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Home My WebLink About12-0396. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A/c Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A10 Tvoe 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derMH idrivb dg 09/2010 Authorization Number All -3(7 r 1 (Office Use Only) +. MIW®rill CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday - Friday.) Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First Middle List 1. Name Came,io., Lee � elv� 2. Mailing Address PO loe `//! Z -,e 7/-e2 In SL7SS 3. Telephone: Home 3/9- 530-/002 Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where W)heen 5cedv-l /Q L�oS_�51/>n —TOW0I / /%L/ 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? A/c Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NO Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A10 Tvoe 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) derMH idrivb dg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number >Si k k ?-0-73 1 understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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/�-r, Date 2- 15- 12 -- STATE 2 -- STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by On this /5 day of SONDRAE FORT Commission Number 159791 My Commission FXWM Notary Public in and for the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signatur4 of Police Chief or designee Sig ture of City Clerk or designee Date -/-6, - Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. 11M1f fllffflflHlf 1f flffYff fM4HllflflflfMfffff f f f #ff 11f1fflHfflflflHf!!'ff !111!#11#*iIHH*4#*#F*fi#fNfYf f4f f f iffYlHlff fllllfffflff f f f1f! Office Use Only Approved application DCI report State certified driving record Website update donna adnwad�ioio.d 09/2010 Iowa Department of Transportation AO Office of Driver Services (foil Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/21/2011 DL/ID #: 359KK2073(IA) Name: Burton, Cameron Lee Class: D Address: 311 W DOUGHERTY DR Audit A: 5685743 Issue Date: 12/15/2011 City/State: LONE TREE, IA Expiration 04/24/2017 527557749 Date: Endorsements: 3 Mailing Address: PO BOX 411 Restrictions: NONE Date of Birth: 4/24/1976 Mailing City/State: LONE TREE, IA Sex: M 527550411 History Information Customer #: 4698203 ID Status: EXP DL Status: VAL CDL Status: None Restriction None Supplement: Office of Driver Services Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR 11/06/2008 472240 IA Name: Burton, Cameron Lee DL/ID: 359KK2073 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: ;- '•:(moi"4 12/21/2011 IOWA*°4 D. 0. T.. Ste; Z* Office of Driver Services Iowa Department of Transportation Name: Burton, Cameron Lee DL/ID: 359KK2073 Feb. 1. 2012 �n 24 12 12:38p 12:t16VM Div of 0iminal Investigation No.11)LI r. I/] Yellow Cab of Iowa City 319-338-2708 p.1 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 2151R. 71t Street Des Moines, town 50319 (515)72S-6066 (515) 725-6080 Fax I nm rennectinv nn Inco Criminal Metnry Rpcnr l C6pr4 DCI Account Number: 9967-F (ifepplicil, ) From: Yellow Cab of Xowa City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 Phone; i Fax; (319) 339-7302 Last Name (mandatory) First Name (m.nda(ory) Middle Natne (recommended) 801' ell CgmG10�) t e [)ate of Birth (rr rdatoryl Gender (mandatory) ,Social Smurity Number recommended 2'/— Z- V — / 9 7 G UNale ❑Female �1!— -7 cv — I 9 b Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history ecord may not be releasable, per Code orfown, Chapter 692.2. For complete criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the refluest. Waiver Release: I hereby give permissioo Por the above requaang off ci.l to conduct ro (own criminal historyrewd check wids he olvision orcrimtml Invraligulron (x). Any criminal history dma concerning nso that is m/rmllaii�nned by the DCI may be released as allowxd bylaw. I Waiver Signaf ire: (DCI use only) As of Q/1 of , a search of tbeprovided name and date of birth revealed: ❑ No Iowa Criminal history Record fotmd with DCI iOWa Criminal History Record attached, DCi 9 N j a a 4 a DCI DCI -77 (06/25/10) R ... ;u. 4 Tim. lea 1A Ini9 17.86piA N) 7n11 Ieb. 1. 2012 Q :hIPM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/02/01 DCI:00462290 NAME: BURTON,CAMERON LSE 130B SEX RAC MGT WGT EYE HAIR SKN PDB 19760424 M W 509 175 DLO BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD •++ 01 ARRESTED 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: 007541901 COURT DISPOSITION AGENCY: 1AUS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3 POSSES SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED 19941125 AGENCY. IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA32IJ-2 owl TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VEH WE INS OWI CHARGE CLASS: MISDE142AMOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL 5D REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE 1A321-210-2 DRIVE WHILE REVOKED CHARD£ CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED 19990522 DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP IEFV PAT 19P50320 No. ld1I r. (/7 Feb. 1. 2012 12:57PM Div of Criminal Investigation DCI 00482290 PAGE 2 OF 2 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE TA321J-2-2-B OWI 2ND OFFENSE TRKN: 500346901 COURT DISPOSITION AGENCY. IA05701SJ LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2B OWI 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE DISP EFF DAT PLEAD GUILTY 19990025 JAIL 7D 19990025 FINE $1500 19990825 COURT COSTS 19990825 04 ARRESTED 20000701 AGENCY: IA0780000 ?OTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 000326701 COURT DISPOSITION AGENCY: IA078015J POTT CO DIST COURT COUNT NO- 01 IA STATUTE IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 800328101 SENTENCE DISP EFF DAT PLEAD GUILTY 20000703 JAIL 21) 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 H -1 No. Ili 11 N. 3/3