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Home My WebLink About14-150Authorization Number ► 1 (Office Use Only) _. awn I CITY OF IOWA CITY APPLICATION FOR TAXIIMOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City, Iowa 5 2240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX Iwame°-F- did"' 2. Mailing Address s, T5 e . ____ �"_--�________-------._______---------- _______---------- ______.------- _____----- . 3. Telephone: Home._1r�.... ...___?v�------- Other: �r- 4. Prior experience in transportation of 10- -ow (_`r7-___ __________ 6. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ,Eyp of offense Where When 6. Have you b- epn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? / 7, Have you been convicted of any traffic offenses in the last five years? .. ` Where MM 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five year's? V ype:,�oyY'ru�f�:itsa Vd r . 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) d dnw,.3dg 03/2014 I hereby certify that I have issued to me by the Iowa Department of .f ransportation a valid Chauffeurs license number �b 1 mak# ro I understand that if I falsely answer any questions in this application, that this applica-in may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) �� b �� Signature of Applicant � p_ ��Datejo� K ! t 7 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn( to before me by Ll&rj � c . ,t �. On this J I -p- day of of Iowa My 1 have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signature of Por f r designee Dake YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Yi �2 S;gn1ture of City Clerk or designee ---- Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 Y? (width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update deddfte,iddvbadgeapp2014.dm 03/2014 Inquiry Datai 7/1/2014 INa sel Buell, Charles Clifford Addremm. 510 7611 AVE City/Statm CORALVILLE, IA 522411947 Ladling Addream 510 7Ti im AVE ski" rlleti®ns CeritiiffBed Alln'traI„�It of, tDlriivililig Relleord DL/ID 0 491XX5036(IA) Customer 0u 0 0 T Class: D IIB Statum VAL Audit : 5102504 DL Statuum;; VAL Issue Date: Ft B1;4�0�IOi1f r 1#IPSgIlb�v None �Ifl 10/02/2016 CIIDL Cart Statuum. None Endorsements. 3 CDIL IRed Statum. None Restrietionm. Corrective Lenses t )fftc4, of I1111Yfr1Service", e", None Date of Birth: 10/2/1977 PO Bou 82.04 DI MoInas, IA, 50306 Sex: Plhnned .515.-244..0 l24 1800-532 112 IRxc 515-2.39.11.437 "&,WNP.. 11wj'.M:i'ct'gov Inquiry Datai 7/1/2014 INa sel Buell, Charles Clifford Addremm. 510 7611 AVE City/Statm CORALVILLE, IA 522411947 Ladling Addream 510 7Ti im AVE ski" rlleti®ns CeritiiffBed Alln'traI„�It of, tDlriivililig Relleord DL/ID 0 491XX5036(IA) Customer 0u 4722954 Class: D IIB Statum VAL Audit : 5102504 DL Statuum;; VAL Issue Date: 04/26/2011 CIDL Statuum„ None Expiration Date. 10/02/2016 CIIDL Cart Statuum. None Endorsements. 3 CDIL IRed Statum. None Restrietionm. Corrective Lenses Restriction None Date of Birth: 10/2/1977 Supplement. Sex: ft IC4f acthpe 11Eind ACD III'lixpllain n'tlV, n accurruVurue :MIR 8181il 0If'I1;12009 OW28120109 SR'l Serioxi!