customer 4006252 Class: A CDL Permit Issue None #: Date: r.a 0 Name: Weese, Seth Richard Audit #: 3540243 CDL Permit — Norte' Expiration Dak- ` �.y Address: 1720 Madison St Issue Date: 01/11/2019 CDL Permit D S2Nor� , 1 Endorsement Expiration 06/07/2020 CDL Permit—inNoft) Date: Restrictions: -< r— rn City/State: Tipton, IA 527729217 Endorsements: Motorcycle ID Status: MNormc r�7 Mailing 1720 Madison St Restrictions: Corrective Lenses, CDL DL Status: C:):'�VAItV Address: Intrastate Only Restriction None CDL Status: VALykp Mailing Tipton, IA 527729217 Supplement: CDL Permit ELG City/State: Status: Date of 6/7/1983 CDL Cert Status: Excepted Intrastate Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation IUR County 01/03/2015 02/11/2015 S92 Speed (10 mph & under in 35-55 mph zone_) IA Dubuque 06/26/2019 07/15/2019 Miscellaneous IA Johnson 06/26/2019 08/06/2019 Miscellaneous IA Johnson 06/26/2019 08/06/2019 Vehicle Overweight IA Johnson 06/26/2019 08/06/2019 Vehicle Overweight IA Johnson 07/29/2019 10/02/2019 Vehicle Overweight 'IA Linn 07/29/2019 10/02/2019 Vehicle Overweight '.IA Linn 08/29/2019 10/16/2019 B64 No Insurance Card IA Cedar 09/26/2019 10/30/2019 S92 Speed IA ,Henry Name: Weese, Seth Richard DL/ID: 555XX5584 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identiflcatlon 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: http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 1/2/2020 OPIDWADOT vinnrw-i©W i3dot.gou SMARTER I SIMPLER 1 CUSTOMER DRIVEN - DFW*r& Identification i0fv o" Pt? BOX 920411 Des Moir, IA 50006.9204 6' a*: 515244-9124 i Fare_ 515-2391837 Inquiry 12/18/2019 Date: Customer 4006252 Name: Weese, Seth Richard Address: 1720 Madison St City/State: Tipton, IA 527729217 Mailing 1720 Madison St Address: A Mailing Tipton, IA 527729217 City/State: neous Date of 6/7/1983 Birth: 3540243 Sex: M Convictions Certified Abstract of Driving Record DL/ID ff: 555XX5584 (IA) CDL Permit Class: None 10 mph & under In 35-55 mph zone) Class: A CDL Permit Issue None IA ,Johnson neous Date: (,Johnson Audit 9: 3540243 CDL Permit None Dverwelght IA 7ohnson Expiration Date: IA Issue Date: 01/11/2019 N CDL Permit Now i Linn ,ance Card I,IA Endorsement, o Expiration 06/07/2020 CDL Permit -`"_n Wig i Date: Restrictions:>—I Z Endorsements: Motorcycle ID Status: C7� Noj� Restrictions: Corrective Lenses, CDL DL Status: Gln— VAL Intrastate Only •_ rrl Restriction None CDL Status: (ZD Supplement: CDL Permit ;`=� ELGz Status: " CD Citation Date Conviction Date ACD Sanctions CDL Cert Status: EXE pted Intrastate CDL Med Status: None History Information Ition JUR County 10 mph & under In 35-55 mph zone) IA 'Dubuque neous IA ,Johnson neous SIA (,Johnson Dverweight SIA .Johnson Dverwelght IA 7ohnson Overweight IA Linn Dverqhweit—_ IIA IA i Linn ,ance Card I,IA (Cedar type Effective End ACD Explanation IUR Oc_c_urre_n_ce_ 3_U_R_ _ suspended 1/21/2020 JINDEFINrrE ID53 I Non -Payment of Iowa Fine IA IA Name: Weese, Seth Richard DL/ID: SSSXX5584 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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