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Home My WebLink About12-212�r'lll� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX II First 1. Name _ Na lw 2. Mailing Address 3. Telephone: Home 4. Prior experienin transportation of passengers: /7/1.T . 1 r Authorization Number \ r,�), - aA _L (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Other: P351 2i 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 91 Have you,bn convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of�offe se Where �_' -_ .i ; _r6 k tirnn e s d 5 Tj., N 'CIA PAl 0 -VOL Tv C fi ,. SC. v 8. Has your river's icense of chauffeur's license been suspended or revoked in the last five 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) 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) d.r .iddwbadg 06/2012 I hereby certify that I h issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (/gL4C 8(n 9 0 A� I 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 ApplicantDate s 2 ###*t#4#i##+##i###H#*t*#*#4RR#**#**R*#**********1R*41RR*ki*FR***R***F#*i#iii#FFit#RR*1RR4t****t**F44**F4RR*iklRtk4f*f4#*kf*#F*R44if444f4Ff4#FRR STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C 1std�1 L�K.�a On this _ day of S, 2 �O� a�.vA_ SONDRAE FORT _ L 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). Siignn�at e of Pol' Yhief or designee / Signature of City Clerk or designee Date -/'I - /a2 - 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 de�idnmadgea,201 0 do 06/2012 Iowa Department of Transportation J Office of Driver Services (roll Free) 800-532-1121 PO Box 9204, Des Maines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/4/2012 DL/ID #: 113ACS690 (IA) Name: Clarke, Charles Creighton Class: D Address: 23 1/2 S DUBUQUE ST APT 1 Audit 0: 4515741 Restriction None Issue Date: 07/15/2010 City/State: IOWA CITY, IA 522403954 Expiration Date: 10/26/2015 M14 Fail to Obey Traffic Sign/Signal Endorsements: 3 Mailing Address: 23 1/2 S DUBUQUE ST APT 1 Restrictions: NONE 52 IA Date of Birth: 10/26/1979 Mailing City/State: IOWA CITY, IA 522403954 Sex: M History Information Convictions Customer #: 2148463 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Speed Citation Date Conviction Date ACD Explanation County JUR 10/02/2010 01/14/2011 S92 Speed 52 IA 01/09/2011 01/24/2011 S92 Speed 52 IA 04/16/2011 05/23/2011 M14 Fail to Obey Traffic Sign/Signal 52 IA 07/01/2011 08/08/2011 064 No Insurance Card 52 IA Operating While Intoxicated Test Refusal/Test Failure violations Occurrence ACD Explanation JUR 10/24/2000 A61 Under 21 -Alcohol Content .02 but less than .08 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 11/04/2000 01/04/2001 A61 Under 21 -Alcohol Content .02 but less than .08 IA IA Suspended 04/18/2007 10/17/2007 D51 Non -Payment of Child Support IA Suspended 01/24/2008 06/07/2009 D51 Non -Payment of Child Support IA ]A Name: Clarke, Charles Creighton DL/ID: 113AC8690 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: Name: Clarke, Charles Creighton DL/ID: 113AC8690 9/4/2012 =4 'I'�4FOf '••••"S`= Office of Driver Services Iowa Department of Transportation Name: Clarke, Charles Creighton DL/ID: 113AC8690 Jul.31. 2012 4:16PM Div of Criminal Investi;ation No.6462 P. 8/15 Jul.1U. 1UI1 IU:31RM City Clerk - City of Iowa City No.2640 P. 2 STATE 111. IOWA A CriminaI Higtory Record Check �•f\i�!'-� tie.+ Reque9t Form • Un'A%v��%x�4 To: Yowa Division of Cthuinal rnvestigation Support Operatlons Bureau, V Izloor 215 E. 71° Sheet Des Moines, rolva 50319 (515) 725-6066 (515)725-6080 Fax DCIAccountNumben 46 " l (ifapplloeblo) Rom; CITY OF IOWA CITY CITY CLERK'S OFFIC$ 410 E. WA.4r3INCrTONSTkTET CITY IOWA 59,240 Phone: 3193565041 Fax: 319-396-5497 Iowa Criminal 1Est01'V Record Check Results roan:aa11iy7 As of , a search of the provided name and date of blah revealed: ® No Iowa Cilminel History Record found v'Ith ACI Iowa Criminal History Record. attached, I)CI Received TimO'Jul.30..1(2012 10:32AM No. 0397 Ju1.31. 2012 4:16PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00761807 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/07/31 DCI:00761807 NAME: CLARKE,CHARLES CREIGHTON DOB SEX RAC HOT NOT EYE HAIR SKN POB 19791026 M N 511 200 BRO BRO YA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20051015 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSE SCH I TRK#: 101681201 COURT DISPOSITION AGENCY: IA052015,7 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBBTANCE COURT CASE ID: 06521 SRCRO14024 CHARGE CLASS: NON CONVICTION TRK#: 101681201 SENTENCE DEFERRED JUDGEMENT PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20071101 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 iA STATUTE IA716.5 CRIMINAL MISCHIEF 3RD DEGREE - 1970 TRK#: IA002PE01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA716.6(2) CRIMINAL MISCHIEF 5TH DEGREE COURT CASE ID: 06521 AGCRO80744 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA002PEOI RESTITUTION SENTENCE TIME SERVED 1D JAIL 1D 03 ARRE8TED 20080509 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA715A.6(2)-C UNAUTH. USE OF CREDIT CARD a $1,000 TRK#: IA0044COI COURT DISPOSITION No.6462 P. 9/15 DISP EFF DAT APPEAL DATE 20060223 20060223 20060622 20061016 DISP EFF DAT 20080425 20080425 Jul.31. 2012 4:16PM Div of Criminal Investigation DCI 00761807 PAGE 2 OF 2 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A.6(2)-C UNAUTH• USE OF CREDIT CARD < $1,000 COURT CASE ID: 06521 AGCROB3213 CHARGE CLASS: MISDEMEANOR CONVICTION TRKµ: 1A0044COl RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $625 20080001 FINE $625 20080801 SUSPENDED PRISON 2Y 20080801 PROBATION IY 20080801 PRISON 2Y 20080801 COURT DISPOSITION AGENCY: IAOS2015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA714.2(5) THEFT 5TH DEGREE - 1978 COURT CASE ID: 06521 AGCR003213 CHARGE CLASS: MISDEMEANOR CONVICTION ' TRK#: 1A0044CO2 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 1D 20080801 JAIL 1D 20000801 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 M 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.6462 P. 10/15