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Home My WebLink About17-004CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NC. 9'-7—M14 (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 First on/C D Middle (A Last 3. Contact Information (REQUIRED) Email: Cell Phone: 3/r1�335 �72� (All written communication sent via email) / 4a. Driver's License expiration date (REQUIRED) ( ;;,V LL2/ns 10,z 3r b. Taxicab Business Name (REQUIRED) Yt //Ow CO U 5. Prior experience in transportation of passengers: 4IL7A� 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When f T FT 2WC' 7-,,h, 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 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? 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 the name(s), DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFJED 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her eb c fy th t JJ�� ha a ssued to me by the Iowa Department of Transportati n a valid Driver's license number Id G/ issued on expiring on 2"0 3 . I understand that if I falsely answer any questions in this application, that this ap Iication 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,, fCha er 2, of the City Code. (Needs to be signed in front of a Notary Public) A�%Signature of Applicant ' % ( Date STATE OF IOWA ) COUNTY OF JOHNSON ) 4bscribed and sworn to before me by �� w ; e S P �_, on this day of C,nv qr `1 SZ NNots�ry Pu is in and for the StSt teaofTowa **f******#f**f***f****f*ff***************###*#****#*#**#***#*4***##***##*#*##**#****!*************ffflff**f*!*+**f*f*!**ff*f*f*fffffffff*ff*fflf 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). Expiratio date river' nse Signalut of Police Chief 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. Sigftakirb of City Clerk or designee ate J I Office Use Only Approved application DCI report State certified driving record Website update CIMJrAXIDRNBADGFAPPL92014ame dW DOC 07/2016 C4J10WADOT www.iowadotgoa SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: 11/30/2016 Customer #: 4773745 Name: Shupe, Daniel Ray Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515239-1837 wwwJowadol.gov Certified Abstract of Driving Record DL/ID #: 958AL2175 (IA) Class: C Audit #: 9582175 Address: 1813 LOWR HWY 6 RD NW Issue Date: 11/18/2015 TRLR 81 Expiration Date: 12/22/2023 City/State: OXFORD, IA 523229246 Mailing 1813 LOWR HWY 6 RD NW Address: TRLR 81 Mailing OXFORD, IA 523229246 City/State: Date of Birth: 12/22/1956 Sex: M Sanctions Endorsements: NONE Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Page 1 of 1 Type Effective End ACD Explanation Occurrence JUR JUR Suspended 02/14/1993 106/19/2015 D53 Non -Payment of Iowa Fine IA Name: Shupe, Daniel Ray DL/ID: 958AL2175 Pursuant to Iowa Code §321.10, 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. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at AnkenK, Iowa this date: _ yEYlflf %�ri�rr 11/30/2016 i T. rrrrrrrrr ...... Office of Driver Iowa Department eof Services r Name: Shupe, Daniel Ray DL/ID: 958AL2175 11/30/2016 Fawn. J, LVII,, 7.VVMir v 1 v u �t liInIitdI Invesigation Volu0ji Y. I/l ' Cl ei.. _... .— -, ,,_•,. 01/04/2017 13;ci 077/ r.u,J2J002 1A TE OF IOWA Criminal History Reca rd Check 11eyuest Form Trc )nwn niv iainn of r,riminnl Invnwicallnn Support Operations Bureau, Ps Floor 215 C. 7t" street !hs Moines, lova 50319 .....