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Home My WebLink About16-064CITY OF IOWA CITY 410 East Washington Street Iowa Cit . Iowa 52240-1826 (3 19) 356-5040 91 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. _ (I vc tT(ce Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) f allure to gone l a fe the "required" information will resuff in denial.of the appticafion First Middle x4P,- Last 2. Address (REQUIRED) 70A0 IJ, 3. Contact Information (REQUIRED) Email: h, 11 rhN,O, cUCell Phone: '311 33 1- 7 3 6 (All written communica ion sent via email) 4a. Chauffeur's License expiration date (REQUIRED) A0D-,-L b. Taxicab Business Name (REQUIRED) r' f'tGrG05, S - r 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? Type of offense --so W, Where When ADO What happened to the charge? (Circle one) o ice Dismissed Deferred Suspended Plead Guilty Other Have you been arreste c arged with any traffic offenses in the last five years? N(D 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 chauffeur's license been suspended or revoked in the last five years? IV 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 provide tk a name(s) N D �.L9 _,- t.� ..W._ DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CEWRTIFIE[3 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEis-RtVIEW r - You must apply for an individual Department of Criminal Investigation Report (form availabipopon requesf),'= (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 4 3 Sp g 6 R`( issued on 1 5 expiring on 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 (A U.� t / Date /a3 1 / wxwwxwxxx:..-x_wwww>wwwxwxwxx+xwwwxw..+xwwwxw>,ew:x<wx.�x.-max.xxxxxx.ka+,ww=wwwwwwwwwxxwwaww>x.t«w-.e�:.x,-..+x...�.x.x.r:wwwew+w.x,waxx.+x>xww>+.�xxx.ww STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by )-6)' (1 m„u ii _ ACI r[., on this 1)_ day 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 or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license/6 Signa ur�c 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. Si e of City Olerk or ignee Date aerF MDRivenoceAPPL92oinamended.DOC 0312015 0 wwwwwxxxxwwxxxxxxxxxwxxwxwwwww.uw<ww+wwawssxxwr.w...xxnxxr.w:s.zxzxwxwwwwwww+w<w+www+<e+x<+a+w>s-�:xs-�:xxxx.xxxx+.xxxxxx%+,exwxraxa�w...a,+.nrt,wx+ M Office Use Only: w r-' Approved application _ - DCI report State certified driving record cn Website update aerF MDRivenoceAPPL92oinamended.DOC 0312015 Vec.L9, 2ul) 12:44r'IV1 Div of 6rim1oaI Investigation No. 4233 P. 1 v••iv °. 91a ucueal.r/ 12/28/2016 16:27 1,364 P.002/Co$ STATE OF IOWA Criininal History Iljec().rd Check Reque=st Form 701 Iowa DiVislon of Criminal Investigation Support Opti-noons Bureau, 1'I Floor 21517"' Street Des Moines, Iowa 50318 (515)725.6066 (515) 725.6000 Fax Jam DCC Account Nwnbcr: �4.0 d (ifapplicnble) t rnm: tjty of Iowa Cif City Clerk's Office - 410 E. Washington Sheet Iowa.City 1A 52240 Phone: 319-356-5041 Fax: 319"356-5497 �Qrr Grp oi'X"�C'� Date of Mirth (manda,ary) Gender mandato ) Social Securi Number (reeemmnlded U a J 1 5 11 y 6 Male Female �s r1 - l f - 5 cif 5- -------------- Waiver Waiverinforntafionr without a signed Waiver from the subject of the request, a complete criminal history record may 1101 be releasable, per Code of Iowa, Chapler 692.2, rot, co_ mntete criminal hislory record information, as allowed by law, always Obtain a waiver si nature from Lhe sub eel of the re uesl. Waiver RcldaS14: I hereby give pemlissien forlle above requesting official to wnduc(an loe•a criminal himaryrccord check with IN Division of Cri incl Investigallon (DCI). Any criminal history data conecming nm Ila is n rained by the DCI may be rel ed es allowed by law. WaiverSignafure: 10wa CHIninal feTistal ftec®1 d C11ecic k2esults (bell use only) As of a search ofthe provided name and date of birth revealed: •-.' `� •'= i � I nr.agl No Iowa Criminal History Record found with DCI i - t t [owa Criminal History Record attached, DCI it (v � � 5 � � 1 � '�•! _ — —�L r " r C-1, IJC! initials h, DCI -77 (08/25/10) Received Time Dec. 26. 2015 3:16PM No. 4541 U rb.C7. LU17 IC.4'}PIYI U I V 01 111111111d1 I II V t; 511 g d 11011 IOWA CRIMINAL HISTORY DCT 00622510 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2015/12/29 DCI:00622510 NAME; BARRY,WILLIAM DBXTER DOB SEX RAC HOT WGT EYE HAIR SKN POB 19670215 M W 509 220 BRO RRO MED MD ADDITIONAL IDENTIFIERS CCH RECORD +*+ 01 ARRBST13D 20000612 AGENCY; 1,40520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA32IJ-2 OWI TRK#: 042151401 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VER WH INT (OWI) / EBR MISD / IST OFF - CHARGE CLASS: 1425DEMEANOR CONVICTION TRK#: 042157401 SENTENCE DISF 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 i 1i I, r Y J 000 -.�,.,,;:µi,r 'y'VVt1Vtt,10vrladil SMARITV, 1 5N PLIEF I(US TOMEE DRIVE':"��..� Office of Driver I ervaces Pc) Box. g2D4 " Des MofnPS, iA 5' 305-9204 Phone: 515 :244-9324 1804-532-1i2t. ; Fax: 515-235-4837 www; cllwadot:go:` Certified Abstract of Driving Record Inquiry Date: 12/22/2015 DL/ID #: 43SAA6946(IA) CDL Permit Class: None Customer #: 3350447 Class: C CDL Permit Issue None pf'AHiYEH Office of Driver Services `o� Iowa Department of Transportation Date: Name: Barry, William Dexter Audit #: 8017126 COL Permit None Expiration Date: Address: 720 N DUBUQUE ST APT 7 Issue Date: 04/26/2014 CDL Permit None Endorsements: Expiration Date: 02/15/2022 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: M 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 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: ....... !,V i 12/22/2015 IOWA D. O. pf'AHiYEH Office of Driver Services `o� Iowa Department of Transportation Name: Barry, William Dexter DL/ID: 435AA6946 ry