Loading...
HomeMy WebLinkAbout21-033� r 1 �fVIII " ; �' Alw=014 Tq CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 13 19) 356-5040 (319) 356-5497 FAX First 1. Name 2. Address 3. Contact Information (Required) IDENTIFICATION NO. 2.1 – b 33 (Office Use Only) APPLICATION FOR NON MOTORIZED PEDICAB DRIVER/HORSEDRAWN DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) 4a.. Driver's License expiration date (Required): ./t%-/- 71117- - 1.-- Cell Phone: SO 72Z -U2 It b. Pedicab/Horsedrawn Business Name (Required): p<-�w ( Pvv 5. Prior experience in transportation of passengers: — /) a 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When S f\ What happened to the charge? (Circle one) Convicted ismiss Deferred Deferred Suspended Plead Guilty Other. 7. Have you been convicted of any traffic offenses in the last five years? Tvpe of offense J7. X. — Where k o" G. N r� / � t What happened to the charge? (Circle one) - ca Convicted Dismissed Deferred Deferred Suspended lead Gui Other TAT 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?D C� Type of offense Where When 9. Have you ever applied to be an Iowa City pedicab/horsedrawn driver using a different name? If yes, please provide the name(s) 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) aerxrtmn rwinoaa am�vrro� oma.., o,;,re eor. 03/2015 I hereby certi�Y,that I have issued to me by the Iowa Qe rtment of Tra/ree n a valid Driver's license numb Y Stl LZ74 I� issued on 1 2 td ex5'/z4 I understand that i1 falsely answer any questions in this application, that this application may be dethat in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their dto examine any and all records and documents relating to this application, and I further agree that, if a license is gromply at all times with all of the pro- visions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front ofublic) Signature STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before ASHLEY AJAY Commission No. 6 1� S�ua-e.f On this 30� day of I have reviewed this application, DCI report, an the StMe certified driving record of this applicant and have deter mined that there is no information which woulcVindicate thXt the issuance would be detrimental to the safety, healtl or welfare of residents of the City of Iowa City Vritle 5, Chapt 2, City Code). Signature of Police Chief or designee AFTER APPROVAL BY THE CITY IN IOWA CITY FOR NO MORE TH THE EFFECTIVE DATE WILL Signature of City Clerk or designee YOU ARE AUTHORIZED TO DRIVE A YEAR FROM THE DATE LISTED BEL THE DRIVER'S LICENSE EXPIRATION IF LESS Date Date A YEAR. VEHICLE *hR*IRR*RR**RIRi*R**R*4R#*i##4###4##R*R########+###################f###ff#41111!!!!f#111Hf111111Rf1f#f1RRRRRR**R*RRIRRR*RR#R**R11R*Rti*iRR*R**R Office Use Only Approved application DCI report State certified driving record Website update de Petl.b Non Mobr¢etl Horseha#n U. APP 2015 doo I hereb. certi that I have issued to me by the Iowa Qe rtment of Transportation a valid Driver's license number S� 54 �L274 1!! issued on i 2" expiring on /Lp . I 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, if a license is granted, to comply at all times with all of the pro- visions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant