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Home My WebLink About17-036CITY OF IOWA CITY IDENTIFICATION NO i -7 --C> 3 U (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) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-SO40 (319)356-5497 FAX First ��, U Middle ( ex,4 - Last 3ar.� 1. Name (REQUIRED) 2. Address (REQUIRED) �1 o�LG la L�i 51))Le S+ A �' �C. 74 5�� I S 3. Contact Information (REQUIRED) Email: tD. I I. w J o-, ,, r%gtr,,, I, c a —Cell Phone: 319 3 3 1 8-73 (All written communiCdtl6fi §&nt via email) 4a. Driver's License expiration date (REQUIRED) 5 Ido0 c;iL- b. Taxicab Business Name (REQUIRED) M 01 r -c Ci `.s - 7 x 5. Prior experience in transportation of passengers: -[)r w I.1 K 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense O k/ What happened to the charge? (Circle one) Where 17� When 3,C)C� Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? bVy Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty OtW 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fiveyears? Type of offense Where hel * r_ -a M 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide ltd 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 1/ 3 S 4& 6 g y( issued on ac+ expiring on -91 / A . I understand that if I falsely answer any questions in this application, that this ap lication may be denied. I agreaking this application, 1 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, Chaptey,2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of ApplicLnt�� Date a -2/� o 1 `/ YHYYff f 1fYY{IHYY#R#IfHYHYHiff 1f fifYffHlHHf f1HHfH1f 1f 1111Nfiflf fHf f 1fHHH1fHfHf f11H1HNHfif f 1f1HHHlffYflHN1fH11HHt11f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by l7 on this ��_ day of � t NDV S. ►pAYFR Notary Public ' and for the State of 1 4P ComN� . My kflkflffllRffeRltltN 1NR1NN}'N1t1(i-IRN!*R1t1tYYRf1NNRNt1HtYifffitll-YllYtMtlH.tk1H 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 141,5/710 710 " ytJYJ Signature of Police Chief or designee "�l7 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. Z_ e " e— 2�� LV� 1�� J) Signature of City ff k or designee 7 Date 1H1111HHHYYHHHHHHHYNN1HNHf NHMNHN1f11NNf111f11111N11N11NHlH1NN11f1NIffI111111f'flf11ff1111f N O Otfice Use Only c� Approved application DCI report State certified driving record Website update C) �r -0 M m 7-7 N Q iY Cl) GerkrtnxiDRAWDcenavk92014n oe.Doc 07/2016 Y Departme Office of [)Fww Seirwices A PO Oft -9204, Dft Mmm% IA W3060204 nt of Transportation (Toll ffee)800,-W-1 121 515244-9124 FAX 515-239.1831 History Information CLEAR DRIVING RECORD Name: Barry, William Dexter DL/ID: 435AA6946 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. T. Name: Barry, William Dexter DL/ID: 435AA6946 2/5/2017 Office of Driver Services,r Certified Abstract of Driving Record Inquiry Date: 2/5/2017 DL/ID #: 435AA6946 (IA) Customer #: 3350447 Name: Barry, William Class: D ID Status: EXP Dexter 1°�A ,73 Address: 720 N DUBUQUE ST Audit #: 9658988 DL Status: VAL APT 7 Issue Date: 12/22/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/15/2022 CDL Cert Status: None 522451925 Endorsements: 3 CDL Med Status: None Mailing Address: 720 N DUBUQUE ST Restrictions: Corrective Lenses Restriction None APT 7 Supplement: Date of Birth: 2/15/1967 Mailing IOWA CITY, IA Sex: M City/State: 522451925 History Information CLEAR DRIVING RECORD Name: Barry, William Dexter DL/ID: 435AA6946 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. T. Name: Barry, William Dexter DL/ID: 435AA6946 2/5/2017 Office of Driver Services,r Iowa Department of Transporation .fir `S} 1°�A ,73 r� heb. 1. 2011 4;11PM Div of criminal Investigation No.J146 V. 1 91.m;.11y of IOwa Ulty Clark Uttlno 310 3666407 02/02/2017 16;60 0616 P.002/002 STATE OF IOWA Criminal history Record Check Request Form DCI Account Nwnbei; L10D7- 0(oppGeabfe) To: Iowa Division of Crlminal Investigation From: City of Iowa City Support Operatious Bureau, V Floor City Cie. If's Office 215 E. T" Street 410 E. wasli a street _ Des Moines, Iowa 5031 --*VjY7H-6066 (515) 725-6080 Fax Phone: 319-3565041 Fax: 319-356-5497 I am requesting an Iowa Criminal History Record Check on: Last Name (inandaso •) First Name (mandatory) Middle Name (reeommeoded) oaf/� w , I I 'i aYN-, -b&>(e r - Date of Hirth (mandatory) Gender (mandatory) Social Security Number (recommendegd) 5 6-7 Male []Female Wrdver Informarlon: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For co. ma)ete Criminal history record itlformatari, as allowed by law, always obtain a waiver signature from the subject of the request, Wnlver Rele(rSe: I hereby give permission for she above reque ting official to conduct an Iowa uimhlal history record check w1W the Divisio0.of Criminal 1. tnvestlgall"(DCI). Anyuiminfthislery•delaeonecmingmethAt' needd�by,iheeDDOmmay be releesed as sllbazd )aw. � � Waiver signature: t t Iowa Criminal History Record Check Results - =I rete eaa9 As of oZ a search of the provided name and date of birth revealed: C— N et ® No Iowa Criminal History Rtcord fowrd with DCI Iowa Criminal History Record attached, DCI #J (olZS1� 4k ) DCI initials_r� DCI -77 (08/25/10) Received Time Feb, 2. 2017 2:39PM No.2132 Feb, 7, 2017 4,i1PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20000612 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 042157401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VER WE INT (OWI) / SER MISD / 19T OFF - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 042157401 SENTENCE DISP 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 No. 3146 P. 2 N d a ZI � n N IOWA CRIMINAL HISTORY r rn ry x'" ca DCI 00622510 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2017/02/07 DCI:00622510 NAME: BARRY,WILLIAM DEXTER DOB SEX RAC MGT WGT EYE HAIR SKN POB 19670215 M W 509 220 BRO BRO MED MD ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20000612 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 042157401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VER WE INT (OWI) / SER MISD / 19T OFF - CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 042157401 SENTENCE DISP 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 No. 3146 P. 2 N d a ZI � n N r rn ry x'" ca