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Home My WebLink About21-006m� CITY IOWA CITY 410 East Washington Street Iowa City. Iowa S2240.1826 (319) 356-SO40 1319)3S6-5497 FAX IDENTIFICATION NO. , \ r �- l,. (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 complete the "required" information will result in denial of the application Last First Middle 1. Neme(REQUIRED) 4a`Isr�� (("'' sr�rt 2 Address (REQUIRED) 160^� 3. Contact Information (REQUIRED) Email: /f "n 7K Q yNko+. <ci. COP phone 3f ri s`yH ev7-1 (All written communication sent via email) tb74 4a. DrIvers License expirallon date (REQUIRED) 261 17D o Z b. Taxicab Business Name (REQUIRED) 5. Prior experience in trensportabon of passengers: C,91- pr :v cf -.C'+ d i i ,c c..L 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? rU0 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? 4/0 Type of offense What happened to the charge? (Circle one) Where When 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? 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) N L' (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0412018 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 iTransportation2 Svalid Driver's license number e understand that If I T Gl P O E, V `IL Issued on P 9 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 Title5, Chapter 2, City Code. (Needs to be signed In front of a Notary Public) L i Signature of Applicant Date 2 v f--M11ffµfffN�f f f f fif LRRiRRMfRf If 1 INf1f M11tff ffflf NH ....... lRf 1111MfN1f1ff1fMlMfIfINNfMffNNMNMMfM1f`�KH, STATE OF IOWA ) FEB 0 S 2021 COUNTY OF JOHNSON ) �aclR Subscribed and sworn to before me by _ on this day of Notary Public in and for the State of Iowa RRtMM4RMM4ffffff «I,f«f«,MR«..+M«MMM«�«•«f.....s,.1f..«.f.+«..,...«.. M««MMMMf11,««khl,lRy#ff«MiMMM 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). 7-- el -zS Expiration date of Driver's license Signature of Police Chief or designee 62. or -- 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 oa-off - a-o�l Date CM,WTAXIDRNBADGEAPR82D78emendedDOC 0mle Ol la «FebLva 1i 2021 2:OOPMCilb DCI IOWA No, 2564 P. fAwl 21iam ' r STATE OF IOWA Crimina11Ustory Record CLeck Request Form DCI Account N=ber: 9967-P MaM,FMSS9921pj�s ftfq�llabw) ;�l'ratiltt t Iowa Dtyuion of Ctiminai ihvestigatioa &wort operanone Bureau, V Nbnr Fame YeDd�Ca6 of ions 215 F_ 70 Sheet - — Dw Motaea, Iowa 50919 Addrew P.O. Box 418 (SSS) 7256066 (515)725 -WW Pax Iowa low@ 323" FEB 0 ° 2011 Phoee 5319) 3389777 - -- Fax 31"59-4142. P -•—�:�� )d`I„..,_ n.. � X176 � -z3oZ +a$«trw�ino•itl.tamor !!�.P�aara.9,r as M�aat ,.rr.. Y...... au JCL13zv xecord -he , As Of = tea v« oaf a srarch of the provided n0fiand daze n _ STATE OF IOWA/DPS NO °°` t°� Y Ftcard fern3 wii�a b(' 'l11114 tion JAN 2 9 1011 .. ; ��ny�nhnnxnmrnnn�^' "�• WF CRIMINAL INVF� Iowa Ciitninal FIiftyy RMQrd Mched, DCI �� •e DM771 18) t _— r Pap 1 of -Received Time Jan 29. 2021 9 DOAM No.2304 Feb. 1.2021 MIN DCI IOWA No.2564 P. 2/2 DISCLAIMER Ihis response can only include public criminal history data. Under Iowa law, most J uvenile 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, it 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,com/, However, even though some Information is available on this site, the actual records for juveniles may still he confidential and any confidential juvenile records cannot be provided with this record. In ordor to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). CZ10WADOT YU N WW'IOW8CI0C. SMARTER I SIMPLER I CUSTOMER DRIVEN I31MM s II INAVM10R 88fvk4s PO Dox g M i On IMOINK IA IS08069taD4 Phone: 515-244.91241 Fel: 513.2$1897 Certified Abstract of Driving Record Inquiry Date: 2/2/2021 DL/ID #: 261DD6492 (IA) Customer #: 4653591 Name: Comstock, Travis Class: C ID Status: None Scott Address: 16 Erobi Ln Audit #: 4548886 DL Status: VAL Issue Date: 02/11/2020 CDL Status: None City/State: Iowa City, IA Expiration Date: 03/09/2025 CDL Cart Status: None 522403012 Endorsements: NONE CDL Med Status:. None, .,. :- ✓ Mailing Address: 16 Erobi Ln Restrictions: Corrective Lenses Restriction None Supplement: FEB 0 ° 2021 Date of Birth: 03/09/1974 City Clerk Mallin Iowa City, IA Sex: M IOWA City/State: 522403012 iowa City, CDL Downgrades History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Effective i End 119sulng 3UR 106/07/2014 106123/2014 IA History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 101/30/2013 724597 IIA Name: Comstock, Travis Scott DL/ID: 26IDD6492 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: P10ENr OF TR4 4.Z beep �l 3 L DDGL�'�� Name: Comstock, Travis Scott DL/ID: 261DD6492 2/2/2021 Aazhf - (_7- Driver & Identification Services Iowa Department of Transporation lii-iLEUD FEB 0 0 1011 _rk Iowa City, Iowa