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Home My WebLink About16-139CITY OF IOWA CITY 410 East Washington Strcct Iowa City, Iowa 5 2240-1 82 6 (319) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. / L,(7 - ) '3 (Office 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) Failure to complete the "required" information will result in denial of the application 3. Contact Information (REQUIRED) Email:Q� ((CrLi1 t��201it�`Jq�T p�, , Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) _&` 7-6Z Z �/ b. Taxicab Business Name (REQUIRED) _%I�ULJ Gqb 5. Prior experience in transportation of passengers: Vnfl0t✓ yah o F Gw li p 5l`y1 :F -y9- 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A)& Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? / O Type of offense Where When What happened to the charge? (Circle one) 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? Type of offense Where When N71h 2ymon'f OF f ^'J �L� it �t y�u7 `fit wX3 ��Zoat $uS�e+'fr%,/ /✓Un P�r/yi�f GG >`fn�f /gr.�'/�a c�rrt 2� 2��1� 9. Have y)ou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) �V ty 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 upoir request) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0712016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Depart ent of Transportation a valid Driver's license number `LyD 2Z 3f a2 issued on 7 7? expiring on 7/2 Y"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 iQ1.il le�l Date ::ww+wwwwww+x:i+ww:wwwwwwwwwwwwwwwww:iwxwwwww<waver++.eaa+::::..r:x>a+ww+awww.:�:.x:xaww+swwwa:x:.xx+xxxwwxwww..+�::wxrwwww+w.rw«tet::fixiwwwwwwwww. STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by J ; " .. L I (i on this Zi day of a- � —i t . V EW Y S. in and for the xxwwwwwwwwwwwwwwwxxwxzsw:rwwwwwwwwww:twwwkxxxawwwwwwwwwwwwwwwx:aixxwwww+wwwwwwwwwaxxxxwwwwwwwww�awwwxxwxwwwwwwwww,t,rw�:txxxxwwwwwwwwwww,rwwnx+ewxwwww 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 Driver's license ?c 11Z2 72, C-( Signatur of ice Chief or designee Z12 6L 6 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. Signature of City Clerk or designee Date ww+wwwwwwwx.wxwwwww+wwwwwwwwwwwwwwwxwwwwwwww+w++w�.rwxwwwwwwwwwwwwwt:..wxwwwwwwwwwwww.+.wx.xxwwwwwwwwwwwwwwwxw:xxwwww #k,r�xxxxxxwxwww+w+:e+.RRwx Office Use Only Approved application DCI report State certified driving record Website update ae�rrwaoRroanocenPPL92014ama�ded.00C 07/2016 Aug.' 1, 2016 4:17PM Div of Criminal Investion No, 9509 07/21/2U1b 'lq:So tel low Cab or Iowa Lity (FAX)3193382,uo STATE OF IOWA HistoryCriminal Record Check i 1 1a . Request Form To: Iowa Division of Criminal Investigation Support Operations Burenu, 1" Floor 219 D. Vh Street Des Molnea„iowa 50319 (515) 725-6066 (519) 725-6090 Fax 1 nnntr....fe r\.l,..L.ol Y.li ernn, V.,,A Chf.f•4 nu- P.'. u- P' ,002/002 DCI Account Number: 9967-I'' (Ir eppllaabte) From: Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (319)339-9777 Phone: Fax: (319) 339.7302 Last Name (mandala First Name (mandmo Middle Namo (,eanmmehdad) R�� k Date of Birth (mandatory)_ Gender (mandato 'So ialto •fiecuri Number (recommended) $��✓// 1%76> r9�n t�Male OFemale 21” 7-Z— G5'? -ell Walver information: Without a signed wal"i- from tho aPbJoot of the regpost, a compigl a criminal history record may not be releasable, per Code orfoyea, Chapter 692,2. Forcomplete criminal hlstoryrecoro information, as allowed by faw, always obtain a waiver signature froin the sub oct of the request, Walter Releftft l hereby ®Iva permission forthe above requasling oftialal to condual an Iowa erimlnat history record chock with Lha Dlvhlon o(Crlydnai Inyesdsnnon(DCO, Any adminal history data conaeming me wi is m�imeined by tho Dal may be released As allowed by law. Waiver Signature! Xo)1fl -Criminal HistoryRecord Che exults As of r a search of the provided name and date of birth roves ed: M, No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI # DCI [nitials� DCIM (08/25110) RPCPivP.4 Time Jul. 97. 701b 1:01PM No.0439 0 .� i�r�"" -- DOT R° www owadiotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry 7/27/2016 Date: Customer 1935963 Name: Lillie, Ricky Ray Address: 2025 WESTERN RD City/State: IOWA CITY, IA Sanctions Pagel of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 wwar.iowadol-gov Certified Abstract of Driving Record DL/ID #: 46OZZ3187 (IA) CDL Permit Class: None Class: D Audit #: 1181627 Issue Date: 07/27/2016 Expiration 08/31/2024 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit 522402333 Mailing 2025 WESTERN RD Address: None Mailing IOWA CITY, IA City/State: 522402333 Date of 8/31/1970 Birth: VAL Sex: M Sanctions Pagel of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 wwar.iowadol-gov Certified Abstract of Driving Record DL/ID #: 46OZZ3187 (IA) CDL Permit Class: None Class: D Audit #: 1181627 Issue Date: 07/27/2016 Expiration 08/31/2024 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: Suspended CDL Permit None Restrictions: .Non -Payment of Iowa Fine ID Status: VAL DL Status: VAL CDL Status: None CDL Permit ELG Status: Suspended CDL Cert Status: None CDL Med Status: None Type Effective End ACD Explanation Occurrence JUR JUR Suspended 02/07/2005 03/23/2016 D53 .Non -Payment of Iowa Fine IA 'IA Suspended 07/04/2006 01/31/2016 D53 _ Non -Payment of Iowa Fine 'IA IIA Name: Lillie, Ricky Ray DL/ID: 46OZZ3187 Pursuant to Iowa Code 9321.10, I, Melissa Spiegel, 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. ry In witness whereof, I have caused my signature and the seal of the Department to be set upon this docurrlent, at Ankeny, Iowa this date: 7/27/2016 7/27/2016 IOWA D. 0. T. of `° pCIVER Office of Driver Services 7/27/2016