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HomeMy WebLinkAbout21-030l IDENFIFIC/ TION No. I-� _ L (Office Use Only) is.s®5 til � APPLICATIOk'FOR TAXICAB I MOTORIZED PEDICFcB VEHICLE DRIVER (Police Department review must be made behveen S a.m. to 3 p.m., Monday- Friday) CITY OF IOWA CITY 4 10 Fast, Washington Sircot Faflure to complete the "reorelred" information tuidf result inderma,' of the apoUcatlon Iowa City. Iowa S1240-1826 (3.19) 356-5Q44, Cast First Middle (319) 356-5441'Fxk / n 1 1. Name(REOUIREDJ Gi0.k (oft f Fvl0e"�' 2. Address (REQUIRED) 12n�/z S Mftk SF bQ-- I A 3. Contact Information (REQUIRED) Email: S cot 1 Ltu k�� Ick, cr7v Cell Phone: ,31'i 5 `i) 05717 '(Atwrtten c municetion sent via email) 4a. Driver's License expiration date (REQUIRED) I\ -Z- Lk - ?-L)2.'5- b. t725b. Taxicab Business Name (REQUIRED) �f e ( l o w 5. Prior experience in transportation of passengers: u P tow t a I 0 wa L (z r) t v e ZonI3-Zo15 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type,of offense Where \AC When What happened to the charge? (Circle one) w Convicted Dismissed Defere Suspended Plead GAP iihKei r 7 Have you been arrested / charged with any traffic offenses in the last five years? ��N Type of offense Where ^ -WhJen - What happened to the charge? (Circle one) nvict 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? v V Type of offense Where When 9. Have you ever alied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0 04(2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND -$TATE 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 Transportation a valid Diiver s license number 39 %G i 8� 3 issued on •2 - oI expiring op Il L4-ZnL5' , t understand that if I 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, 6authorizationto be a taXieab drNer is.granted, to comply at all times with all of the provisions o i 15, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applica Date STATE OF IOWA )-• COUNTY OF JOHNSON ) Subscribed and sworn to before me by Oil this day of Notary Public in and forthe State;oflo4iA " 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 Cityof Iowa City (Title 5, Chapter -2, City Code). Expiration date of Driver's license 2 J� Sgadure of Police Chief ordesignee Date AFTER APPROVAL BY THE CITY CLERKYOU ARE AUTHORIZED TO DRIVE A,TAXICAR W IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. 7 C01ce Use Only Approved application DCI report r' State certified driving record Website update MWTAXDRN GWPLq t .de DOC 0412018 osfyv 1,- 2021 1:17PMcob DCI IOWA MMM 80MMU I fA10.' =2".1 6437 P.r i4b00z STATE OF IOWA Criminal History Record Check Request Form Mail or Fax coutpined, forms_tQ: Iowa Division of Criminal revestigadon Support Operations Bureau, 1" boor 215 E.7` Street Des Maker, Iowa 50319 (515)725-6066 (515)725-6080 Far G V -a%-" DCI Account Number: 9967-F (IfwPeastr) ,Send xerults tQr Name wjONILot lova City Address P.O. Box 426 Iowa Ck7 Iowa 52244 Phase (319)336-9777 Fax 319-35MI42 -- Scofii' � � ' ' 1 S 5r I I3Male ©Female 14 e A S'q 2 3 j W 11 y:"verd may ra 6 fiy law,. •c r , i�- ,Iowa Lminni ui"orY ncecQru %,nem -mmuilyk r r As of (� �L,7- _, a seaxrl of the provided mise and date of birth M. N $ vti Z ❑ No Iowa Criminal history Record found with DCI., t T' r� � U Iowa Criminal History Record a tacked, DCI f)_ "r"a o a > DCI iuitiah o DCI -77 (updated 06-26-2018) RICliVtd Tii1 MAY. 12, 2021 11:4?AK 1o.4-3" Papp 1 oft May, 14. 2421 1:18PM DCI IOWA IOWA CRIaIINAL HISTORY DCI 00261899 MISDHISQANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2021/05/14 DCI.00262*99 NAME- ORAD, SCOTT ROSKRT DOB SEX RAC NOT NOT EYE RAIR SXN POB 19551124 M W 601 166 BLU BRO MED IA ADDITIONAL IDENTIFIERS 9C RACK CCN RECORD *** 01 ARRESTHD/TAKM INTO CUSTODY 19800129 AGENCY: IA0770300 DES MOINES PD CHARGE NO- 01 IA STATUTE IA321-281. OHM TRK#: 1.17524201 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE: IA321-281 No. 6437 P. 2/3 OMVUI CHARGE CLASS, MISDEMEANOR CONVICTION TRK#: L17524201 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT PLEAD GUILTY 19800418 0 PROBATION lY 19800418 ^= DEFERRED SENTENCE IT 19800418 " An arrest without disposition ie not an indication of p guilt. This rec'og,,.r N maintained by the Iowa Division Of Criminal Investigation, Bureau Of �; �-; Ln Identification is a public record but can only be released to non -law ;-G -p enforcement agencies by the DCI. This response can only include public criminal history data. Under Iou'Claw, , Mgt juvenile records are confidential. Confidential juvenile court records, c, it any, cannot be included in this response. A signed release authorisation 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(19). Additionally, criminal bistory data concerning convictions for certain juvenile sex offenses can be found an the lOwa Sex Offender Registry: http://w .iowasexoffender.com/ . However, even though some information is available on this site, the actual records for juvenilea 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). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I6 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD May, 14. 2011 1:1 BPM DC 1 IOWA COVERS TRE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No.6437 P. 3/3 a , �r U1 -0 70 O ct� this date: QapP�N£ryt Oc rgsry9po., 9 1, Name: Grau, Scott Robert DL/ID: 139ACIS73 5/12/2021 C Driver & Identification Services Iowa Department of Transporation a O �t C-) Ul e t'r = N �g m C A0114 4610WADOT . SMARTER I SIMPLER I CUSTOMER DRIVEN uvww•iowadogov Drum s wuwni:anon suvio" PO Box 9204 I On Moines. IA 50306920/ Ph" 515-204-91241 Fax 515.239-1637 Certified Abstract of Driving Record Inquiry Date: 5/12/2021 DL/ID #: 139ACIS73(IA) Customer #: 3383405 Name: Grau, Scott Robert Class: D ID Status: None Address: 120 S MAIN ST APT Audit #: 4195530 DL Status: VAL 4 Issue Date: 09/25/2019 CDL Status: None City/State: ELKADER, IA 52043 Expiration Date: 11/24/2025 CDL Cert Status: None Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: PO BOX 96 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 11/24/1955 Mailing ELKADER, IA Sex: M City/State: 520430096 History Information Convictions Citation Date Conviction Date ACD Explanation County lUR 05/23/2017 06/05/2017 M42 Improper Lane Linn IA (changing lanes 04/06/2018 08/02/2018 M14 Fall to Obey Traffic Johnson IA SI n Si nal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 03/05/2019 1102412 IA -- Ln I "'I {" J Name: Grau, Scott Robert DL/ID: 139AC1873 —,G -0 igg 'fi�t ?J N Pursuant to Iowa Code 4321.10, 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