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Home My WebLink About20-015IDENTIFICATION NO. 20 �0/� _ 1 (Office Use Only) - -4 CITY OF IOWA CITY APPLICATION FOR TAXICAB) MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Slrcct Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)356-5040 (319)356-5497 FAX First Middle Last 1. Name (REQUIRED) Theodore Alexander Ballantyne 2. Address (REQUIRED) 4890 Orval Yoder Tpke 3. Contact Information (REQUIRED) Email: Bal lantyne099(agmail. com Cell Phone: N/A (All Written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 09105/2022 b. Taxicab Business Name (REQUIRED) Yellow Cab of Iowa City 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When— Simple hen -Sim le Misdemeanor Iowa City, la 20137 t 5f") 2-j I ; What happened to the charge? (Circle one) -- r.3 Convicted Dismissed Deferred Suspended Plead Guilty Other Guilty Plea/Paid Fine 7. Have you been arrested/ charged with any traffic offenses in the last five years? NO 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? NO 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) NO 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a v lid Driver's license number 435ZZ2245 issued on 08/01/2014expinng on 09/05/2022 . 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 atl 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 Dale al ««««««««»««++««+xxxxxxxxx»xxxxx+«x+x«««««+«««.«x+xx«xxxx.xxxxxxxxxxxxxxxxx«x«xx««xx«««««««««+x«+xxxxxxxxxxxxxxxxxxxxx«x,x«x«»«x«x«x««««+« STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by r tNc e d rC Al2 on n� = ar t0 ; ,ten Cl, . 1 r... . I this day of 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 Driver's license Sian of Pali ief or designee Date 1APPROVAL BY THE CITY CLERIC YOU ARE AUTKORIZE13 TO DRIVE ATAXICAB IN IOWA CITY FOR NO THAN ONE YEAR FROM THE DATE LISTED BELOW. Office Use Only Approved application DCI report State certified driving record Website update Date Clerk/ DRIB GEA W014aman .DOC 07/2016 �klFelb. 112020 3:21 PM Cap PCI IOWA ffArAy83g2No.0064 P. 1/2a0os 07JFEb.12.2020 7:56AMcw DCI ls(3k (AMISSWZNo.9826 P. lwjoo2 s . STATE OF IOWA C adl6 dory Record Check fi Request Verbaur -fD� 1DCIAwouutNpmbw: 99677 FEB 13 2020 .r(ifpydR.b7e) dMuts to, love lon � � I)JtV OF CRIMINAL INVEST tsg�egeel i7.ns Ye &e6ofh"c1ey Bvppmt op'emfiew Burea� l,�TIOIN _. 219 K 76 8teeat, AAeewt . �.Q. Hdx 428 Deehleiles;)00 Y logo... `;, 'Mfl)TXf-404f 4011)P 1 FOR I"Mcn le" 52114 1!)72�6080Ifx T lg'fEQ TA Ti T ISpL opFRN HF.._C10wn� PM i am an &M— C�ltolnai td CJwok on Y As of a ❑ Nolgwtel ❑ IowaGiipiiDalii�mtyl s . .DCdi DCI -77 (Upda2Nd o6-26-Wjs) 6ce ivel• Time Feb. 6.` 2b2a '10: T! Received Time Feb. 13. 2020 3:10 'the pe'a«Nkd auto erad. date,ofblrtfs xvveeled: :ocUA fmxod weh DCI rd attaaited, Dc[ f0 i s. No. 6904 No. 0053 +u'GP9�1F}�IIYv�W�iyY�1�Y1 OAt�� .kVw'�.�.+wwuau! OYII IIIWIw � W'�Jn pT FEB: 017 6 201.0 OF CRIMINAL INV � Paget oft , `4 Feb. 13. 2020 3:22PM DCI IOWA No. 0064 P. 2/2 IOWA CRIMINAL RIOTORY DCI:00400312 NAME: 9ALLANTYNE,ALEX BALLANTYNE, ALEXANDER THEODORE BALLANTYNE,THEODORE ALEXANDER DCI 00400312 PAGE 1 OF 1 DATE PRINTED - 2020/02/13 OB SEX'C~FIaT—WGI�EYE'—t.43RSFfi� 19710905 M W 600 240 BRO BLK MET] IA ADDITIONAL IDENTIFIERS CCH RECORD *" 01 ARRESTED/TAKEN INTO CUSTODY 19900121 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 EA STATUTE IA321A-17 DRIVING U/sUSP TRRB: L17421401 COURT DISPOSITION AGENCY: IAUS2015J COUNT NO- 01 DRIV UNDER SUSP TRX#: L37421401 SENTENCE FINE JOHNSON CO DIST COURT IA STATUTE: IA321A-17 $150 PAID SURCHG DISP EFF DAT 19900423 An arrest without disposition isnot an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of Identification is a public record but can only be released to non -law enforcement agencies by the DCI:. This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to requeWt the releasa of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found On the Iowa Sex Offender Registry: http%y/www.iowasexoffender,com/.. However, even though some information is available on this Bite, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code Section 232.147(18). IN THE ABSENCE OF FINGERPRINT$ 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 a N b N C5 Y -{{ rn a, m C_0 -I f*1 E ;`O y CO rn 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 requeWt the releasa 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%y/www.iowasexoffender,com/.. However, even though some information is available on this Bite, 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 FINGERPRINT$ 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 a C,4010WADOT SMARTER I SIMPLER I CUSTOMER IIRIYEfE WVtN�+.VDUWadC3t �(7� Dnvtr a ;Zwiftatlon Sarvic&s PO Sox 920.4 ; Des #Aches IA 5030&9204 Phone 1515-2.447-9123 1 Fax 515.239-1537 Certified Abstract of Driving Record Inquiry Date: 2/6/2020 DL/ID #: 435ZZ2245(IA) Customer #: 2956512 Name: Ballantyne, Class: C ID Status: None Theodore Alexander Address: 4890 ORVAL YODER Audit #: 8314432 DL Status: VAL TPKE SW Issue Date: 08/01/2014 CDL Status: NorLa� N City/State: KALONA,IA Expiration Date: 09/05/2022 CDL Cert Status; Norfe 522479234 rT'I Endorsements: NONE CDL Med Status: - NorW Na Mailing Address: 4890 ORVAL YODER Restrictions: NONE Restriction -^� ,.None— TPKE SW Supplement: r— Date of Birth: 09/05/1971 `� M Mailing KALONA, IA Sex: M%'� City/State: 522479234 _ History Information CLEAR DRIVING RECORD Name: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 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: Name: Ballantyne, Theodore Alexander DL/ID: 435ZZ2245 2/6/2020 j5v&::�'7 Driver & Identification Services Iowa Department of Transporation