HomeMy WebLinkAbout18-024 IDENTIFICATION NO. )ej- oZ
t 1 1 FI (Office Use Only)
McOOPg; FEB 2 G 2018
APPLICATION Ci
/MOTORIZED PEDICAB VEHICLE DRIVER
CITY OF IOWA CITY (Police Department review ,b1Ctnade between 8 a.m.to 3 p.m., Monday-Friday)
410 East Washington Street
Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application
(319) 356-5040
(319) 356-5497 FAX
First Middle Last
K-e
1. Name(REQUIRED) 8laAt/4.--1/ �e(/me-
2. Address (REQUIRED) 20 C, 0/ 5J 4v,e 7/ C' ,,,,/„d//, .7,4 S-2.Z 4',�
3. Contact Information(REQUIRED) Email: .414k.Q,d`vo�e.44 /1.1.4,"/.(0r%- Cell Phone:t-1I '5'I E' ,
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED) (:::: --/.2 4-// 2OZ "
b. Taxicab Business Name(REQUIRED) r'�//p,.,, Ca 4 o Iowa Ci=71-2.,
5. Prior experience in transportation of passengers: Yes
6. Have you ever been arrested /charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
<_,!.'J-= ray-e..-1-1-e_ Ca-An �y I i /1 7 /z 0 J /
What happened to the charge?(Circle one)
Convicted Dismissed eferred Suspended Plead Guilty Other
7. Have you been arrested/charged with any traffic offenses in the last five years? J i�{c? S
Type of offe e Where When
�J -� �l � � Lj tin p.J,/`.� ��
/LY /L ^'�il�
/
What happened to the charge? Circle one)
Con_v�ir d 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? ..
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).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER Fit..Page 2 En
I hereby cit-3710
rtif�r that I have sued to me by the Iowa Depar€i $mf nsportation a valid rivers license number
1 &5710 7 6, 3) issued on I(ZS-/I ex g on ‘27,,,/2 �//2 DLL/. I understand that if I
falsely answer any questions in this application, that this applicatiortttnay 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, Ch ter 2, of th Ci y Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant�� �/ Date 7.12--/2 .>/14
STATE OF IOWA )
COUNTY OF JOHNSON )
SAscribed and sworn to before me by i31 ct\— A , ----L- p i-C on this Z. day of
),-• .du. , Zv1:. � A
WENDY S.MAYE17 ' i J w`cze—k__4}
ri:l 8
Commission Number 72942otary Publ in and for the State f Iowa
u r iss Expires
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 ofj Dui s se 01 -Z4 - Z 1
-- / ` —47
oZ- z ? - /9
Signature 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.
/1 -� -IY/
Sign ture of City Clerk o designee Date
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Oe',/7 AXIDRIVBADGEAPPL92014amenjed DOC 07/2016
Iowa Department of Transportation
C83Office d Dfwer Servitces (TOO Free)800-532-1121
V PO Box 9204,Dos Manes,La.5030E-92d4 515-2444124
FAX:515-239-183?
Certified Abstract of Driving Record
Inquiry Date: 2/8/2018 DL/ID#: 963AA7633 (IA) Customer#: 515410.
