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Home My WebLink About16-1121 P 1 � 111 CITY OF IOWA CITY 410 Cast Washington Street Iowa City, Iowa 52240-1876 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. 1 C_0 -- 1 I Z., (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 .d u is aai 1. Name (REQUIRED) rn n ` ' 2. Address (REQUIRED) �e) f_ r 3. Contact Information (REQUIRED) EmailT✓4,aSi GJ Fr 4,3 c(��r G Cell Phone: (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) c --�' b. Taxicab Business Name (REQUIRED)! 4fUU 5. Prior exRerience in transportation of passengers: z9hiiiilCif✓��c ! +�/� ✓1 v 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �1 Type of offense Where When r-. What happened to the charge? (Circle one) VC Convicted Dismissed Deferred Suspended Plead Guilty -Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense WhereJ When What happened to the charge? (Circle one) �� Convicted Dismissed Deferred Suspended_ leltsl Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When /(/ SlL.t Vi�l� Pli d oVq 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 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 her certify that I have issued to me by the Iowa Depfg�rtm nt of Transportation a vali��jj Chauffeur's license number ?s /gL �aaL ), issued on /07 6 expiring on /j �N7� . 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 applica ' , and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisns Tile 5, Chap 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofApplicant Date 6/ / l STATE OF IOWA ) COUNTY OF JOHNSON ) s� Subscribed and sworn to before me by �j(Ii/4h3 on this day of r..... —I.. it 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 �_ 42--�3 r/2 -J Signature of Police Chief or designee 6-0116 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. Signatdre of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update �,�� Date ClerklrAXIDRIVE DGE PPL92014amandeaDoc 03/2015 rti. Vu-.; 0�10a12016 13:2r v30n F-00$l00o STATE OF IOWA Criminal History Record Check Request .Form DCI Account Number: LE 00a' - To -, 0a'-Ta: Suwa pport peratiCrimureau,vI"Fl or From: t�p� Support Operations Bureau, 1" Floor 215 E, 7h Street J Des Moines, Iowa 50319 (515)725.6066 (515) 725-6090 Fax Phone: 77 Fox:.�i��-. am /-,2 - Male LI -Female , �ef,s ��v�rtcord WQrver it farM0760rt: Without a Signed waiver from the subject of the request, a complete criminal hiyno be releasable, per Cade of Iowa, Chapter 692.2. For corn tee eriminal history record information, as allowed by law, always' Obtain a waiver sipnature from Waiver Release: t hereby give permission for rhe ebuve requeadng olrcial to oenducr an lowacriminai history record check with the Division ufCrimirrat Investigntion(DCl). Anycriminai history' dam conecming me is maintained bythc VCl may bo released as allowed by tow. Waiver Sign ntftre::1 --i Io'+v. a Criminal History Record Check Results `•;;�_ � yto As ofa search of the provided name and date of birth retire&d: -1-7 A ' N .J ❑ No Iowa Criminal History Record found with DCC Iowa Criminal History Record attached, DCI # . a9(v DCT initials DCI -77 (08!25110) Received Time Feb. 4. 2016 12:15PM No.6640 use only) DCI:00425266 NAME: WILLIAMS,LYNN EARL, DOB SEX RAC 19611126 M W No, 6649 P, 2A IOWA CRIMINAL HISTORY MISDEMEANOR CONYiCPIONS ONLY DCI 00425260 PAGE 1 OF 1 DATE PRINTED - 2016/02/08 HGT WGT EYE ak-R SR,N POS 506 1@= BRC' BRC LG? IA ADDITIONAL 1DENTIFIERS SC FACE CCH P.FCO§D +<* 01 ARRESTED 1991080/ AGENCY: IA0770300 DFS MOINES PD CHARGE NO- 0i IA STATUTE !A725-1 PROSTITUTION TRK#: L40392$01 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE: IA725-1 PROSTITUTION CHARGE CLASS: MISDEMEANOR. CONVICTION TRK#: L40392oo1 SENTENCE DISP EFF DAT FINE 000 19910909 02 ARRESTED 19950627 AGENCY: 1-40770500 WEST DES MOINES PD CHARGE NO- Ol IA STATUTE TA714-2-2 THEFT -2ND TRK-#: 016119901 COURT DISPOSITION AGENCY; IA077015J POLL CO DIST COURT COUNT NO- Ol IA STATUTE: IA714-2(2) THEFT 2ND TRK#: 010119901 SENTENCE DISP EFF DAT DEFRRREO JUDGEMENT 19960131 PROBATION 2Y 19960131 2Y DEFERRED JUDG-120 HRS COMM SERV AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT, THIS RECORD MAINTAINED BY THE IOWA UIVI3ION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY RE 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 INOUIRY. DIVISION OF CRIMINAL INVESTIGATION CjoZiOWADOT VWmiowedotoov SMARTER f SIMPLER i (llJ7(iMEEii DRdidEN. Of# ce of Drives' Services Pa Box 8204 I Des Mares, iA 5030&-8204 Phone: 515-244-9424i8GO-5332-1129:'s FaX515-239-18,37 w w.mackkT gov Certified Abstract of Driving Record Inquiry Date: 2/12/2015 DLJID #: 878AL2002 (IA) CDL Permit Class: None Customer Ira 4832230 Class: D CDL Permit Issue None Type affective End ACD Date: occurrence ;UR JUP Name: Williams, Lynn F Audit #: 8782002 CDL Permit None Suspended 12/07/2000 02/06/2001 053 Expiration Date: IA Address: 320 2ND ST APT 127 Issue Date: 01/21/2015 CDL Permit None Endorsements: Expiration Date: 11/28/2023 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522412657 Endorsements: 3 ID Status: None Nailing 320 2ND ST APT 127 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA 522412657 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 11/28/1967 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date 03/21/2015 Convictions Date 04/21/2015 ACD Explanation S92 Speed County JUR Johnson IA Sanctions Type affective End ACD Expiana£ion occurrence ;UR JUP Suspended 11/02/2000 02/06/2001 D53 Non -Payment of Iowa Fine IA Suspended 12/07/2000 02/06/2001 053 Fail to Satisfy Non -Iowa Citation IA Suspended 01/09/2004 11/22/2004 D51 Non -Payment of Child Support IA Name; Williams, Lynn E DL/ID; 87BAL2002 ,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 'he 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: `*wu j OSSyENIC[f 2/12/2016