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Home My WebLink About17-028IDENTIFICATION NO. / -7 —0 7-,�-) l (Office Use Only) �► �IIIMlp�� APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER C ITY OF I OWA C ITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City, Iowa S2240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 3S6-5040 (319) 356-5497 FAX Middle �j/ Last 1. Name (REQUIRED) �� h Y, / / !G C a� L�c•� 2. Address (REQUIRED) Z4 s z:l c � 3. Contact Information (REQUIRED) Email: Cell Phone: 3/9 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) L/2 3� IC 07426 �,Zp /g b. Taxicab Business Name (REQUIRED) Ye- lo io 5. Prior experience in transportation of passengers: e r 5 r n cP r ,r?o /6 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? ✓ o Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty OtherA Have you been arrested / charged with any traffic offenses in the last five years? ✓L o 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? ///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:pto-vide the name"( DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATECERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE'CHIEF_f EVIEW 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 hereby certify that I have issued to me by the Iowa Department of Transportatio)i a valid Driver's license number 9S 5' 22 �G l 0 issued on '� �= 1e "expiring on D 7 G n . I understand that if I falsely answer any questions in this application, that this ap lic tion 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, ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant ��/ Date ,2--2)- /7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Prj r� ^ Q IA r C.f2r- h eA on this 9 day of Kol.. .. — —, � 2_n Ii 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 Driver's license /�7iC /7iO/ Signaltw1rolice Chief or designee !�Zwlz Da e 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. nat i e of Cil Clerk or designee Date ,7 Office Use Only Approved application DCI report State certified driving record Website update rn -o t rs DeM/rAXIDRIVBADGEAPPL92014 .nded DOC 07/2016 CIowa Department of Transportation AW onfoe d Diner Services (Tai Ffee) 80-632.1121 PO Box 82114, Des Mokres, IA 5D3W9204 515-244.9124 FAX: 515.239.1837 CLEAR DRIVING RECORD Name: McCracken, Alan Paul DL/ID: 958ZZ3610 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 Ankeny, Iowa this date: IOWA D. 0.1 Name: McCracken, Alan Paul DL/ID: 958ZZ3610 2/6/2017 Office of Driver Services Certified Abstract of Driving Record Inquiry Date: 2/6/2017 DL/ID #: 958ZZ3610(IA) Customer #: 2863431 Name: McCracken, Alan Class: D ID Status: None Paul Address: 401 N 4TH AVE Audit #: 7148208 DL Status: VAL U7 Issue Date: 07/19/2013 CDL Status: None City/State: WASHINGTON, IA Expiration Date: 07/26/2018 CDL Cert Status: None 523532206 Endorsements: 3 CDL Med Status: None Mailing Address: 401 N 4TH AVE Restrictions: NONE Restriction None Supplement: Date of Birth: 7/26/1953 Mailing WASHINGTON, IA Sex: M City/State: 523532206 History Information CLEAR DRIVING RECORD Name: McCracken, Alan Paul DL/ID: 958ZZ3610 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 Ankeny, Iowa this date: IOWA D. 0.1 Name: McCracken, Alan Paul DL/ID: 958ZZ3610 2/6/2017 Office of Driver Services o_ Iowa Department of Transporation U7 Fcbr 9. 2017 2:20PM Div of Criminal Investigation No.3388 02/06/2017 11;13 Yelton Cab of Iowa City (FnX)3193382703 STATE OF IOWA Criminal History Record Check a Request Form Tat Iowa Division of criminal Investigation Support Operations Bureau, 1" Floor 213 It. 7° Street Doi Molnes, Iowa 50319 I.,.. --- . nax P. 3 P.002/002 DCI Account Number; . 9967-F ilreppllubta) Froml Yellow Cab of Iowa City E0. Box 429 Iowa CIF, IA. 32244 Phone; Fax, (319)339-7302 I am reeueanna an TAWr1 CAminel Last Name (mandaloame - --^--- •...... r.;Gon .�VII• manduo Midle N ta a (rreommanded)Date of Birth (mandato me date ) 3ocia13ecurl Number racenroendt n71�6/tale ❑Female �{8� 60 - 8S ! 7 Walvar)(/'ormatlonr Without a signed waiver from the subleot of the request, a complete criminal history record may no be releasable, per Cod of IOWA, Chapter 692.2. For .00pRiet crlminal hlstory•ret Information, as allowed bylaw, always obtain a walveral nature frofn the subject ofthe re uast. Waiver .!Release: i hereby give parminlon for the above roeuosting official to conduct en Iowa oriminel hldoryrecord ofink whh the Dlvhlon of crlminal Invaalptlon (DCn. My edminel history dale ooneeming methajl�b M I Wnad�b th OCT maybe ralauad u allowed bylaw. Waiver Signature:_ Iowa c:riminal.klstory Record Check Results (OCT use only) As of. I 1 OL / a search of the provided name and date of birth revealad: $- -No Iowa Criminal History Record found with DCI -{1) ❑ Iowa Criminal History Record attached, DCI # DCI Initials - DCI -77 (09/25/10) Rerr.ived Time FPh A 9617 II.9IAM Nn )RAO