Name: Devore, Blake Alan Class: C ID Status:- /one
Address: 206 21ST AVENUE Audit#: 2494126 DL Statuk 0
Issue Date: 01/25/2018 CDL Status:C. Nd O
rie
City/State: CORALVILLE, IA Expiration Date: 02/24/2024 CDL Cert Stas:c^Nor
522411467 .O
Endorsements: NONE CDL Med Status, None
Mailing Address: 206 21ST AVENUE Restrictions: Corrective Lenses Restriction None
PL Supplement:
Date of Birth: 02/24/1990
Mailing CORALVILLE, IA Sex: M
City/State: 522411467
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
11/19/2011 04/04/2012 A20 Deferred Judgment Fayette IA
OWI
01/11/2018 02/06/2018 S92 Speed (10 mph & Washington IA
under in 35-55 mph
zone)
Operating While Intoxicated Test Refusal/Test Failure Violations
Occurance ACD Explanation JUR County
11/19/2011 A98 OWI Test Failure IA Fayette
Sanctions
Type Effective End ACD Explanation Occurrence JUR
JUR
Revoked 01/13/2012 07/10/2012 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:
y 2/8/2018
4:' IOWA 1**74
vD. O. T. :
* 117446414111414:6;61449
Office of Driver Services
Iowa Department of Transporation
Name: Devore, Blake Alan DL/ID: 963AA7633
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02/Feb. 22. 2018E_9.O1AMa193Div of Criminal Investigation No. 4515 P. 1/2,
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? " ;, STATE OF IOWA �� �,�: n„r�0
i,-,,f-..,Ingo'• Criminal HistoryRecord < �+'� N. �,,
; Request form 0 1 •::::,......1...:."I
tirt
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DCI Account N$mbcr:.,_9967-F
To: lows Division or (irapplicoelc)
Crlmlllatl lnvucclgnt'on From: Yellow Cnb ofIown C!
Support Oporatlons Bureau, 1”Floor
215 E.7 Street r•C. 130X 4z8
Dos Moines, Iowa 50319
(515)725-6066 Iowa City,l'A, 52244
(515)725-6080 Pax
•
(3I9)338-9777
Phone:
Fla: (329)339-7302
I am re.ucstin• an Iowa Criminal Histo Record Check on:
+ First Name(mandato ) •
Middle Name(roeommCndad) •
IDR-)v re,
�lc_a—•
nate of Birth (mandate ) '�
Genderdemandato Soollal•$ccuri Number(rccommcndeo)
OD- 15 0 lla vIale ❑Female
Walv¢I'Information: Without o signed waiver from the subject of the request, : eomploto criminal history record flay not
be releasable,per Code of lows,Chapter 692.2.For complete criminal history.re •rd irlformution,u Allowed by law,always
obtain a waiver sl_nature from the sub rct of the reues4 t•
Waiver Release;I hereby give permission for the ahnvc requesting official to conduct en lawn c mina)history record check with the Division Of Criminal
Invcsligutlon(DCI). Any criminal hletory data concerning mo Mut is maintained by the b I mu •c eotod as alloyed by law.
Waiver Signalure; r-- -.•'...--''' ,
Iowa Criminal HistoryRecord Check Result§
(Det use only)
As or P�01'li , a search of the provided name and date of birth revealed:
0 Y •
No Iowa Criminal History Record found with DCI po
14— Iowa
Criminal History Record attached, DCI G 3 9()IY
r „
DCI initials C C 1.1-'
DCI-77(08/25/10)
Received Time Feb. 20. 2018 3:59PM No. 4359
Feb. 22. 2018 9:01AM Div of Criminal Investigation No. 4515 P. 2/2
•
IOWA CRIMINAL HISTORY DCI 00943984
NON CONVICTION PAGE 1 OF 1
DATE PRINTED-
2018/02/22
DCI:00943984
NAME: DEVORE,BLAKE ALAN
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19900224 M W 509 190 BLU RED LGT IA4.11.11
O
T
4 imam
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y W
TAT UL ARM
TAT UR ARM _ (D N rn
CCH RECORD *** E R
a v
01 ARRESTED/TAKEN INTO CUSTODY 20111119
AGENCY: IA0330000 FAYETTE CO SO
CHARGE NO- 01 IA STATUTE IA321J.2(A)
OPER VEH WH INT (OWI) / 1ST OPF
TRIO: HN001B001
COURT DISPOSITION
AGENCY: IA033015J FAYETTE CO DIST COURT
COUNT NO- 01 IA STATUTE: IA321J.2 (A)
OPER VEH WH INT (OWI) / 1ST OFF
COURT CASE ID. 01331 OWCR063338
CHARGE CLASS: NON CONVICTION
TRK#: HNOO1B001
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 1Y 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 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
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