—X5151725-606(, . (315) 725-6080 Fax I and re(.Itse0ina an TrIma i not 7.3;"Yr e.....d r4.e,.1. _... DO Account Number:._ 400,2 (ifapplicv!, -- From: Cltauaf M% -A (:Itv City Clerk's Office 4101. Washington Street . lows City, I,g, 52240 Phone: 319-356-5041 Fax: 319-356-5497 LOSt Name (mandatory) w (First Name (mandatory) Middle Name (rewnvnmded) 12gyJE !2 Date of Birth (mandatory) Gender (mandato) — Social Security Idulnberr (mcon,menoed) - Waiver XnforMIZ00nl Wuhout a signed walver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, al}veys obtain a N'alvtr si nature from the subject of the request. Waiver I herebygivepemllesionforthe aboverequestingoFicial to conduct all lona criminal history lemsd chmit with the Division oresinlinal Investigation (DO). Any criminal history dais concern] n^ n al is maintained by she DC ,ay Is rtleased I all e4 by law. Waiver Sign am, Iowa Criminal History Record Check Results ` As of . , a search of the piovided name and date of birth revealed: ® No ]owl Criminal History Record fouled with DCI Iowa Criminal Histofy Record attached, DCI u-23QllAs1— DCI initials -h--__ tq,a-II tvoleallui Received Time Jan, 4. 2017 12:31PM No.0944 (I)4 nse only) an. zvir y:itnni uiv or � r i m i n a I inves[igalion No,Ub3Z DCI:00261161 NAME: SHUPE,DAN SHUPS,DAH M SHUPE,DAN R SHUPE,DAN RAY SKUPE,DANIEL RAY DOB SEX RAC 19561222 M W ADDITIONAL IDENTIFIERS SC L HND IOWA CRIMINAL HISTORY FELONY CONVICTION HGT WGT EYE 509 165 SRO CCH RECORD ++'w DCI 00261161 PAGE 1 OF 6 DATE PRINTED - 2017/01/05 HAIR SKN POB BRO MED IA 01 ARRESTED 19600110 AGENCY: IA0940100 FORT DODGE PD CHARGE NO- 01 IA STATUTE IA716-5 CRIM MISCH 3RD DEGREE TRK#: L17418901 COURT DISPOSITION AGENCY: IA094015J WEBSTER CO DIST COURT COUNT NO- 01 IA STATUTE: IA716-5 CAIN MISCH 3RD DEO CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17418901 SENTENCE PROBATION lY SUSPENDED 90D 02 ARRESTED 19871121 AGENCY: XA0920000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA204-401 FOSS COCAINE TRK#: L17419001 CHARGE NO- 02 IA STATUTE IA123-46 PUBLIC INTOX TRW L17419002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204-401 POSSESSION-SCH II -COCAINE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1,17419001 SENTENCE FINE $250 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA123-46 PUBLIC INTOX CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19900317 19600317 ro �,7 '7 DISP EPP DAT •• 19880331 pan. 7.. (VII 7. ILn6i U I V UI ,I IIIA IIdI InVB5l18dllon TRK#: L17419002 SENTENCE PLEAD GUILTY FINE $50 03 ARRESTED 19880115 IA STATUTE: IA123-46 AGENCY: IA0460000 IOWA CO SO . CHARGE NO- 01 IA STATUTE IA908-11 PROB REVOCATION SENTENCE TRK#: L17419101 PLEAD GUILTY COURT DISPOSITION FINE AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA908-11 PROB REVOCATION AGENCY: IA0520200 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17419101 IA STATUTE IA321J-2 SENTENCE JAIL SOD COURT DISPOSITION REVOKED 04 ARRESTED 19890909 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA123-46 PUB INTOX TRK#: L17419201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA123-46 PUB INTOX CHARGE CLASS: MISDEMEANOR CONVICTION TRK#' L17419201 —p SENTENCE PLEAD GUILTY PAY SURCHG FINE $25 COURT COSTS 05 ARRESTED 19891026 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND TRK#: L17419301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI 2ND CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17419301 DCI 00261161 PAGE 2 OF 6 DISP EPP DAT 19880405 19880405 DISP EFF DAT 19900201 19900201 19900201 No. Mz r, S/ I ro -J t0 '1 —p ro qan• 7.