iz &---- Date ��'JU/fl fx+xY+#wwwxR*R*wwww#w+wRRwwwxxfw+RwwRk++R+++x+nr,ww+wrRRY##+++w«*x++#ww+w+w++x++x++#+ww+x++++##+«x#xx++RRx+RY+wx+xx+#+we+wwxx++#Rw+ew#++ww+;#+R+k STATE OF IOWA ) COUNTY OF JOHNSON ) tefore me S VAS44'0. . On this 30' day of ASHLEY A JAY•PLATZ Commission No. 765030 1/u rn.....te.L... ca.,b..n Olntonr Dahlin � ..e •Lo 6.. cbd ., Y....... � XRRXX#;;;MR;h;RRR+RMt;kR;RhRR;#R;#;;hR#tYRflRww#k;RRR;;#t1RR;RRYR;;#;hRRR;RRMR##R;RIM#R;1M#f;*RR#;RR#RRRRRRAR#h;kRRR;RRR#hR;;RR#h;;R+R#Qf�/�R;;# I have reviewed this application, DCI report, and the State certffied driving record of this applicant arnbhave diiier- mined that there is no Information which would indicate that the issuance would be detriment8f I the efety„hey h or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). v ' � o SigiVature of Police Chef or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A PEDICAB/HORSEDRAWN VEHICLE IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATC E DRIVER'S LICENSE EXPIRATION IF LESS THAN A YEAR. gLDL— Signa are of City Clerk o esignee f Dd to YfkkkMMlklr#Rf R#MRRkfMRRR*Rikf:IIRRRRf lM#f#k#Yk##RR'R#R####M#R#R#M####hRRtk#;{}*k#MkifRRf;kM**hkkkR+t}Y*R1ltrfRRw*fN*y RRklkf#kyR*RR*kk1;#k RR Office Use Only Approved application DCI report State certified driving record Website update CWWPhd ab Non MoM M Ho.�Omni PPP M15AM �. _iIQ•?1.?p01,.11;1')AMrle.4li(•f 111wA iIG ARRR609 <IFOY 17A9 •a.aia, 1191)a3aN, 1/7/nag Nn .;. L► nod- IF •(iPappl(cahlcj -u To: Iowa Divisimt of Crlmilial Llvr,:tfgntion •,illi7or� vl%i•� V4lV 11 ) Ji'Ylr hit, I :-.:ul 71 j A., 71n Fn•ngr lS,B �oinea, lawn ]V319 (515)725.6066 (515) 725.6000 ray. i Fi:il rCC1:iC,itiilj: ilii iVIT Criiii iiia( LI: )a- 1. i u;ord chcGa an; Firom: Cl(v of lows Ciry I y' wr (•V:SSIIC (:i;r�i;L :r.ri Ijl n, ` r, r• S `3t l•::SS ::: (1:ixl:,;x;wy; :7ti.�ii: � � i%SSSSC (rtt1ii11;;itiiLtLj 0 /1 vl lh.Jl dJ C. V+dI 511 Z�' /I y �') �Nlalo �Cenlale ¢1(17, 4•Ja<GFnofnn .Crraar be releasable, per Colic orlawa, Chapter 692.2. For complete criminal history record Infarmaw tion, as allowed by law, always obtain awalverBtXnaog'epromjhesubtactofthe reringgt. _•,_•,,,,,_, ,Y/.. <..... Yi .<. .._.`01\1\\\11111Iiiiiiillllll/I!/////U•. Ir,lav4l L1.410I0JP:\IICKYI'YJVGnI'1II118310111Uf lIW aUYYG1G41105YI11t Yr1141tlIWGU9YIIfiCW111U1Ti101WMYf9D1 Yry TCVyIU0114CKWilI1111C 111vin011111 willi111a1 1 11 ..... •. •-• .-J nYA A . 1 � m mj:n Wi lv.�..t%. nn). M:.I\Olm uJ :: r �✓1yaN`VV rJ.,n, VNn,v�, �� •i��• %�-'o•..-. � '` A:`� �':��• a fi�aiverlSieunlYaufure: _-_� ------ _ ^� : owa chrmj6aL .-- -- q lorm City, TA x2240 o r Pholtot 319-35640¢1 C"3 -- r AX: N I y' wr (•V:SSIIC (:i;r�i;L :r.ri Ijl n, ` r, r• S `3t l•::SS ::: (1:ixl:,;x;wy; :7ti.�ii: � � i%SSSSC (rtt1ii11;;itiiLtLj 0 /1 vl lh.Jl dJ C. V+dI 511 Z�' /I y �') �Nlalo �Cenlale }n0111inal•P.ro ri�QrP@Yrf'lOYri7rlr1!111: Wthantnx(011ed wAivi-vfram.tar.a++h`I,Pet of the. Pilftblit,A CM11n1C C. l IdOm•v P/I m itiv lint be releasable, per Colic orlawa, Chapter 692.2. For complete criminal history record Infarmaw tion, as allowed by law, always obtain awalverBtXnaog'epromjhesubtactofthe reringgt. _•,_•,,,,,_, ,Y/.. <..... Yi .<. .._.`01\1\\\11111Iiiiiiillllll/I!