HomeMy WebLinkAbout20-057i r t
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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iorca 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
IDENTIFICATION NO. ol,Q - US i -
(Office Use Only)
APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday)
Failure to compiete the 'required" informatiun wiii result in denial of the application
Last
First
2
e(
L-
2. Address (REQUIRED) 2110 N ±)O'tU(?yG
3. Contact Information (REQUIRE__. Email: 616 kt iyrr -(14 Cell Phone: I I9-43 G -a0-15-
T(All written communication sent via email
4a. Driver's License expiration date (REQUIRED) Dt -3.R6 2( rt -Z
b. Taxicab Business Name )i EQUIRED) yrU-0 J CA -d
5. Prior experience in transportation of passengers: I YriAR6 6 2t ✓rrV_e (!_p, 6
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? No
Type of offense Where When
What happened to the charge? (Circle one) -
Convicted Dismissed Deferred Suspended Plead Guilty Other `.,J
_1
7. Have you been arrested / charged with any traffic offenses in the last five years? 06
Type 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? ACU
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)
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).
's license
I hereby certify that I have Issued to me by the Iowa Department of Transportation a valid Driver' understand umbf I
er
()I!)t>R �l NZ Issued on 114 a �, expiring on
falsely answer any questions In this application, that this application may be denied, 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
imes with all oftheprovisions t
of Tittle 5, Chapter 2, of the City Code. (Needs to be signed n front of granted, Notary Pub ic)y et al
tl
7
-.— Date
Signature of Applicant i
*N*hh*t*#**RYt*M**hti hN*NX**X*Yiat*tN*Nt*XX*N*RNtt*hY**N*tthXtX**XX*N*t*NXh*hNtX**Ya***t***X*YR**a*****tt#*RhNX***t*t***ttN*tR,FR*#
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and swom to before me by
on this day of
Nt*h***N**tN*h*****t****N**N****}t'*tk*kF*MM' t
�y}*}***t***IIfi1N*}}}**Nt*}N}*}*NNh}h****Nh**hR#*}NM*}*t
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 real -
dents of the City of Iowa City (Title 6, Chapter 2, City Code). {
,y
Expiration date of Driver's license Z ' C:)
i 2. /DY iJ
Signature of Police C afar Uath
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.
481gnreLof City Cler or `eslgne Date
***}Nk*Nt*h***hNX}}*NY**}RR*#}*#t##h*h*#tkY#}kk**ki*N4*XY*MMX*hhk*Y*i*t*t#}Yi*k*RYR#*R RRRR*RRR**h*N**hhhhNtkh*YthaaaN}N4a*Mai*N#iX#4R#
Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClaWMIDAIVPDOLAPPI MiOameMed.D00 04/2018
121lDec. 6.2020. 2:23PMpb DCI IOWA
FMM=ZNo.6133 P. 1/21002
STATE OF IOWA r
Criminal History Record Cieck . .
Request Form
Iovni I)Mstan of Climioal hvest;getion
r4woore Operations Bnraaq, 1, �Jfw,
21 70 street
Y Oi Jbinay Iowa 50919
] am renne,
Aa of
Fax
DCI Account Number. 9967-F
+�+ruaaYUCiLe
Name
YellQwCa6 oFlowa Cies_
Addrew
P.O. Box 428
Iona City, Iowa 52244
Phone
--PPJ139-9777
Fax
310J50.4142
sem'ch of the provided new sad dace ofbittb
No low' C tl2lnal History Record (band with
13 Iowa Chznla l History Record smubcd, DQ I
I
DCI initial' CJr
DC1-77 (nl" 06'-26-2013)
Received Time Dec. 2. 2020 2:08PM No.5245
Crimina1
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STA E OF IOWAIDPS
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Pap I of 2
Dec. 8. 2020 2:24PM DCI IOWA No. 6133 P. 2/2
DISCLAIMER
This response can only Include public criminal history data. Under Iowa law, most
Juvenile records are confidential. Confidentlai juvenlfa court records, If arty, cannot De
Included In this response. A signed release authorization Is re sufficient fo obtain this
Informallon from the Division of Criminal Investigation. In order to raqusat the release of
Conti dentlai 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 Sax Offender Registry..
However, Won
on this alta, the actual records forJuvenlies May aavailable
N I be coMdentlal andtion anylconfidential
Juvenile records cannot be provided with this record. In order to request the release of
conildentimi juvenile records, If any, an application must be filed pursuant to Iowa Code
section 232.147(18).
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SMARTER I SIMPLER I CUSTOMER DRIVEN 9
Dfwac & IdlMmleex"n 54nbm
PO Box 92041 Des IAxneS, IA 50306420/
Phone 515-256-9124 1 Fax 515439.1837
Certified Abstract of Driving Record
Inquiry Date:
12/2/2020
DL/ID #:
013BB2642(IA)
Customer #:
3959505
Name:
Casella, Michael
Class:
D
ID Status:
None
Peter Jr
Address:
2110 N DUBUQUE
Audit #:
5104890
DL Status:
VAL
ST
Issue Date:
11/08/2020
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
12/27/2028
CDL Cert Status:
None
522451624
Endorsements:
Chauffeur 3
CDL Med Status:
None
Mailing Address:
2110 N DUBUQUE
Restrictions:
NONE
Restriction
None
ST
Supplement:
Date of Birth:
12/27/1956
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522451624
History Information
b
O o
Convictions o '
n s
Citation Date
Conviction Date
IACID
Explanation Count E)
11/01/2009
111/30/2009
S92
Seed Johnson IA —�
103/11/2020
103/19/2020
S92
Seed Johnson IA r
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Name: Casella, Michael Peter Jr DL/ID: 013BB2642
Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation,
do hereby certify that 1 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
Name: Casella, Michael Peter Ir DL/ID: 013BB2642
12/2/2020
V
Driver & Identification Services
Iowa Department of Transporatlon
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