°V Io:l Muurn 1,d , p M RAM. Y •:i4 f f ONWIv �. /� �I' ,1 �. . 4 i '(11 _ C _ 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: m=°°°°,°°°4 Ag L -40i Office of Driver Services Iowa Department of Transportation �JuL A. 201.4 _9:35AM Div of Criminal Invest-,gation DCI I0r`No.3722 P. 3/5 C STATE. E. IOWA,. ;�:..•• ,,;�,. r' camMtainal IfIfi kr Check' .aRtqvest For R .UmaR Tmu jQwVV DMIbaofewoosal laca tC0m ALrEL5 a mmI dpmmw norm@, 10 u, RR^aa ass 706trmmd D"Momm, RDwaSul .._....wn_ ._ '6....G�._�._k_ r-. .Yia$_n .__. 72 ybamk '( 31q '55r- )em%a... VV9 5fll' Y'PIP _. ..._. 1H V b VII 6.� ....__..r.....�.�...we.... .. _. __ aAo�fI� n �mresalewimp'" ddirl �Ie �IWmr� 8 sa¢ m vd dwror fldWdt r m8 4kn mm m pie mrktlmmk �sAtddry nward may uupt rejumble, per CW& e"la ws, CI Apamr WX2, FaroaWBM UIMWI ILII brY Mud eWQVMd6b, At OH 0d b,Y 9w, dwAY& aI IWWftIxkMPC& AN As of m much of the paovIulod iw= and dates of bkth Mveswed.- No Iowa Mrd hal Irl.` .d fasvrnal with DO V_ krry m CdminsERistwy Record imtBmc, . „ —4 a �.., Received Time Jul, 3. 2014 11:00AM No. 3546 Jul. 8. 2014 9:36AM Div of Criminal Investigation XDWA MINIMAL' WSTORY Dcl: 00893025 HTSUMEAMOR CONVICTIONS ONLY PAGE 1. OF 2 DATE PRINTED- DCI:00893025 2014/07/05 WPAE; BUILL,CRRRLES CLIFFORD DOB SEX RAC HOT WGT EYE HAIR SKN POB 19771002 M W 600 270 BLU RED FAR KY ADDITIOINA?. IDE IFIERS PUOTO AvhILABLE.- Y TAT L ARK CCH RECORD 01 ARRESTED 20100317 AGENCY: IA0520400 p� IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE I'A724.4(3)(B) OD AR D/RKEFE SLAD'E 5 TO 8 - 1988 TRKµ: 1A008YO01 CHARGE NO- 02 IA STATUTE 1A155A.21 UNLAWIFUL POSSESSION OF PRESCRIPTION DROO TRKµ; 1A008Y002 COURT DIG TYO* ENCY€ IA052015J JOHNSON CO DIST COURT COUNT NO- 01 XA STATUTE IA724.4(3)(B) 00 ARM=/XNrFE 13LABB 5" TO 80 - 1989 COURT CAPE IDs 06521 9RCR090215 CHARGE CLASS: MISDEMEANOR CONVICTION TRKµ: 1A000TOo1 SENTENCE LISP EFF DAT DRPPRRED JMOENENT $31.5 CIVIL PENALTY 20100728 PROBATION IY 20100726 UNSUPERVISED PROBATION,INFORNAL PROBATION REVIEW 02/01/11. JAXL .5D 20130814 FI $3M� 201.30814 REVOKED 20130814 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIRT COURT COUNT NO- 02 IA STATUTE IA155A,21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG COURT CARE ID: DES21 SRCRO90215. CHARGE CLABSE MISDEMEANOR CONVICTION TRKµ.- 1A008YOO2 SUBSTANCE ABUSE EVALUATION SENTENCE DISP RPP DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20100728 PRORATION 1Y 20100728 UNSUPRRVI,SxO PROBATION,INPOR PROBATION REVIEW 02/01/11. JAIL 5D 20 -130&14 - FINE $315 20110814 No. 3722 P. 4/5 Jul, 6. 2014 9:36AM Div of Criminal Investigation No.3722 P. 6/5 Dcx 000-911125 PP 'R 2 OV 2 DISPOSITION)W ARREST WITHOUT A- F MAINTAINED 9V THE 1004 DIVISION rl)kNTIFICATION IS ,r PUBLIC RECORD BUT A ENPORCEMMT AGENCIES BY THE DC1. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD 19 BASED ON INFORMTIONFURNISHED- DIVISIONCOVERS THE SUBJECT OF )OUR JNQUIRY