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Home My WebLink About12-211r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-504 CA �— (319) 356-5497 FAX 1. Name 2. Mailing Address _ 3. Telephone: Home Authorization Number /2 -X11 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) /uESQfw /Wl Middle �J Last eAV a n U .h /�T � �/✓ i.! /i n nn �1�fi Sol 7;d 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/ L Where n When Pn rrSJ 40 (�Odr.ffe/ �ikj(a.,c L �� /(/ f)Ur KA to, A' �'000'000q 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? r o Type of Offense Where When i 7. Have you been convicted of any traffic offenses in the last five years? , V o Type of offense Where When B. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? T e J TvRe of offense n /%n / Whered When CJ!JfI/'n Lnnr%n/l/ �J/]�Jp ,.,, e (///r1/ /"', / l �agal 9. Havey ever applied to be air Iowa City taxi driver using a different name? If yes, please provide the name(s) 7 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) derW Idnvb dg 06/2012 I h r .erth I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7 �4 Yi Q 5 . I understand that if I falsely answer any questions in this application, that this app ication 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 � -,;j Date a� RfRf*##Y'h#f#4fY#+#########**F#RRRIRRR*+**#++##+Fit#RR##R**RRf1R4M111fYY#+#i#+#*##FkRFFRR**+*RRRf**Rf*fffNt44l4fH41F#4RRff**4f11fR11H+###*k+-k STATE OF IOWA ) COUNTY OF JOHNSON ) r1 I- $ubscribed and sworn to before me by ck On this d�� day of �tao12.� i ota Public in an for the State of Iowa 4144###*##ii*Rk**#*RR#RR**443#iiiRRR**k**R**#R3*R3#3iR33*iRRl4#Rk##RR****k**R*#*R*#Rii#ittiii*i#+k+i*!*Ri*#****R*#***R*i*RRR**#RR3iR4RR#*k*****i 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). .4 ignature 6f Police Chief or designee Signalttm of City Clerk or designee` 2k,/ -z-- Date Date Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update 60MM&.bad �2010.m 06/2012 Iowa Department of Transportation o Office of Driver Services (Toll Free) 800-532-1125 PO Box 9204, Des Mines IA 503D6 9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: Name: Address: City/State: Mailing Address: Certified Abstract of Driving Record 8/21/2012 Clarke, David Kenyon 1502 S BLUFF BLVD CLINTON, IA 527326550.,4 1502 S BLUFF BLVD Mailing City/State: CLINTON, IA 527326550 Convictions DL/ID #: 799YY8365 (IA) Customer #: 3280076 Class: C ID Status: VAL Audit #: 6031861 OL Status: VAL -Issue Date: 06/06/2012 CDL Status: None Expiration 07/29/2017 CDL Cert None Date: Status: Endorsements: NONE CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 7/29/1981 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County IUR 02/14/2009 .04/29/2009 A33 'Drug/Drug Related Conviction 23 IA Sanctions Type Effective Revoked ,06/09/201 Suspended 106/19/201 End ACO .12/05/2009 --A33 _ i Related Conviction lent of Iowa Fine Occurrence 7UR ]UR IA IA IA IA Name: Clarke, David Kenyon DL/ID: 799YY8365 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 custodyof said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In wlt.ness whereof, I have caused_ =my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: 3. �� 5o,`O�••-G004! 8/21/2012 ' IOWA ''t o e �t.D.O.T.sys W �OfRRIVEBSR�``' Office ofDriver ervics Iowa Transportation rtme t Aug; 21; 2012 10;03AM jDiv of Criminal rInvestigatio� NNo.�9922 PP. �1 STATE OF 10WA (C.Aminal History Record Check r Request Form DCI Account Number: Y-6 Z, � — Ofoppllcabla) To; Totva Diviston of Criminal Investigation Support Oporatlohs Bureau, V'Floor 215 P" 7i1, gtreet DOS Wines, Iowa 50319 (515)125.6066 (515)725-6090 Fax I am requost(nA anTown Criminal HistoryRecord Check on: From: CITY OF IOWA CITY CITY CUM'S OFT1CF 410)3• WAS1IrN•OTONSTRRET IOVVA.CITY IOWA 522Q0 )?hoho: 319.356.9041 rax: 519-356-5497 I,asfName mondolaty MY9tName(mandelo Middle Name rerommende X, zl,d t: Date of Birthmonearoty) Gender (n,anaalory) SocialS)CCUR Rnnober`(re omramded / ( I�1Yfale Q� emale `jam U O� Y 1 d�J YYa1VePBzfarJna77on, VVlthoutasigned vialverkomthe subjcot ofthe request, acomplatecriminalhistory rcCord maynot be releasablo, per Code oflowa, Chapter 692,2, For complete o171minal1119t0ryrec0rd taforpratlorl, ns allowe(l bylaw, always Wai'VCP- 2e7et7Se: I hueby g1Ye pcnnlaslon tbrlba abavo Invraligation (oCD. Any cdmi),sl history dole cnnctmingyl,ol Waiver Signature; iowscriminaf hiatoryrecord oltukw11111he T)Iviaion of Ctiminel be relomcd 29 allowed by lav, Received Lim11A%jj3j131012 11:28AM No. 143 Iowa Criminal history Record Check Results (Octuscoaly) k; of A2 11,Q- a search ofthe provided name and data of birth revealed: ;z r Ji c� rD No Iowa criminal HistouRecordfound with DCI =1 C, ui IoyraCriminal l3istoxyRecord attached,pCZ# O� N f N DClinitials Received Lim11A%jj3j131012 11:28AM No. 143 Aug.21. 2012 10:03AM Div of Criminal Investigation No.9922 P. 2 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00602686 NAME; CLARRE,DAVID K CLARKE,DAVID KENYON DOB SEX RAC HGT WGT EYE 19810729 M W 602 175 GRN ADDITIONAL IDENTIFIERS CCH RECORD *** DCT 00602656 PAGE 1 OF 2 DATE PRINTED - 2012/08/21 HAIR SKN POB BLN IA 01 ARRESTED 20001103 AGENCY: XA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE XA715A-2-2-A FORGERY TRK#: 500904401 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2(5) THEFT STH DEG COURT CASE ID; 06571 SMSM021569 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500904401 SENTENCE DISP EFF DAT PLEAD GUILTY 25 DOLL COSTS;SURACEG 20010104 FINE $50 20010104 02 ARRESTED 20090214 AGENCY: IA0230100 CLINTON PD CHARGE NO- 01 IA STATUTE IA124.401 - POSSESSION OF SCHEDULE I CONTROL SUBSTANCE TRK#: 083150401 COURT DISPOSITION AGENCY: IA023015J CLINTON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE. COURT CASE ID: 07231 SRCROS9648 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 083150401 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 60D 20090429 JAIL 60D 20090429 FINE $500 20090429 UNSUPERVISED 12M 20090429 PROBATION AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVY810H OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAPP ENFORCEMENT AGENCIES BY THE DCI. Aug -LL Lulz Iu:UJAkl Uiv of 0 iminal Investigation IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFYCATYON THIS RECORD IS EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION I No. 9922 Y. 3