The URL can be used to link to this page

Home My WebLink About21-029f r vim„ fsf eem CITY OF IOWA CITY 410 East Washington Street Iowa City. lora 52240.1826 (319)356-5040 (319) 356-5497 FAX 1. Name .U:.._„ PA 2. Address C: a:= _ IDENTIFICATION NO. a 1 - C:Xq (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review ►'st�ea>"a iiia 6•. a.m. to 3 p.m., Monday —Friday) 10'01A CITY - Last _First Middle 3. Contact Information (RECUI'ED) Email: S_ % A!?)2IYkAer.31)^Q g7nA ! •CA41cell Phone:, All iftn o�mmu�nicatio sept ntviaemail) 4a, Driver's License expiration date b. Taxicab Business Name (RE :UI'.ED) 5. Prior experience in transportation of pa 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?�e� Type of offense Where When A 5ku jk Che-raKe e- a 3-y5 - What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? On 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? i G Type .ofoffense f Where When n!is )A�'�i�QDf��J��SfMPr17 �(1L>]Y1 LC15� %(n✓ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) OM2018 Page 2 .. APPLICATION FOR TAXICAB VEHICLE DRIVER ., DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICfa GHIEPRg?dlW 1c =' inal Investigation Report (form available upon request). You must apply for an individual Department of Crim 5/W�2uiy I herb ce ti a I have issued to me by the Iowa ,Department of Transportation a v lid Driver's license number ?� expiring on = I understand that if I issued on ( P 9 false) answer any questions in this application, That this application may be denied, I agree that in making this application, I consent to allow agents questions employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records end 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 bsigned in front of a Notary Public) Date 5 Signature of Applicant +rexr<rrrxxrxrx«r«aaa<x«arr:xa<ra«aarrwaw«a«rrrrxar«+rra««««raaa«aarrr<««a«««««xa«rr<xrrax«rraaa««a««r«+ra«raraaraaaxr+rararrar«ra«r+«rxra«ra«r. STATE OF IOWA ) COUNTY OF JOHNSON ) on this day of Subscribed and sworn to before me by for the State of Iowa +wrrxarrr+xa.«rrrarra<rr«««r«r.aK«: I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that thereis o information Iowa City would Indicate t 2t the City Code). Expiration would be detrimental to the safety, health or welfare of resi- dents date of Driver's license 3/ 2 6�2Y zd2, �— Date Sign'atre of Police Chief or designee AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THEUr,�TE LISTED BELOW. Office Use Only Approved application DCI report State certified driving record Website update .may 2 2 - Date C6rWTA%IDRNSADGEAPPL9Mi8a=nded.DOC 0412018 i°a20I21AM DCI IOWA �P.r1/ velwui5vrwCob fP111�lnieMW STATE OF IOWA 4 PM 2t Criminal History Recor( ,Ph, CL Request Form l i S ,fit 4Ry; �. DCI Account Number: 9967-F Of 11P1luh;.; Jam bWi or F" coMRIctod forma to: lnwo Division of Criminal Iltvaetisetton Support Operativar Human. V Floor 215 L 7a Street Du MOiaef, Iowa 50319 (63� 725-fOG6 (815) 725-080' Fax send results t3; Name Yellow,Cob of lo- a Com__ Addrut P.O. Boa 426 Iowa City, Iowa 522" Pboaa (319)33&9777 Fax 310.359.4142 ❑Fetnale As of _ (0' 1'1-x) a search of the provided name and ❑ No Iowa Criminal History Rai. -Ord fottnd with DCI --' Iowa Criminal history Rcwrd i tachod, ACI M DCf initial DCI -77 (updated 06-26-1018) Received Timt Jun,15. 