/////U•. Ir,lav4l L1.410I0JP:\IICKYI'YJVGnI'1II118310111Uf lIW aUYYG1G41105YI11t Yr1141tlIWGU9YIIfiCW111U1Ti101WMYf9D1 Yry TCVyIU0114CKWilI1111C 111vin011111 willi111a1 1 11 ..... •. •-• .-J nYA A . 1 � m mj:n Wi lv.�..t%. nn). M:.I\Olm uJ :: r �✓1yaN`VV rJ.,n, VNn,v�, �� •i��• %�-'o•..-. � '` A:`� �':��• a fi�aiverlSieunlYaufure: _-_� ------ _ ^� : owa chrmj6aL .-- -- (`— 1f .,;:. g.:.,, :.•. ..11[]I': nA,;.... 111 nn.. n,,il ,YvR------- CA:1Fr s I x Tv..:::::::p:S:.:CLv1 L,:ea,•..:.:; .. : a.a. �, ::...,.., wiS., •, C i dude Ilse alllrf i . 1. }1.. 1_.f _...i. {M JJ'l va..•i lV'. A� . 1 :11111 w t 1111 1 J \ >l lfrll l:l 111 lllr 111ll VlrlflA IITIIIII%AIIMAJn 111 111111iLRm1an11'It: .I I �..,-•-/:...,h- F._o..w..........•i i Q-rAilF f IF tt_IWAIDra 1 L JUN 19 2021 bio Iowa Criminal History Record found \+lith DCT ! / D V OF CRIMINAL INVE9 Iowa Criminal History Record attachal, DCI DCI initials Re I.A T:..( I„6 + 'M 11+ Q.+oa11 AI_, +AQA Juo.21.2021 11:13AM DCI IOWA No. 119D P. 2/2 limn'e PARCO - y1 V ..rr.IVII�1 Thin nnnn wen nn/., :nnh.An huh/Iw wrlm:nol h:cinr.: daft llndar In11/9 I9n/ mnef ... Spvr... ...... r...J ... r.rrr ,.r�..r r........r. ...r.r.J _r.r r.._r. •_.._ ._.., ...__. ... rC .......... rrrrr rr r.r rv....rv.r.rr••__••..__.•.••J •.•• • • I"��'JI •• Included in this response. A signed release authorization Is not sulfIclent to obtain this :nfnrmafinn frnm the 111dainn of rrimin3l Invaefinnfinn In nrdar in ran/lect fho rolpasp of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). A dd:i:n Hell.. .. nel h:c{nnJ a�{a nnnnnrn:nn nnmdnflnne fnr r`nrf�in irn:anila car ....,.r..r, r.......r....r..r .r .a r ..rrr..r .r. rr..r.. Jr. _•...- __. on this site, the actual records for juveniles may still be confidential and any confidential L,.. 1I ...I I! .-[-I_J... :II_IA I I__.J_-I- l L ..... ........... .r_ W14.9 confidentiai juvenile records, if any, an application must be filed pursuant to iowa Code section 232.147(18). C) C7 ^�; :: } C-7 W r r'n -a O O WWA DOT mxoj.iowadot.gov Dnvef & IdeMdcation Selviees 110 L'cy i Des tizines. [A St34,kI03 vhene :515-211-91211F3x 51r2Y-W,7 Certified Abstract of Driving Record Inquiry Date: 6/21/2021 DL/ID #: 854ZZ7418(IA) Customer #: 4245770 Name: Snyder, Benjamin Class: C ID Status: None 592 Seed David Address: 2002 5th Ave SE Audit #: 4999154 DL Status: VAL Si n Si nal Issue Date: 09/28/2020 CDL Status: None City/State: Cedar Rapids, IA Expiration Date: 05/24/2024 CDL Cert Status: None 524032713 Endorsements: Motorcycle CDL Med Status: None Mailing Address: 2002 5th Ave SE Restrictions: NONE Restriction None Supplement: Date of Birth: 05/24/1983 Mailing Cedar Rapids, IA Sex: M City/State: 524032713 N _ o History Information .� c c Convictions Citation Date Conviction Date ACD Explanation County © ZiR r\.)Johnson 04127 2018 05 /20/2018 592 Seed IA •' 11/27/2019 12/22/2019 M14 Fail to Obey Traffic Linn IA r7 Si n Si nal Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Snyder, Benjamin David DL/ID: 854ZZ7418 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: Snyder, Benjamin David DL/ID: 854ZZ7418 6/21/2021 Driver & Identification Services Iowa Department of Transporation ev C3 > C-) w �h M rn o � � > o C=