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HomeMy WebLinkAbout15-306j r t .dmp-=0®4It i._ CITY OF IOWA CITY 410 East Washington Street Iowa City, toiva 52240-1826 (3191 356-5040 Tr -97356-S497 FAX IDENTIFICATION NO./ � 3n a (Office Use Only) APPLICATION FOR TAXICAB i 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 First 1. Name (REQUIRED) w)1I rl c 2. Address (REQUIRED) ire iae l oubuqve S+ Last -T tr �i. A ' s D'av S 3. Contact Information (REQUIRED) Email b i I 1 . v.ld ba j ® I M,„ 1, t or,-) Cell Phone: 3 I ± 331 - 573 6 (All written communicaTtion sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 02� IS / a° D -- b. Taxicab Business Name (REQUIRED) _ No, j h Cn —4 C- 5 C - 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tyne of offense ©w7 -10 Wu, Where When ,)DO What happened to the charge? (Circle one) o Icte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arreste c arced with any traffic offenses in the last five years? fyn Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? V- n Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provideahe nariid(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIErREVIEW r $•• You must apply for an individual Department of Criminal Investigation Report (form available Upon request)" (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) r,. 02/2015 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 ti 3 S r� A 6 R '1 Io issued on a as I J expiring on _.2 //s%waw . 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 Date /_11-311/ STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by � iltm u I _ n ,rl i on this day of WENDYS MAYER mission Vinlue, '.j 27" iy Commission. Expires Public i(jand for the State 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license,/G Signa ure f olice(.hief 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. Signat&e of City Olerk or Ztetignee V)1kt L< Date *#***bAAd*****}duk4+f r t') Office Use Only cn < Approved application - LL DCI report r':a State certified driving record cn Website update CleddrAXIDRHEADGEAP P L92014ame nded. DOC 0312015 f Dec Y2 . 2D1h 12:44FM Div of Grlminal lnvestlgatioo No.4233 K 1 F.-..y..e...- .....y CFO,_ 12/28/2016 16;27 4364 P.002/0M) \ STATE OF IOWA Criminal History Record Chock `' I Request Ft rni To: Iowa Division of Criminal lnves(igaiion Support Operations Iturceu, i" Floor, 215 E. 716 Street Des Moines, lows, 50319 (515) 725.6066 (515)725.6000 Fax o,rr vs, )Is J1y67 on: 1 1I1 Gr+1 DCl Account Mimbcr: _410 O Z — S (_(applicable) From: 01ty of lower CRicleric's offie3 c ----'- 410 E. Washington Sheet Iowa City, 1A 52240 Phone: 319456-5(141 Fax; 319-356-5497 -� ❑Female (oe)(Y(f'(- ,5's`!- n - Sasy rrolver I)7J01"Mal ioli: Without a signed `WAVer from tilt subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chni ier 692.2, roe comnlete criminal history record information, as allowed by low, always obtain a waiver signature from the subieti of the rrnllrcl Waiver Release. I hereby give permission for Ne above Iavenigodon (DCI), Any UN111121 hislOry data concerning me r Wafver Signature: official to wnduel m luw'o erinlinal hissory rewrd check with the Nvisior ailed by the DCI maybe rclfaSed as allow¢d by Ilsw. - -- lwvv uaaV (V(:i ll$C 011ly) As of 1a\a°j11,� , a search of the provided name and date of birth revealed:El •--' o No Iowa ()iininal History Record found with DCI f f) ^ "T ^I fowa Criminal History Record attached, UC14 (v Y: S 1 DC1 initials_ � r r c" ��. ----�.—_�.�—_----- DCI -77 (08/25/10) --- Received Time Dec. 28. 2015 3:16PM No -4541 uecLV17 IL:44nvi UIV of uYlniInaI In Ves llga llon Iuo.4LJ} r. L r IOWA CRIMINAL HISTORY DCI 00622510 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2015/12/29 DCI:00522510 NAME; BARRY,WILLIAM DEXTER DOB SEX RAC NGT WGT EYE HAIR SKN POB 19670215 M W 509 220 SRO SRO MED MD ADDITIONAL IDENTIFIERS CCH RECORD •*+ 01 ARRESTED 20000612 AGENCY; IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 042157401 COVRT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VER WH INT (OWI) / 89R MISD / IST OFF - CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 042157401 SENTENCE DISP EFF DAT JAIL 2D 20000720 ATT DDS SA EVAL FINE $500 20000720 AN ARREST WITHOUT DISPOSITION IS NOT 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 r� 0 nt� G7 r=Y y - to e.a C-JiuvvAkDOT SiM:AR TEP 1 5!MF£LF I C USTti&iEF b 2fVIE. i Ot€ee of i4rlver services PC Box: 92C41 Des Moines.. IA 5030b-9204 Prime- 515-244-5224 j 500-532-1121 1 Fax: 515-235-1837 www C3Yace"'9av Certified Abstract of Driving Record Inquiry Date: 12/22/2015 DL/ID #: 435AA6946 (IA) CDL Permit Class: None Customer #: 3350447 Class: C CDL Permit Issue None Date: f`:J Name: Barry, William Dexter Audit It: 8017126 CDL Permit None Expiration Date: Address: 720 N DUBUQUE ST APT 7 Issue Date: 04/26/2014 CDL Permit None Endorsements: Expiration Date: 02/15/2622 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522451925 Endorsements: NONE ID Status: EXP Mailing 720 N DUBUQUE ST APT 7 Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522451925 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 2/15/1967 CDL Cert Status: None Sex: iv CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Barry, William Dexter DL/ID: 435AA6946 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 ropy 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: .......... 76�pt 12/22/2015 IOWA' ¢y D. 0. T. # 4r s►? r es pf'•••• •' Office of Driver Services y9HIVE�a— Iowa Department of Transportation Name: Barry, William Dexter DL/ID: 435AA6946 ru b� f`:J