HomeMy WebLinkAbout21-012r 1
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CITY OF IOWA CITY
410 East Washington Street
lona City. lona 52240.1826
(319)356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
IDENTIFICATION NO. Z.1 -01
(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)
Failure to complete the "required" Information will result in denial of the application
Last 11 / First
41,1 l 11
Middle
2. Address (REQUIRED) 1403 wobii-wexJ ye 6ws
l.
3. Contact Information (REQUIRED) Email: Cia;-Il+t.1 % IR. C2 Mfj;I .Com Cell Phone: 3)4-"q-)LgV Z
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) 4 -7N - L3
b. Taxicab Business Name (REQUIRED) '-?fA0 j (At n '5 - zyesw. C
5. Prior experience in transportation of passengers: yclloW (f,6 o1- g'0 0 a C• p"t-
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? V 0
Type of offense
Where
When
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guil Other
7. Have you been arrested / charged with any traffic offenses in the hast five years? — ycC
Type of offense W here When
Crn:Iyfs to D12?4tr4( n
( Signa( -So h11S4,1 ' %-
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? 410
Type of offense
Where
When
9. Have you fever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
i �u
PAGE
04/2018
Page 2
APPLICATION FOR TAXICAB VEHICLE DRIVER
DEPARTMENT OF CRIMINAL INVESTIGATION (Dcq 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).
r's license number
I hereby certlf� that have issued to me by the Iowa L -If- Ire of
on 14 Transportation H v7-3 D. I understand that if I
n . r Issued on �_Iti'
falsely answer any questions in this application, that this application may be denied. I agree that in making this application, I
to examine any and all records and
consent to allow agents or employees of the City of Iowa City Iowa, in their discretion,
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 T'tle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Date
Signature of Applicant
•HYYH1f1HYaiN1Nf
Yf1HRfkYtfYhlhlftl Rifflf�
STATE OF IOWA )
COUNTY OF JOHNSON )
an this day of
Subscribed and sworn to before me by
in and for the State of Iowa
1ffR.f.ff«.ffi,,. fY.«..f.«ff+R
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 o M
a3-ol. z)
Signature o ice 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.
Offles Use Only
Approved application
DCI report
State certified driving record
Website update
D-s—OS-2-1
Dete
CIadJTAMRNDADOFAPPL07016..cn&d.DDC 0412018
Feb. 18. 2021 10:310 DC[ 10141
0211712021 0ez3 vel ow Cab
b. 4870 P. 1/2
TAV1s338270B P.0021002
STATE OF IOWA"' �;i11 '�
Criminal History Record Check
Request Form
NM 1
DCI Account Number: 9967•F
(4rspyac4%)
Mail to • Send res& to:
Iowa Dhlsion of Cr[minal Inv"Hintion
Snpport Operadona Boreau, In Floor
215 E 71b Sued
Des Molnes, Iowa SD319
(MIS) 715.6066
(515) 725-6080 Fax
I em requesting an lo wn Crimiaol MStworyRecord Check on:
Name Yrndw.Cab of Iowa City
Address P -0 -Box
Iowa City, Iowa 52244
Phone (319) 3389717
FIX 319-359.4142
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,rimmal History Record Check Results
As of a 1 l0 a- ( , a starch of the provided name and date of birth revoaled:
A` No Iowa Criminal History R=rd found with DCI
13 Iowa Criminal History Record attached, DCI —-------
DCIIniGals f� ,
DLT -77 (updated 06-26.2018)
D... L..d T:... C.6 17 1101 o•a1hU w. 4441
P0001 of t
(DCI Usk oniN
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Feb, 18.2021 10:32APd DCI IOWA No.4870 P. 2/2
DISCLAIMER
This response can only include public criminal history data. Under lowa law, most
Juvenile records are confidontial, Confidentlai juvor►ile 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
confidonflal juvenilo records, if ony, an application must be filed pursuant to Iowa Code
section 232.147(98).
Additionally, criminal history data concerning convictions for contain juvenllo sex
offenses can he found on the Iowa Sex Offender Registry.,
htta://www.iowasexoffender.com/, However, even though some information is available
on this site, tho actual records for juvonilos may still be conlidenDal 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).
C401%
410WADOT
SMARTER 1 SIMPLER I CUSTOMER DRIVEN vvww.lowadot~gov
DrN« a Idereftation satvices
PO Box 9204 I Des Manes. IA 503069204
Phone 515-244-91241Fax SIs239-1897
Certified Abstract of Driving Record
Inquiry Date:
2/24/2021
DL/ID #:
Name:
Lottich, Christopher
Class:
8934357
John
VAL
Address:
1463 WESTVIEW DR
Audit #:
04/24/2023
CDL Cert Status:
Issue Date:
City/State:
CORALVILLE, IA
Expiration Date:
NONE
522411031
None
Supplement:
Endorsements:
Mailing Address:
1463 WESTVIEW DR
Restrictions:
M
Date of Birth:
Mailing
CORALVILLE, IA
Sex:
City/State:
522411031
Convictions
769YY1758 (IA)
Customer #:
1272105
D
ID Status:
EXP
8934357
DL Status:
VAL
03/18/2015
CDL Status:
None
04/24/2023
CDL Cert Status:
None
Chauffeur 3
CDL Med Status:
None
NONE
Restriction
None
Supplement:
04/24/1979
Security for an
M
History Information
Citation Date
Conviction Date
ACD
Explanation
County
JUR
06/19/2016
07/07/2016
M14
Fall to Obey Traffic
51 n SI nal
Johnson
IA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
JUR
112/22/2008
1480109
IA
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence
JUR
JUR
Suspended
03/04/2009
12/21/2009
D38
Fail to Post
IA
IA
Security for an
Accident
Name: Lottich, Christopher John DL/ID: 769YY1758
Pursuant to Iowa Code §321.10, I, Darty 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: Lottich, Christopher John DL/ID: 769YY1758
2/24/2021
Driver & Identification Services
Iowa Department of Transporation