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Home My WebLink About15-075IDENTIFICATION NO. - I , (Office Use nly) • rrr��m� a� APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East Washington Street Iowa cityIowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 9) 356-5497 FAX First Middle Last 1. Name (REQUIRED) C C""C"' /- re- Ag"o .., 2. Address (REQUIRED) iii w l�:u�nerr� I�i (onL %ec L^ 5755 3. Contact Information (REQUIRED) Email:Cell Phone: 311-9 50 - q$S i (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 1-1-,2 4/- t 7 b. Taxicab Business Name (REQUIRED)_ Ke_//c✓ Cab ori C'It.., 5. Prior experience in transportation of passengers' 1Pr„ ok C c•v S 'f 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? T5 Tyne of offense Sc dole 1 lla55cS5ic„ Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? U Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five Type of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please a M :7Tame(s'7�" N 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 359 kk ZO73 issued on /2-)5-/1 expiring on 4/-2°/-!7 . 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 authorization to be a taxicab driver 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) Signature of Applicant_ 1/1�011 Date Z-1-1-1-5 x+x+z+www+++a+++++...w+++a.+++xxx+xxxwxxxwxxxwxwwwxxx:eww+a.x.xx.x.w+a.x.xx.a..xwwwaxw++++xx+x+.t..++++++«:+xxxxxxxxxxxxxxwxwwwx-xw+++++++:x+wxxwxxx+++x+xwxx STATE OF IOWA ) COUNTY OF JOHNSON ) Sy�cribed and sworn to before me by act FVNe r' - Cr\ +ll-40Yl on this �s+ day of :y s KF:L K TUTTLE $10 Notary Public in and for the State of Iowa 4 >, _ Expires 14 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 a of ffeur s license � d `� /� T � it Sig re P64e6tWefbrdesignee 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. Signatbre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ? // //_5 Date M,e A%IDRIVBADGEAPPL9z01q mended. Doc 0312015 Mar.30. 2015 11;30AM Div of Criminal Investigation`/ 1— i- Ll• LV IJ IL•IV•it V11, Vl,,n VI L, VI IVIVa V11) �r,�p�F1'un�,! r 9 I ` i l (OFROW S` o� "•'•"tier\ III I:d� Illtr Ali li'1ar (Check 1.1 �mlvn� '; l�f .eJ I" a II m II -. Fra'+� � To: Iowa Division of Criminal Taveallgatlon Support mperarioas EureaO, In' Floor 215 L 7rh Street Des Moines, loxia 50319 (515) IM -6066 (515) 725-6000 Fax I am rr Last of 'V - ?—'y — Ll1minad Recordr�C,Theck on: IRMt NAhle (mart No, 3690 P. 2/6 1.1,, Jruj IX DC1Ao0ountNumber: rtOC�2—l` (irappllcable) l+roml City oflawa city City Cleric's ®.Rice 410 F, Washington Street Aowa City, !A 522A0 Phone: 919-356-5041 Pax: 919.3565497 t�alo OVemale Name MORAM Waiver.fr(forfnaflofa: Without a signed w>aWel' from the subject of fha request, a complete criminal history record may not be releasablo, pet, Code of Iowa, Chapter 692.2. For ,completeerimival history record ihformation, ns allowed by law, always Waiver Re)'euxe: Iheroby givo perolisslon for the above requuling oftfolal to conduct an Iowa a n inel h6tory rewrd check afrh the DWlalon of Crlmmai tnvarl:gation (I)% My a nihiol hhlory da/a wn¢miny me lhet to mehttalned by dig DCI may 66 releaud as eflorrcd by law. Waiver ftnafure: Iowa Criminal ffistou Record Check Res"Ita ' CDC, w; only) As of 3 3fl a search ofthe provided name and date of birth revealed: I® No Iowa Climinal History Record found with DCI T Iowa Criminal Ristory Record attached, DCI DClinitials heti Received T1m-Na'.fV)2015 12:14PM No. 3592 tar. 30. 2015 11:3W Div of Criminal Investl,ahon IOWA CRIMINAL HISTORY DCI 00492290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- DCI:00482290 2015/03/30 NAME: BURTON,CAMERON LEE DOD SEX RAC HGT WGT EYE HAIR SKN PDB 19760424 M w 509 175 BLU BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19940704 AGENCY: TA05201DO CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#r 007541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESS SCHEDULE I/MART.IUANA CHARGE CLA55: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED 19941125 AGENCY: ZA0520000 JOHNSON co SO CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#: 012452301 COURT DYSP081TION AGFNCY: IA052015J JOHNSON CO DIST COURT COUNT 140- 01 IA STATUTE: IA321J.2 OPER VEH WH TNT Owl CHARGE CLASS: MISDEMEANOR CONVICTION TAH#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50N JAIL 51) RBVORED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321-210-2 DRIVE WHILE REVOKED CHARGE CLASS- MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No. 3690 P. 3/6 V1ar. 30. 2015 11:30AM Div of Criminal Investigation No, 3690 P, 4/6 CHARGE NO- 01 OWI 2ND OFFENSE TRK#: 500346901 COURT DISPOSITION AGENCY: IA057015J COUNT NO- 01 IA STATUTE IA321J-2-2-8 LINN CO DIST COURT IA STATUTE: IA321J-2B OWI 2ND OFFENS4 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE PLEAD GUILTY JAIL 7D FINE $1500 COURT COSTS 04 ARRESTED 20000701 AGENCY: IA0760000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J^21 DRIVE WHILE DENIED OR 14PVOXED TRK#: 600328701 COURT DISPOSITION AGENCY; IA078015J POTT CO DIST COURT COUNT NO- O1 IA STATUTE: IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR C014VICTION TRK#: 800326701 SENTENCE PLEAD GUILTY JAIL 2D DCI 00482290 PAGE 2 OF 2 DISP EFF DAT 19990825 19990825 19990825 19990825 DISP 8FF DAT 20000703 20000703 AN ARREST WITHOUT DISPOSITION IS 90T AN INDICATION OF GUILT. THIS RECORD MAINTAINED By THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION 0 C1410"AWADOT ltVVlVtI,tmt q.sw U=V SMARTER [ SIMIRLU i CUSTOMER =iRIV 0 Office of Driver:Serviices PO Box 9204 ! Des Moines, IA 50306-9204 Phone: -515-244-B124 f PAD 532--11211 Fax 515-239 18337 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 4/1/2015 DL/ID #: 359KK2073 (IA) Customer #: 4698203 Name: Burton, Cameron Lee Class: D ID Status: EXP Address: 311 W DOUGHERTY DR Audit #: 5685743 DL Status: VAL Issue Date: 12/15/2011 CDL Status: None City/State: LONE TREE, IA Expiration 04/24/2017 CDL Cert None 527557749 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: PO BOX 411 Restrictions: NONE Restriction None Date of Birth: 4/24/1976 Supplement: Mailing City/State: LONE TREE, IA Sex: M 527550411 History Information Convictions Citation Data Conviction Date ACD explanation County: JUIR. 06/29/2012 `07/18/2012 N82Improper Backing Iohnson •IA Name: Burton, Cameron Lee DL/ID: 359KK2073 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: 4/1/2015 ;rye MAN f itr p d s� D. O. T. &I h, Aof Driver Srvcs A BRIVEe owaeDepartme teof lTeansportation Name: Burton, Cameron Lee DL/ID: 359KK2073