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Home My WebLink About17-049CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 3S6-SO40 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. — (Office UseOnly) 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 Middle Last 2. Address (REQUIRED) Ste/ /I/ S,< /-cc Twee. 7, SZ %is 3. Contact Information (REQUIRED) Email: J.;- /9 7l e_ :2,,5// Cell Phone: (All written communication sent via email) 4a- Driver's License expiration date (REQUIRED) y- Z el ,' / b. Taxicab Business Name (REQUIRED) Ta11ar., Co h 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? l� _Type of offense�((�/ / W here When Wry D OT What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guil Other f Have you been arrested / charged with any traffic offenses in the last five years? e 5 I Type of offense Where When'--) 144179 re AgcXloS �wa i.F. 2ol'L What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other !/c /e 7` 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO 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 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 - valid Driver's license number 357 /Ck 2o73 issued on 3.3&-17_expiring on L/_ �Jj 17 . 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 4n� �� Date 3 .»...».»:...:.r.:».».»»»».»+.++..»»...r...:a�..».a».».:....:...:e.....tie.+».....:..»»»».....r�.»»a::..»».»»:..»..:... STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C_G on this day of �\- � C L.. -7 -0) 77 \ _ - A c A in and fdr the State of Iowa 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). t-/Expiration date of Driver's license L ( — Signature vli56 Chief or designee 3%3aJi� Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MO HAN ONE Y FROM THE DATE LISTED BELOW. Signature of City Clerk or designee D to Office Use Only Approved application DCI report State certified driving record Website update - CIeArtAXIDRNBADGEAPPL92074ercren WDOC 0712016 Mar.27. 2017 10:23AM Div of Criminal Investigation No -6606 P. 4/6 03/24/2017 05155'1'el low Cab. of Iowa City (FAX)3M352708 P.002/002 .c.(0 runSTATE , • . , ,� " �n s Record _ C 011 y e�l s a Check Request cy To! Iowa Divlsloll orCrimlltel Investigation Support Operstlona Bureau, I". Floor 23S E. 711 Street Des Moines, lows 50319 (515)725.6066 I em requesting an IOWA Criminal History Record Check on: DCI Account Number: 9967-F (Irappllaable) Froml Yellow Cab of Town City P.O. Box 428 Iowa City, IA,'52244 Phonal ItpX( (919) 339.7302 Lest Name menaalary) First Name (mendela Middle NAZ40 (recommended) ��7�6 C9mer l e Date of Birth (Ihandala Gender (mandato 'Social Securlty Numberreeommenaed) OL..�ev-/'9>a" f Male ❑Female yg� s�L/"L1 q� waiver Information; without a signed waiver from the subject of the retivost, a aomplete prlminol history record spay not bo releasable, per Code of Iowa, Chgpicr 692.2. For complete eriminnib lstory'reoord Informatlon, as allowed by (aw, always WafYGr RG/GRse11 hereby gW0 permieslan Ibr the aboVe requastlna emalol to oonduol An IOWA criminal historyrosord ohsok Willi the Dlvlstan ofCelminel Inrerllgatlan (Don. Any criminal hislory dela eanaamlng me Ihe(Is maintained by the DCI may be released as allowed by JAW, Waiver Slgnalurei wnn 4A11lLLGl .47.A36V A- GUA' L.IIGGIC lCCSu11:5 .rDCl.Iua Only) As of a search oiF the provided name and date of birth revoaled: • U. ❑ No Iowa Criminal History Record found with ACI r- Iowa Criminal History Record attached, DCI # DCI Initials Ilk C— DCI-77 (08/15/10) n , r - .I Ad qn.l l Ar AIA AI. rAtO� Ma r. 27. 2017 10:23AM Div of Criminal Investigation ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: 007541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL SD REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 XA STATUTE: IA321-218-2 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED/TAKEN INTO CUSTODY 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 DISP RPF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No -6608 P, 5/6 IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/03/27 DCI ;00482290 NAME: BURTON,CAMERON LEE DOB SEK RAC HGT WGT EYE HAIR SKN POB 19760424 M W 509 175 BLU BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: 007541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL SD REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 XA STATUTE: IA321-218-2 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED/TAKEN INTO CUSTODY 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 DISP RPF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No -6608 P, 5/6 Mar.27. 2017 10:23AM Div of Criminal Investigation No -6608 P. 6/6 CHARGE NO- 01 OWI 2ND OFFENSE TRK#; 500346901 COURT DISPOSITION AGENCY: IA057015J COUNT NO- 01 IA STATUTE IA321J-2-2-B LINN CO DIST COURT IA STATUTE: IA321J-2B OWI 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE PLEAD GUILTY JAIL 7D FINE $1500 COURT COSTS 04 ARRESTED/TAKEN INTO CUSTODY 20000701 AGENCY: IA0780000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 800328701 COURT DISPOSITION AGENCY; IA078015J POTT CO DIST COURT COUNT NO- 01 IA STATUTE; IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 800328701 SENTENCE PLEAD GUILTY JAIL 2D DCI 00482290 PAGE 2 OF 2 DISP EFF DAT 19990825 19990825 19990025 19990825 DISP EFF DAT 20000703 20000703 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 MAN QJ10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadotgov Office of Dr'wer Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1 8DO-532-1121 I Fax: 515-239-1837 www.ioradol.gov Certified Abstract of Driving Record Inquiry Date: 3/30/2017 DL/ID #: 359KK2073 (IA) CDL Permit Class: None Customer #: 4698203 Class: D CDL Permit Issue None Date: Name: Burton, Cameron Lee Audit #: 5685743 CDL Permit None Expiration Date: Address: SD1 N DEVOE ST Issue Date: 12/15/2011 CDL Permit None Endorsements: Expiration 04/24/2017 CDL Permit None Date: Restrictions: City/State: LONE TREE, IA 527559208 Endorsements: 3 ID Status: EXP Mailing PO BOX 411 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing LONE TREE, IA 527550411 Supplement: CDL Permit Status: ELG City/State: Date of 4/24/1976 LDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions 'itation Date Conviction Date ACD Explanation County JUR 76/29/2012 ,07/18/2012 IN82 'Improper Backing ,Johnson ,IA Accidents - Accident Involvement indicated does NOT mean the Individual was at fault or given a citation. tccident Date Case Number JUR 74/27/2016 19fK63 IIA Name: Burton, Cameron Lee DL/ID: 359KK2073 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: Name: Burton, Cameron Lee DL/ID: 359KK2073 r�'• IOWA• �y' 3/30/2017 Office of Driver eof Services IowaDepartment Name: Burton, Cameron Lee DL/ID: 359KK2073