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Home My WebLink About14-083Authorization Number I r 1 (Office Use Only) "000111 �` ® !lam Cee CITY OF IOWA CITY APPLICATION FORTAXI/MOTORIZED 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 S2240-1826 (3 19) 356-5040 (399) 356-5497 FAX First (Middle, 11 ah 1. (Mame � ...��apa�r� a.......... ,/ .° .................. m �1.�""esu 2.IMailingAddress .....�.�:.........L k:........��srd...............G..... .,�.............................. ................................... ........ 3. ..I..elephene: Nome.../.�!= �...�1.... "'d > Other: ............................. 4. IPd�o^r experience ini transportation dl' passengeryI- e d A/— Ore,fk "' C4.4 -4 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? V.yys, ,p musPtireo Where When � ::1... ... F, mm ......�. ... `.�. o.pia.........�......r....................................../ _. _. .......................................................................................................... 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Where 0.',•, oma Y When (& .pB....m...�.f...3. ....::.�:.� ......... 7. Have you been convicted of any traffic offenses in the last five years? Tvoeof offense ere Reil ueirn .............. a r .............._..........._ t..._._._.__................_.............................................. ��a' „B _ ............._________.........................._.. _______________________________----------------_.________________________------------._______�_/______. _--____ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fire years? ---- 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) . r ,. , •., ,, .1 . (OVER FOR REQUIRED SIGNATURE AND NOTARY) deddlaWntrbadg 03/2014 I hereby certi� that 1 have issued to me by the iowa Department of Transportation a valid Chautteurs license number '/t' I understand that if I falsely answer any questions in this application, that this application 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 Ci!y Code. (Needs to be signed in front of a Notary Public) 9 pp � Date w ....... �' / �✓ Signature licant 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 ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by ( �� . � � � On this _,,,,,,,,,,,, ;fir ,,, day of I 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 t......Police Chief or designee /2 J Date 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. Signatu& f City Cl rrk*" or designee ......... Sale Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 5 %11 (height) and prominently displayed to all passengers. Office Use Only Approved application DC! report State certified driving record Website update darwftddnvbmgeappzou.ccc 03!2014 Apr. - 1. 2014 3: 3 3 PM Div of Criminal Investigation STATE OF IOWA alffi I stoyRe mII�i#,d Check Rrc equest Form' To: Iowa Diviblon of Criminal Invg5tiptlon Support Operations Bureau, V Moor 215 X 741 Street DOE Morn", Iowa 90319 (515) 725.6066 (515) 724-6090 Fax an Tows Cffininag to of Birt) Y KKR 1. 0 Wa V& fivorm Max Witho 91 Nast Wax,per slglxaeupe: OW ACI Account Number: NNo. 6454 P. 2, U. 'rJjV F. z/ 2 ! . 8110W% rlt� cay 0;:'Wi orfire 4 WR .9..2 & .......... .............. Streat .-- C 11VVIA 52740 rhow.31.9;.3.565041 . . .............................. — 3M396-5497 As ... ....... �A L mm .................. a search of thDprovidod name and date of birth revealed: . 'with .... USI No Iowa CrimbiAl 111,areq Recardfound DCI ,n Iowa CYffninal History Record attached, DCT # DCJ. ffliti* Received he�Y-17 tA2h<J1QN T i me Ma r. 28. -2014 11: 45AM No. 6211 Apr. 1. 2014 3:34PM D v of Criminal Investigation DCII 00482290 PAGE 2 OF 2 AGENCYe IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA. STATUTE IA32ILY-2-2-H OWI 214D OFFENSE TRK#: 5003469o1 ;f [1111tL Y�+3� f�17AT;�Ti��55 i Ey IA05701SLI LINK CO DIST COURT — COUNT 01 IA STATUTE IA321J-2B WZ 214D OFFENSE = ROE C W S: MISDEMEANOR CONVICTION 500346901 SENTENCE OISP EFF DAT PLEAD GUILTY 19.990025 JAIL 7D /9990825 FINE $1500 1999002.5 COURT COSTS 1.99.9002: 313 : ) i... AGENCY: IA0780000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 b9XVR WHILE DENIED OR REVOKED TRK#: 800320701 CYC r. IA078015,YPOTT GO DIST OUR.. CONO- 01 IA STATUTE IA321.218 DRIVING WITH StIsP9ND9D LICBNsz CRARaS 870 88NTENCE DISP EPP DAT PLL" GUILTY 20000703 JAIL 2D 20000703 AN—A"IREST WITHOUT DISPOSITION;O MAINTAINED 13Y THE IOWA DXVXSXOR CRIMINAL INVESTIGATION, IDENTIFICATION M. *. BUREAU TO ENFORCEMENT AGEN IES BY e R, No. 6454 P. 4 Apr 1. 2014 3:34PM Div of Criminal Invest gation IOWA CRIMINAL HISTORY DCI 00402290 MTOT)EMgANOR DATE PRINTED - 2014/04/01 PC1:00482290 NAME: BURTON,CAMERON LEE DOB SEX RAC HGT WGT EYE HAIR Sm FOE 19760424 M w .509 175 BLU BRO FAR. 1A ADDITIONAL ID=TXVXBR9 CCH RECORD *** 01 ARR39TED 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POk:"v�f.1ES.qSCILEOULE I/MARIUVANA, TRK#s 007541901 COURT DISPOSITION AGENCY: XA052015a JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401,-3 POSSESS SCHEDULE I/MARXJUANA CHARGE CLASS€ MISDEMEANOR CONVICTION TRK: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 1'.A ,STATUTE :11A321.J-2 owl TRK#: 012452301 COURT DISPOSITION AGENCYD IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J, 2 OPER VER WE INT OWI CHARGE CLASSi MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 5OH JAIL 5D REVOKED COURT DISPOSITION AGENCYg IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA321,-21.0-2 DRIVE WHILE REVOKED CHARGE CLAW MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED 19990522 DISP EFF DAT 19940810 19940010 DISP EFL+ DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 Na, 6454 P. 3 Cortffied Abstract of DrMing Record Inquiry Date: 4/2/2014 DL/ID 359KK2073 (IA) Name: Burton, Cameron lime Clasag D Address: 311 W DOUGHERTY DR Audit 5685743 None Issue Dateg 12/15/2011 City/State: LONE TREE, IA 527557749 Expiration 04/2412017 Date: Endorsements: 3 Mailing Address: PO BOX 411 Restrictionm NONE Date of Birtm 4/24/1976 Mailing City/Staten LONE TREE, 1A 527550411 Som M R-TIVIM 0=1 cillaftni Date conACU11941 11N11ate ACID 1111*11113naVan 06/29/210 2 0111'OjAiL:i N82iinjjxolm ilm Name: Burton, Cameron Lee DL/ID- 359KK2073 Page I of I Customer 4698203 ID Station EXP DL Statuin VAL CD1i. Statung None CIDIL Cart Statum None COL Med Statum None Restriction None Supplement: County 10i 4:4 44 44 0 RION NO A VOR 001*0 WOMAN 1.4440W.4 0,4001OU 0AINAARQ', certify. 4/2/2014 Office of Driver Services Iowa Department of Transportation 4/2/2014