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Home My WebLink About18-017� r 1 ► ^� MIM®i�Il CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240.1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. /b -Q 1 -1 (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 Middle Last 2. Address (REQUIRED) 2i o i /U, 4/14, /4c- ��,s X •' c 4 Lz 5� 3. Contact Information (REQUIRED) Email: nl[a cc- piowr.lele-C4. Inco -f- Cell Phone: 3/4 Sof£'-/y53 (All written communication sent via email) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tvoe of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other / 7. Have you been arrested / charged with any traffic offenses in the last five years? Nb Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other n / 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When N 0 O m 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please a name" DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STPA� ERIIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE Q jEFr&VIE0 - o You must apply for an individual Department of Criminal Investigation Report (form available i@'on 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 a valid Driver's license number '15 S z z 3(�, o issued on 7/ o f expiring on Z62 6120 / 8. 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 Zti li Date �2' 12-2r, /? Hff fYfmfYfffYfllf!llflflMYYHmImllflflfYtFf}R1el-ff-ff 11fmY#fY1!lmflmfmmYYYmM11ffH1ffYfYYfyflflff YYYmlflffmlflft}}tfl1H! STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C iLQcC_ Via,..` on this / day of %--eln,rtinnrv, 7.01.E 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). Expiration date o D. er' license O 7-Z& - Z fl i Signakfe of Police Chief or designee Date 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. 0 Sig Lure of City Clerk 6f designee Date lfinefYf YeY++YYmlmlfllmff•+++mf!!f flfmffff ffff 1ffaYlfflmmf f 11f Y�YIm!lmllfllff+llrYaYfflflfmll�y�lmlmlmllfffffmfffY 0 Office Use Onlyn m Approved application DCI report State certified driving record Website update n-< N 1 my. M �x o 0 0 cWr✓rn DRfVBnocEnaa92014 �ooc 07/2016 /' Iowa Department of Transportation . 01ce el UfT&N Services (fell t•fee)806 b32 1121 PO Bon 9204, Dc-, Manes, IA 50300 9204615-244-9124 0 FAX 61&239 1937 CLEAR DRIVING RECORD Name: McCracken, Alan Paul DL/ID: 958ZZ3610 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: IOWA D. 0. T Name: McCracken, Alan Paul DL/ID: 958ZZ3610 2/11/2018 Office of Driver Services Iowa Department of Transporation p O m "n ::r-- S2 m 3> --I 03 r n-< N -1 Cl) < rn y" 0 0 Certified Abstract of Driving Record Inquiry Date: 2/11/2018 DL/ID #: 958ZZ3610(IA) Customer #: 2863431 Name: McCracken, Alan Class: D ID Status: None Paul Address: 401 N 4TH AVE Audit #: 7148208 DL Status: VAL Issue Date: 07/19/2013 CDL Status: None City/State: WASHINGTON, IA Expiration Date: 07/26/2018 CDL Cert Status: None 523532206 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 401 N 4TH AVE Restrictions: NONE Restriction None Supplement: Date of Birth: 07/26/1953 Mailing WASHINGTON, IA Sex: M City/State: 523532206 History Information CLEAR DRIVING RECORD Name: McCracken, Alan Paul DL/ID: 958ZZ3610 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: IOWA D. 0. T Name: McCracken, Alan Paul DL/ID: 958ZZ3610 2/11/2018 Office of Driver Services Iowa Department of Transporation p O m "n ::r-- S2 m 3> --I 03 r n-< N -1 Cl) < rn y" 0 0 reD. Y. z u i u L:I[rm UIv 0 �nminaI Investigation no. jJ00 r. I/9 Fro m:�.,sy m lewd 1-.Ity 010fk l ?1100 JIV JbbbCtlr 02/07/2016 12:63 0370 p.002/002 STATE O IOWA Criminal 2 eCk � IkrtFy sf.equest Form To: Iowa Division of Criminal Investigation Support Operations Bureau, l" Floor 215 E. 7'a Street Des Moines, Iowa 50319 (515) 725.6066 (515) 725.6080 Fax y/tel 4 L r a t. (< 67 -26— /ei S3 DCI Account Number: `(a 4�y= o •Yr^ v From: C"' f Town city City Clerk's Oftico 410 E. Washington Street lova Cit IA 52240 Phone: 319-356-5041 Fax: 319.356-S497 LYI►1a1e ❑Female Ylk3-6, 2817 Waiver lfllilrAtaliofr! Without a signed waiver from the subject of the request, a complete criminal history record may got be relegsable, per Code of Iowa, Chapter 692,2, FOrPoInviete criminal history record Information, as allowed by law, always obtain a weiver si¢nature from the suhlert nflhn r.n.,.ra Waiver Release: I hemby giro ptneisilm for the above hlvastigallon(M). My cdminal history dais mnceming mol Waiver Signature: to maduct m Iowa crimlnel history ra rd check with the Division ofCtin+ieal r Ne DCI may be released as allowed by law. (DCI use only) c� pr As of a i p , a search of the provided name and date of birth revealed: zt Q No lows Criminal History Record found with DC1 r:' wb T-- -® 13 Iowa Criminal HistoryRecord attached DCT # DC1 Initials fir, W DCI -77 (08/25/10) Received Time Feb. 1. 2018 11:28AM No -3053