• IV II 7:IIhivi u i v 01 brlminai investigation DCT 00261161 PAGE 3 OF 6 SENTENCE DISP EFF DAT JAIL 7D 19900112 FINE $750 19900112 PROEATION 2Y 19900112 SUSPENDED 233D 19900112 CREDIT W/TIME SERVED 7R CR;SAE/TRMT;PD 19900112 SURCHGi022692 PROS VIOL - 233D 06 ARRESTED 19920200 No. u0ji Y. 4// AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 3RD OFFENSE TRK#: L17419401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI 3RD CHARGE CLASS: FELONY CONVICTION TRK#: L17419401 SENTENCE DISP EPP DAT JAIL 5Y 19920414 PAY SURCHG PINE $750 19920414 07 RECEIVED 19920511 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE 1A321J-2-C OWI 3RD TRK#: L17419501 (OWI HOUSING) INMATE #, 026564 CHARGE NO- 02 IA STATUTE IA321J-2-E OWI 2ND ^� r.� TRK#: L17419502 -:.. COURT DISPOSITION '=*' AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2-C " ' OWI 3RD CHARGE CLASS: FELONY CONVICTION TRK#: L1?419501 .• SENTENCE DISP EFF DAT JAIL SY 19920511 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J-2-E OWI 2ND CHARGE CLASS: MISDEMEANOR CONVICTION Jan. h- 201/ 9:13AM Div of Criminal Investigation DCi 00261161 PAGE 4 OF 6 TRK#: L17419502 SENTENCE DISP EPP DAT JAIL 233D 19920511 CONCURRENT W/CT 01;SENTENCE DISCHARGED 19920511 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 03 IA STATUTE: IA321J-2-C OWI 3RD CHARGE CLASS: FELONY CONVICTION TRK#: L19419503 SENTENCE DISP EFF DAT CONSECUTIVE SENTENCE W/CT 01 19940506 JAIL 5Y 19940506 CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 19921109 PAROLED CUSTODY AGENCY: IA062015M OAKDALE IMCC B 19940506 PAROLE REVOKED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19950105 PAROLED CUSTODY AGENCY: IA052015M OAKDALE IMCC D 19950901 PAROLE REVOKED VIOL PROD ADMIT CUSTODY AGENCY: IA077015G ADULT PAROLE SVC E 19951107 PAROLED VIOL FROG CUSTODY AGENCY: IA052015M OAKDALE IMCC F 19960509 PAROLE REVOKED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC G 19970124 PAROLED CUSTODY AGENCY: IA052015M OAKDALE IMCC H 19970509 PAROLE REVOKED FOLLOWING FINAL REVIEW HEARING CUSTODY AGENCY: IA077015G ADULT PAROLE SVC I 19970714 PAROLED W/IMMEDIATE DISCHARGE 00 ARRESTED 19940127 AGENCY: IA0160000 CEDAR CO $O No, 0632 P, h// N r-� .J �D tV yafl. i.. LvI( 7.unln viv u vrIIIII11dI 1 11ve5iIga(10n DCI 00261161 PAGE 5 OF 6 CHARGE NO- 01 IA STATUTE IA321J-2 $O OWI -3RD CHARGE NO- 01 IA STATUTE TRK#: 004722201 THEFT 2ND COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE? IA321J-2 OWI 3RD AGENCY: IA052015J CHARDS CLASS: FELONY CONVICTION TRK#: 004122201 IA STATUTE: IA714.2(2) SENTENCE THEFT 2ND DEGREE - 1976 DISP EFF DAT PLEAD GUILTY 19940506 JAIL 5Y 19940506 COURT COSTS CONVICTION 19940506 09 ARRESTED 19960103 TRK#: 100010901 AGENCY: IADS20100 CORALVILLE PD RESTITUTION CHARGE NO- 01 IA STATUTE IA124-401(3) POSSESSION-SCH II -COCAINE TRK#r 013266201 DISP EFF DAT TIME SERVED COURT DISPOSITION 20040806 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 SY POSSESSION SCH II -METHAMPHETAMINE 20040806 COURT CASE ID: 06521 SRCR040178 CHARGE CLASS: MISDEMEANOR CONVICTION TRW 013266201 SENTENCE DISP EFF DAT JAIL BAD 19960406 FINE $250 19960408 10 ARRESTED 20000906 AGENCY: IA0520000 JOHNSON CO $O CHARGE NO- 01 IA STATUTE IA714-1-1 THEFT 2ND TRW 100010901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(2) THEFT 2ND DEGREE - 1976 COURT CASE ID: 06521 FECR0SS571 CHARGE CLASS: FELONY CONVICTION TRK#: 100010901 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 24D 20040806 FINE $750 20040806 SUSPENDED PRISON SY 20040806 PROBATION $Y 20040806 No. niz Y. 0/ / ,ran. 5.•t6ir I:i)AM uiv or � r i m i n a i investigation NO. VOR DCI 00261161 PAGE 6 OF 6 PRISON 5Y 20040606 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 RELEA89D 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