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Home My WebLink About20-004IDENTIFICATION NO. _ ZC , OO —t (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington strecl Failure to complete the "required" information will resuk in denial of the aovlication Iowa City. Iowa 52240-1826 (319) 356-5040 Last First Middle (319) 356-5497 FAX 1. Name (REQUIRED) S "- Sc 2. Address (REQUIRED) y 9 0) / y c'c^ D r'r f c <✓ r ' ry�y 3. Contact Information (REQUIRED) Email: S11146 �/ r) a—,4"';7 9^q/ Cell Phone: 319 (All written communication sen email c ;, 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: C 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elpwhere? r� 0 Type ofoffense Where Whiii fV 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? /(-O Tvce 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? /yy Tvce 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) NUI ARY) 0/3v 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 have issued to me by the Iowa Department of Transportation a valid Driver's license number �" a 7 f I 41Sf h issued on -Z -QD-/f expiring on / i—dG I -Q61 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 51 Cha ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant / -(/ Date/ —1 L)' � D o� 3 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by '�!C L, on this lflt day of 2-02-0 ASHLEY A JAY-PLATZ Com mission No. 785030 Notary Public in a fo to of I ., My Commission Expires rows July 14, 2020 _y I have reviewed this application, DCI report, and the State certified driving record of this applicantrefd havg deter Mi ed that there is no information which would indicate that the issuance would be detrimental to the safety�lea�th druelfatg of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). N N Expiration date of Driver's lic e I Z -Z L (o 0l -/G -7_a7! Signature'ofidia 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. Of City Office Use Only Approved application DCI report State certified driving record Website update / —/D Date oe*/TMORN64DGEA 9201ftm nC DDG 04/2016 01!0312020 15:57 Yellow Cab (FAX)319 338 2708 STATE OF IOWA Criminal History Record Check Request Form DCI Account Number: 9967-F (if sWiable) Man or Pax completed fb= to: Send results to: Iowa Division of Criminal Investigation Support Operations Bureau, 1w Floor 215 E. 71d Street Dos Moines, Iowa 50319 (515) 725-6066 (515) 7554080 Pax I am reouest iar : ac Iowa Criminal History Record Cbeck on: Name X0110w,Cab of Iowa City Addren P.O. Box 428 Iowa Clry, Lowe =0 Rhone (319) 339-9777 Fax 319-339-4142 P.001l002 Iowa Criwinal HistoryRecord Check Results (oa.00fy) As of Lo a search of the provided name and date of birth rovoale;lr p LATL-' OF IOWA/DPS No Iowa CrimirAl History Record found with DCI JAN) 0 6 2020 L; F C31MINAL INVEST ❑ Iowa Criminal history Record attached, DCI # I DCl initiais__jL� . DCI -77 (updated 06-26-2018) R.r.iu.a Tim. .I,. 1 1A1A A'd7PM Nn -3110 Page 1 oft 1 4 _'. r;COpYO9epd0�i1 —alp, i47q VMale OFemale �� . ' sio ';per§dbnd eaa'Y 0 0 -. ik pis aRtttroed 6 1Nrr; IN My b � ' ' C• r ' " cfdbo foatr�'yr'i,'a'dm oe1°'1�a�'�•Bk��C;ufidi�Wi UI61�(on Ot _ 4 119�1blv�d��ylett' iundZrlWxl.this can lnoLldo, Iowa Criwinal HistoryRecord Check Results (oa.00fy) As of Lo a search of the provided name and date of birth rovoale;lr p LATL-' OF IOWA/DPS No Iowa CrimirAl History Record found with DCI JAN) 0 6 2020 L; F C31MINAL INVEST ❑ Iowa Criminal history Record attached, DCI # I DCl initiais__jL� . DCI -77 (updated 06-26-2018) R.r.iu.a Tim. .I,. 1 1A1A A'd7PM Nn -3110 Page 1 oft DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidentiai 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). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowasexoffender.cont/. 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). ti a o a C-) r— r N N 004,10 WADOT SMARTER I SIMPLER I CUSTOMER DRIVER www.lowadotgov DrIver 6 kl aNrkatt m 84n ic" PO Box 92041 Des Moine& IA 6090&WU Pfine 51'5-24491241 Fax 515259-1857 Certified Abstract of Driving Record Inquiry Date: 1/3/2020 DL/ID #: 259DD5747(IA) Customer #: 4630458 Name: Tustin, Scott Harden Class: C ID Status: None Address: 4921 HERBERT Audit #: 3631717 DL Status: VAL HOOVER HWY SE Issue Date: 02/22/2019 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/26/2026 CDL Cert Status: None 522408062 Endorsements: NONE CDL Med Status: None Mailing Address: 4921 HERBERT Restrictions: NONE Restriction None ry HOOVER HWY SE Supplement: o Date of Birth: 12/26/1974 Mailing IOWA CITY, IA Sex: M City/State: 522408062 C�-< ^W- History Information - C-) M m E5 CLEAR DRIVING RECORD IV rV Name: Tustin, Scott Harden DL/ID: 259DD5747 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: g4paM1N£MT oc 1pgtis$6� 4 7, L `J= Name: Tustin, Scott Harden DL/ID: 259DD5747 1/3/2020 Driver & Identification Services Iowa Department of Transporation