1091 4:13PM Ro.1048 lcYtimelraaealsattawalt •::-' 1I it ' • ��Q11�T=NieDiaratded) �t �p ii(Y1 ilfii(b 1q . I�lii�yli'i>Aiwi11f�6ylrxr . irdlywit of ;+� bkth reveelod: ? ' ! t hfstory est all Page ] of 2 a Jun -17-2021 9:01AM DCI IOWA No.1298 P. 2/3 IOWA CRININAL HISTORY ,.DCf ,21*1463 MISDEMEANOR CONVICTIONS ONLY p $, :-(yP 2 DATE MNTKD- 2021/06/37 OCIe00951853 7��1 24 NAME! PEDERsON,TRAv - PEDERSON,TRAVI6 CLARK DOB SEX RAC HGT NOT EYE HAIR 19910308 M N 511 175 HA2 BRO FAX IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ARM TAT R ARM CCH RECORD ••* 01 ARRESTED/TAKEN INTO CUSTODY 2012030E AGENCY: IA0180100 CHEROKEE PD CHARGE NO- 01 IA STATUTE IA708.2(2) A08AULT CAUSING BODILY INJURY -1978 TRK#: 009158201 COURT DISPOSITION AGENCY: IA018015J CHEROKEE CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 03161 SRCAO24380 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 069156201 RESTITUTION SENT8NCK DISP SFF DAT FINE $65 20121012 02 ARRBBTBD/TAKEN INTO CUSTODY 20121223 AGENCY: IA0710000 OBRIEN CO SO CHARGE NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1978 TRK#: KLOO17901 COURT DISPOSITION AGENCY: IA071015J OBAI£N CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONBUfPTION / INTOXICATION - 1978 COURT CASE ID: 03711 SMSM024137 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ KL0017901 SENTENCE DISP EFF DAT PINE $65 20121224 An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau or Identification is a public record but can only be released to non -law enforcement agencies by the DCI. Jan. 17. 2021 9:02AW DCI IOWA No. 1298 P. 3/3 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 auttorizo d4o4 a; is net sufficient to obtain this information from the Division of Criminal,-" Investigation. In order to request the release of confidential juvenile c records, if any, an application must be filed pursuant to Iowt-rpodll,.�Q&I A, 232.147(19). ..LT Additionally, criminal history data concerning convictions for cssr4"11 Y, UA �"t juvenile sex offenses can be found on the Iowa Sex Offender Registrye http•//www.iowaeexoffender.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 teleaee of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 133.147118). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM nR DENY THAT THD RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION Im 1SA]WADOT e a&t.mi -5` Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date SMARTER I SIMPLER I CUSTOMER ORNEA-- TUR 110119/2018 DtNN a Iaem lltaUon Semees IA 3UR po aDx 9¢01 r Das AAcirlEs jA 5vme Phone 515 -2A4 -912A I Fait 5 1 5239-1837 Certified Abstract of Driving Record Inquiry Date: 6/15/2021 DL/ID #: 486AF7752(IA) Customer #: 5780588 Name: Pederson, Travis Class: D ID Status: VAL IA Clark Address: 932 Duck Creek Dr Audit #: 5607080 DL Status: VAL Child Support Issue Date: 06/15/2021 CDL Status: None City/State: Iowa City, IA Expiration Date: 03/08/2024 CDL Cert Status: None D51 522468674 IA IA Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 932 Duck Creek Or Restrictions: NONE Restriction None Supplement: 11/29/2019 04/25/2021 Date of Birth: 03/08/1991 Mailing Iowa City, IA Sex: M City/State: 522468674 Child Support History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date I Case Number TUR 110119/2018 1073952 IA Sanctions Type Effective End ACD Explanation Occurrence 3UR 3UR Suspended 08/11/2017 08/13/2017 D51 Non -Payment of IA IA Child Support Suspended 01/17/2018 02/04/2018 D51 Non -Payment of IA IA Child Support Suspended 11/29/2019 04/25/2021 D51 Non -Payment of IA IA Child Support Name: Pederson, Travis Clark DL/ID: 486AF7752 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: Pederson, Travis Clark DL/ID: 486AF7752 6/15/2021 2nii ,U Zit FIA E- 5 QC J�/1C•cr IA�IC�- _ Driver & Identification Services Iowa Department of Transporatlon