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CITY OF IOWA CATS'
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name (fi"Lt;,}tl,.d6RED)
(w-
(Ohluce Use OnIly)
APPLICATION 11-0118 TAXICA13 A MOTORIZED IPEDIICA.16 VEHICLE DRIVER
(Pollee Department irevMew urnaust be made (between 8 a..rn.. to 3 )p..irin., Monday •- FrMday)
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2. Address ., (� pll)uUdclrr a¢mnu Iu a i a, Ularolnt
ltion(I"M,I'iyllifl l':d)) IlIlrnarPhon
�sffArif)ts. un oo, CI
3. Contact lnforma
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4a. Chauffeur's License expiration date (R QUIR,
b. Taxicab Business Name(dl'(;(U'Il
5. Prior experience in transportation of Irars,rsse6 geulrs:
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State m elsewhere? 5
Y 7 af...r q§,'.. 2
Where
-------------------
MM
What happened to the charge? (Circle one)
p Guilt) ,
Convicted Dismissed Deferred Suspended "'Plead � Other
Have you been arrested / charged with any traffic offenses in the Il ast Pulse yearn? ........................
......................................
D.pe cLf e?rfeuse Where
What happened to the charge? (Circle one)
rype of orfensp
Convicted Dismissed Deferred
Where
When
Suspended Plead Guilty Other
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
DEPAR1iIItdNIEN1" OF CRBPtNgNA,N INVES-1113 ,Tflt7N (DCQ REPOR—II" AND ST'A'TE CERI
DM MIPMNIG RECORD mus"M" ACCOMPANY THIS APIPM..ICA"II10N FOR POLICE CHIEF REVIEW
You must appl y for an lndMvMduuaM Department of Cifiraniinall Mnvestlgabon Report (rormn avWM able upon request).
(SECOND (PAGE FOR 1REOWRED SIIGN .M"U. RE AND NOTARY)
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Subscribed and sworn to before me by ryaa".. "f� �t"p rr; .n�i this _ f�t �. day of
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Date,
AFT R APPROVAL IIB ('TTI IIE CiTY C11 ERIK YOUR ARE AUU"II"U flOR01: ll:t TO DRIVE A TAXICAB IIN IOWA CN'fY U:::0R INN
IIMCU•CII:::' '111 UAN ONII:.:. YEAR II IROM TU•1111: DATEU...IIS"UTE D IIBILII...OW.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
ClerlOfAXIDRIVBADGFAPPLM14amended.DOC 0212015
Feb.27. 2015- 9:21AM Div of Criminal Investigation
rep. LU. LV I) II:)OMa'1 WLY t.le(K WIly 01 1OWa Ll I
STATE OF U: `ldA
Criminal History Record Chedi
Request Form
{l ytlifF
To: Tows Division of Criminal Investigation
Support apevatioua Bureau, T' Floor
2151.71h street
Dea Moines, lows 50319
(515)725-4066
(515)723-6080 Fax
I sol=20121n! c os i an
I111'Iia a (n+®ne
30- 1A 9'A
Record Cheo&c ow
No.1305 P. 6/9
No.901L r. L
DCI AccountNumbor; C m d
(ir®ppitca61e1
City Clork'a Office
1oll Street
lows trity, I�. 5'1<2A0
FBrono: 319�54m5041
Fax: 319-356-9497
Iowa Criminal HigtprXRecord Check Results (DCl ese only)
As a, search of tho provided name and date of birth revealed: '
No Iowa Criminal History Record found with DCT
DCS initials
Received Tl me�(N-10%2015 11:34AM No. 1753
�IIowa Department of Trans portation
kP0,1= !04, Des Mum, IA 50M 1264 515-2W9124
Inquiry Date:
2/20/2015
DL/ID #:
Name:
Jackson, Dallas
Class:
Joseph White
Address:
920 N GOVERNOR
Audit #:
ST
Issue Date:
City/State:
IOWA CITY, IA
Expiration Date:
522455920
Endorsements:
Mailing Address:
920 N GOVERNOR
Restrictions:
ST
Date of Birth:
Mailing
IOWA CITY, IA
Sex:
City/State:
522455920
230AD2948 (IA) Customer #:
D ID Status:
8858609
02/19/2015
07/30/2022
3
Corrective Lenses
7/30/1989
M
Name: Jackson, Dallas Joseph White DL/ID: 230AD2948
5386301
EXP
VAL
None
None
None
None
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do
hereby certify that I am the custodian of the records held by the Office of Driver 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:
AMU
U ..Nil 2/20/2015
M1 N,b N'MRHT4py, t
D.
�WF ELL %
0 01
Office of Driver Services
Iowa Department of Transporatlon
Name: Jackson, Dallas Joseph White DL/ID: 230AD2948