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Home My WebLink About21-047� r 1 CITY F IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Name (REQUIRED) R6(Sm[[SSFih. V�lry /7(�ah Address (REQUIRED) 41 r, VeQra.., Contact Information (REQUIRED) Email: acrm Cell Phone: 3f 9 325 34GO (AII written communication sent via email) IDENTIFICATION NO. 21 - 0 L 11 (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 First Middle 2. 3. 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) "art" 6" n -p -16ura 5. Prior experience in transportation of passengers: Ove 7.5- Vpa rs_cQr,Q_ia�i£3 jp� ar-0. ht-4t'cA -hy ns .. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? h 1j Type of offense Where When 0 E a4 —t C-) 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? 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? t2d 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) no (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 I lk Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number �f3O Wk/ Rs'57 issued on 16-24-1H- expiring on [1—I8 2022. 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 A* and all records and documents relating to this application, and I further agree that, if authorization to be a taxicab d0uer is gt anted, to+comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in fr6ilfof aLcaptary,Public) Signature of Applicant ,J2�?�� Date rj*1 z tv STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by � f 671 VANDv s. in and fbl the State Ice on this � — day of 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 �/% 2 2 J� S t 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. jp - Signatibre of City Cler or esignee Date +++++HHH+HM++++++++++++X+++H+H+HHRH+HHRH+++H+++H++++HH+HH+++HH+++HHHH+H+++f++t++#1+H++++++kH+H++HHH+t++f+++++ Approved application DCI report State certified driving record Website update CedR IDRIVBADGEAPP 9201 Bamended.DOC Office Use Only 04/2018 0s/z,S' , 2 . 2021 12:6C'�" -DCI "NA Na 61l?0 :, 19Yziuez c STATE OF IOWA - Criminal History Record Check Request Forms To: Iowa Division ofCrimival investigation Support Operations Bureau, l" Floor 115 E. 7th Street We Moines, Iowa 50319 (515)725-6066 (515) 715-6060 Fax I am requesting an Iowa Criminal History Record Check on: DCI Account Number, _ C".(ifaDDl�le) Frohn _ City of Iowa CIO � city clerks Offt �0 ` 410 E, Waahingtou'�treet !"t'e Iowa City, IA Phone: 319-356-5041 .r— N Fax: 319-356-5497 Last Name (mandatory) 1Firat Name mandw Middle Name ren Trona, e Rasnlusse.yl d3'LrfrY Rl1att Date of Birth (mandatary) Gender (man Social secuik Number (recommended) IV -(FV- /q6 male ❑Female �f 8rs—qQ. G�f7/ Waiver l4armafion: Without a Oped waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, es allowed bylaw, always obtain a waiver signs Cure from the sab'ect of the request Waiver Reieare t hemby give permission Por rhe above requesting official to conduct an lows ttimhtal history record check mg the Division of Criminal Investigation (DC7). Any criminal history data wncemhtg v,e that is maintained by the DC[ may be mk.ascd a allowed by law. Waiver Signature: i%a�1pa,.�_ Iowa Criminal History Record Check Results < (DCI use only) As of '%�► '�� a search of the provided Dame and date of birth revealed: n N a M m O No Iowa Criminal History Record found with DCI i A o rN ❑ Iowa Criminal history Record attached, DCT # m y M y a DCI initials DCX -77 (08/25/10) Received Time Sep.24. 2021 1:30PM No.5521 Sep• 29. 2021 12:48PM DCI IOWA DISCLAIMER W11 1111 1 This response can only Include public cr/mina/ h/story data. Under Iowa law, most Juvenile records aro COnf/den8al. Confldentla/ Juvenile covet records, if any, cannot be Included In this response. A signed release authorization is not auf/Jc/ent to obtain this Information from the Division of Criminal Investigation. In order to request fhb release of sectioonfion 23Z Juventio records, if any, an application must be filed pursuant to Iowa Code section 232,!47(18), Additionally, criminal h/story date concem/ng convictions for cad a/n Juvenile sex oBenaes can be found on the Iowa Sex Offender Registry: h c com/. However, orota alta, the actual receven though Some Information Is available n records Oven may still be confldential and any confidential JuveMle records cannot be provided with this record /n uest the re/ease of order to req confidential Juvenile records, If any, an app//cat/on must or flied pursuant to Iowa Coda section 232.!47(18). o= �n n <r - '�rTi o� A 3 N 4PIOWA DOT wwaiowadot av SMARTER I SIMPLER I CUSTOMER ORt' N Drw" & iddowleatlon savWs pU Sox 9'204 I Des fhoam8 IA60 069204 pRvlpe "u 46-z+: t-95;14 j P7k- 545.299.3837 Certified Abstract of Driving Record Inquiry Date: 10/17/2021 DL/ID #: 430WW8558 (IA) Customer #: 1306832 Name: Rasmussen, Perry Class: D ID Status: None Allan Address: 414 Pleasant St Audit #: 8571396 Issue Date: 10/29/2014 City/State: Iowa City, IA 52245 Expiration Date: 12/18/2022 —� Endorsements: Chauffeur 3 Mailing Address: 414 Pleasant St Restrictions: NONE Date of Birth: 12/18/1960 Mailing Iowa City, IA 52245 sex: M City/State: History Information CLEAR DRIVING RECORD Name: Rasmussen, Perry Allan DL/ID: 430WW8558 OL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction �rie C^? Supplement: C —� r .T"� N 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: Rasmussen, Perry Allan DL/ID: 430VM8558 10/17/2021 Driver & Identification Services Iowa Department of Transporation