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Home My WebLink About17-080_=- r _4 CITY 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 NO. "I 6� 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) Failure to complete the "required" information will result in denial of the application First Middle Last Ala L Vpft Oh ZIS��iJz Y iacL �y0\V�� \jac 3. Contact Information (REQUIRED) Email: written communicb1ion sent via email) 4a. Driver's License expiration date (REQUIRED) O b. Taxicab Business Name (REQUIRED) }Vtp-w 4 5. Prior experience in transportation of passengers: 6. Have you ever -2, 9 /-wig Cell PhoneAt0_1 4 _Aaa O� 3 n s -< ui r with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When owt Oe�we r I rt jt NOV. //., Z01 / What happened to the charge? (Circle one) Convicted Dismissed eferre Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? /Vr 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? IVP 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) /INS 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 Ihp3 4416 that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 33 issued on 046-7/1Au4 expiring on 07-/2- yj-Zat$ . 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 1,of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant�Date 05-17-�;-1ZO/ :�- STATE OF IOWA ) COUNTY OF JOHNSON ) �u scribed and_ sworn to before me by !'S �0.)� JC) fes, on this day of r y p` KELLIE K. FRUEHUNC CWWNUMNMneEerotary Piublic in and for the Wale 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-aflQwa City (Title 5, Chapter 2, City Code). : �y/j � designee 512 q[ Dam 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. Sigh n ` of .City Clerk orZresignee Office Use Only Approved application DCI report State certified driving record Website update uAte� Clerk/rAXIDRIVBADGEAPPL92014emendetl.DOC 07/2016 rn C:) W Clerk/rAXIDRIVBADGEAPPL92014emendetl.DOC 07/2016 ,May, 5. 20170 4:23PM ,.Div of Criminal_Investigation 06/02/2017 „ No. 00240BeP, -loom/002 STATE OF IOWA Crisaainal History Record Check . Request Form' '1'0: byre Division of Criminal Investigation Support Operations Bureau, is'Floor 215 F. 7'h Street Deg Maines, Iowa 50319 (51S)725.6066 (515) 72.5-6000 Fax am requesting as Iowa C Last Name (mandatory) D'— U,o .— Date of Birth (mandaimy) o,Z-/a y/(i5C) Name (&,ke— DO Account Number;(l pp - EL (iroppliaable) From: Cit'ofznxacit� X-il Clerlt'sOtCce 410 F, Washington street Iowa City, IA 52.240 Phone; 319-356-5041 Fax: 319-356-5497 L'd1Vlole ®Female A& j y& 3—f -?--73aD Waiver Information: 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_ plete criminal history reoorA information, as allowed by late, always Obtain A WAivortivnofnro r- nwu, rho M—. -ell— IftiverRelease:Iherebygivepennissianfofdieabovcreges3tingatfieialtownd,ctAnlav riminsthistory record che&With thoDivision ofCtisninal Invesilgatian(DCQ. Any criminal history data eoneeming nit that is mainia' dby t¢nCl moyb r leased as allowed by lar. Waiver Signaffire: Iowa Criminal History -Record Check Results (ocl are only) As o£_rJ' ( a search of the provided name and date of birth revealed: ® Na Iowa Criminal History Record found with DCI IO\va Criminal History Record attached, DCI DCl initials-SZF r DCI -77 (08/25/10) MM Received Time May, 2. 2017 1:45PM No -9669 May. 5. 2017 4 : 2 4 P M D l v of Criminal Investigation No, 0024 P. 2 UNSUPERVISED lY 20120404 PROBATION SELF PROBATION DISCHARGED FROM 20130701 DEFERRED JUDGEMENT 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 NOW -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 IOWA CRIMINAL HISTORY DCI 00943984 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2017/05/05 DCI:00943984 NAME: DEVORE,BLAKE ALAN DOB SEK RAC HGT WGT EYE HAIR SKN POR 19900224 M W 509 190 BLU RED LOT IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT UL ARM TAT UR ARM CCH RECORD +*+ 01 ARRESTED/TAKEN INTO CUSTODY 20111119 AGENCY: IR0310000 FAYETTE CO SO CHARGE NO- 01 IA STATUTE IA321,7.2(A) OPER VES WH INT (OWI) / 1ST OFF TRK#: BN001B001 COURT DISPOSITION AGENCY: IA033015J FAYETTE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEE WE INT (OWI) / IST OFF COURT CASE ID: 01331 OWCRO63338 CHARGE CLASS: NON CONVICTION TRK#: HN001B001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION RESTITUTION SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 1Y 20120404 20130404 CIVIL PENALTY $1250 1/2 WAIVED W/PROOF OF TEMP.REST.LIC. UNSUPERVISED lY 20120404 PROBATION SELF PROBATION DISCHARGED FROM 20130701 DEFERRED JUDGEMENT 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 NOW -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 AC Iowa Department of Transportation Oikoe of Dmrer Services (Toll Free) ODO-532-1121 PO Box 92134, Des Mans. IA 503069204 5) 5244-9124 FAX. 515.239.1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 5/2/2017 DL/ID #: 963AA7633(IA) Customer #: 5150445 Name: Devore, Blake Alan Class: C ID Status: None Address: 3722 RAVENWOOD Audit #: 7771260 DL Status: VAL CIR Issue Date: 02/07/2014 CDL Status: None City/State: WATERLOO, IA Expiration Date: 02/24/2018 CDL Cert Status: None 507025503 Endorsements: NONE CDL Med Status: None Mailing Address: 3722 RAVENWOOD Restrictions: Corrective Lenses Restriction None CIR Supplement: Date of Birth: 2/24/1990 Mailing WATERLOO, IA Sex: M city/State: 507025503 History Information Convictions Citation Date Conviction Date ACD lExplanation County IUR 11/19/2011 04/04/2012 A20 Deferred Judgment OWI Fayette IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation 13UR _ _ Coun 11/19/2011 IA98 _ _ _ _ I OWI Test Failure IIA _ I Fayette Sanctions Type Effective End ACD Explanation occurrence 7UR JUR Revoked 101/13/2012 107/10/2012 A98 OWI Test Failure IA IA Name: Devore, Blake Alan DL/ID: 963AA7633 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: r`1�ui�f6�'4 5/2/2017 IOWA D. 0. T. I�1%, Office of Driver Services Iowa Department of Transporation Name: Devore, Blake Alan DL/ID: 963AA7633