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Home My WebLink About21-016� r � CITY OF IOWA CITY 410 E251 Washington Street lona City. lona 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. — r> (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 2. Address (REQUIRED) .CDd c 3. Contact Information (REQUIRED) 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) th"I as (All writen c D) oa, 5. Prior experience in transportation of passengers: First Middle -6FFt2GY AIA Phone: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) m &t Convicted Dismissed Deferred Suspended Plead Guilty Other, _ -- •' 7. Have you been arrested /charged with any traffic offenses in the last five years? Type of offense W here When' - -^ �— — N n 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? Q 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 O (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0412018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER CI) REPORT AND STATE CERTIFIED DEPARTMENT OF CRIMINAL INVESTIGATION (D 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). valid r's license number I hereby e i t at I have issued to me by s ued on ODBDS�ent of Transportation � xpl 9 on n? — ;;toe . I understand that If I Ig88Byo1� application be denied. I agree that in making this application, I falsely answer any questions in this appiioetlon, that this appimay 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 wHh all of the provisfo of le 5, hapter e i de. (Needs to be � /�d in t of a� N ry Public) Date Signature of Applicant f MMfxxxflxMtMxxlaxila<RlxxxflMlMxRaxxMfRxlxMMxxMxMlxafMlxlxf •1xMMMxlMMxxM,lxxaxxxfx+xarxax<MrxrMxrxaxxxlxxaxxxaxMrMx+xx.a rx STATE OF IOWA ) COUNTY OF JOHNSON ) da of on this Y Subscribed and sworn to before me by Notary Public in and for the State of Iowa „x,}l,,.xxxx.xxxxMa.M.x+M.xMxxxxxMMx.xx.M*•x•M<xMxxx M}}}}! fx11M/hlxxxhfAMxMxM 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 62 'iL --z 5 Signature of Police 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. Office Use Only Approved application DCI report State certified driving record Website update O,WAXIDRNBADDEAPPL9POiBamended.000 04/2018 Date YtltMMttffM}}f,4M1MRRMjlRIlMxif�eMtlN}9 /Yf S2 — WM �r 1 %_0 r <r.,l --a 0 O,WAXIDRNBADDEAPPL9POiBamended.000 04/2018 03Nar_18:2021.`2:,12P cw DCI IOWA f =2No.8596 P. 1/22!1= AX STATE OF IOWA Criminal History Record Check Request Form CD *T-, Mail of Fax comoletod fonncto: Iowa Division o(Criminat lovanRaGon huppore Opermious Bureau, V t1oor 215 E. 7d Street Des Mointe, Iowa 50319 (515) 7256066 (515) 725-4080 Fax DCI Account Number: 9967 ir2 (esppxntle� n k.,,4 ti S "w rrs.r .. n — a Same Com# yfuow,Oaboflo sSij� N t W .kddress P.O. Bo: 128 O iswa qty, Iowa 52211 Phone (319)338-9777 - Fa: 119-359.41112 DCI -77 (updated 06.26-2018) Paso 1 of 2 Received Tine Mar. 15, 2021 9:40AM No -6071 Mar, 18. 2021 2:12PM DCI IOWA ND. 85M P. 2/2 DISCLAIMER 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 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 sax offenses can be found on the Iowa Sex Offender Registry. htto://www.iowasexoffender.com/. 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). J W C,101NADDT SMARTER I SIMPLER I CUSTOMER DRIVEN vvww-iowadotr gov Driver A kWWW Dion Savkes PO Boz x2011 Des Milnes. IA 5030&WU Phone 515-244-91241 Fax 515-299-1837 Certified Abstract of Driving Record Inquiry Date: 3/16/2021 DL/ID #: 198BB4017 (IA) Customer #: 3866674 Name: Rothermel, Jeffrey Class: C ID Status: None Alan Address: 2024 SHERMAN DR Audit #: 5214594 DL Status: VAL Issue Date: 01/05/2021 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/16/2029 CDL Cert Status: None 522404768 Endorsements: NONE CDL Med Status: None Mailing Address: 2024 SHERMAN DR Restrictions: NONE Restriction No' Supplement: _ Date of Birth: 02/16/1965 CD c... 7 Malliny IOWA CITY, IA Sex: M City/State: 522404768 �..1 History Information CLEAR DRIVING RECORD O ry w Name: Rothermel, Jeffrey Alan DL/ID: 198BB4017 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: Rothermel, Jeffrey Alan DL/ID: 198BB4017 3/16/2021 C� Driver & Identification Services Iowa Department of Transporetion