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Home My WebLink About13-113 r Authorization Number _ 1 (Office Use Only) -•• ••dialimisli MEG Alt 'ft AO all II WIT Haas._ APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 (319) 356-5040 (319) 356-5497 FAX Fir§t Middle., ) 1 1. Name �1Civ`�PPS C � �Gr Gc� I 2. Mailing Address i C2 1-70)." f1 O 3. Telephone: Home 3 f ? 6 a4 Other: 4. Prior experience in transportation of passengers: (.Q k d y i V C fa r Ce,bent-1- -F . v e (.v 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 'i Type of offense ,p/ Where When Armed w/ (ck e 5 d - ovVez Cit 34-7//0 «vVFa I055C510)/ 11i tier‘Q-r1c�i 20110 e(-}/ 3/17/id 6. Have you leen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? .� Type of Offense Where When U , 7. Have you been convicted of any traffic offenses in the last five years? ) �y Type of offense Where When ee d t`kiC ��wa et44-/ �C'7 /O I ) Ped 4 �°�� - 720 /0/(77/0 c 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Yec Type of offense (( Where When , 9 Sn e yt�/�a ! -e- fia c£`t old (a 5 we/ (1`�`/ o 1 9. Hay ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) ' Y U 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). (OVER FOR REQUIRE[)SIGNATURE AND NOTARY) cler'tax dr.vbady 0312013 I hereby, c that I ba_ye issued to me by the Iowa Department of Transportation a valid Chauffeur's license nurrrber `I 3 5i )30 . 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) j / Signature of Applicant % '"� Date O 3� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by (144x)e.0 ..ii' . On this /f day of .g o/3 SONDRAE FORT Commission Number 159791 Notary Public in and for the State of Iowa My Commission Expiraa 3/7/ =o,5 ************************************************************************************************************************************************ 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). Signa e o Pol.'e 'hief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Sig e of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update „P:wta>-�rt.tadgeapp201 o doc 03/2013 • Page 1 of 2 iIowa Department of Transportation Office of Driver Services PO Box 9204,Des Manes,IA 50305-9204 (Toll Free)800-532-1121 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/14/2013 DL/ID#: 431XX5038 (IA) Customer#: 4722954 Name: Buell, Charles Clifford Class: D ID Status: VAL Address: 809 S SUMMIT ST Audit#: 5182504 DL Status: VAL Issue Date: 04/26/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 10/02/2016 CDL Cert None 522403337 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 809 S SUMMIT ST Restrictions: Corrective Lenses Restriction None Date of Birth: 10/2/1977 Supplement: Mailing City/State: IOWA CIN, IA Sex: M 522403337 History Information Convictions Citation Date conviction Date ACD Explanation County JUR 08/29/2008 _ +10/05/2008 _ 1592 _ 'Speed _ _. 52 `IA ' 09/06/2008 .10/09/2008 �� S92 Speed, 57 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR _i ._ ..... ___.... Suspended 104/16/2009 06/28/2009 :592 Serious Violation 'IA IA j Suspended 09/12/2010 ,04/15/2011 B63 Fall to Ruffle SR22 (IA� IA Name: Buell, Charles Clifford DL/ID: 431XX5038 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: ..y 1 (1 ? :C)_$%.........re ilr5/14/2013 1t hR S =owce of Driver Department eof Transportation May. . 6. 2013 2:41PM Div of Criminal Investigation 4 DCI IOU No. 2226 P.0 2/4 ud 09/ivi<oia iu.ua me • STATE OF YOWA . `';;, Criminal History Record Check , Request Form ,, • • Del Account}lumber 38_ 3� — yrs arts rl '[p: IonDivision ionBaarII taP�mm*.Street �ejk.evtwa Or. support Opera Del 215E.Mohan, han,loNs 30119 k 5)310 DnMolaa.l C(aA • (313)123.6063 (3l4 W 'Wit(SSS)715•50 50 Fn • Mont 7 • rail.• en 561'41 I amoestin• nn fovea In••. lit Record Cheok o Mtddle Name t.•. • ke 11 C \lay% k Date et tilrtb mmde,e �a 7~o g-0%01 O�O a /( l - limb ❑Female rd Waiver II(f0Yrrta110n:Without atlpdllower from the toclretmto 1perryHeardrequest,a mtete tecrminal history aAvowedbelow.may yyt he re aJabla,per Code of Iowa,Ch■pter o9f.t,Far temnt113 obtain• elver al••.star from 1.•I 01 the 1:.:pott M1 Er ncoro cTak„Aa,the nlvlaho orchwaa an ratntteovonsnolemewleCOM=MU 1 ualmveatybw Waiver RD/ease:tcaeny tl ea mown!• me lbh mthesimd• .. - a Im,roy+len(Pa}�'1171110•1 N�hY • Waiver Signature: Le��9- ______~ IovtrACriminal H>w(lt.4p �eenrd Giteck Re�uit¢ (DCI wnt'y) N a search of the provided Hama and data of birth revealed: As of �7 0 No Iowa Criminal History Record found With-DCI kit Iowa Criminal History Record attached,DCI ii6a6 • • DClinitials .`�eJ DC147(08125/10) I / / r n. __ :....I Timo f)nv 7Q 7013 10;05AM No. 1560 IOWA CRIMINAL HISTORY DCI 00893025 COURT DISPOSITION PENDING PAGE 1 OF 2 STATUS UNKNOWN DATE PRINTED- DCI:00893025 2013/05/06 NAME: BUELL,CHARLES CLIFFORD DOB SEX RAC HGT WGT EYE HAIR SEN POB 19771002 M W 600 270 BLU RED FAR KY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ARM CCH RECORD •*• 01 ARRESTED 20100317 AGENCY: IA0520400 IOWA CITY UNIV SEC PD ' CHARGE NO- 01 IA STATUTE IA724.4(3) (II) ' GO ARMED/KNIFE BLADE 5 TO 8 - 1989 TRK#: 1A008Y001 CHARGE NO- 02 IA STATUTE IA155A.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG TRK#: 1A000Y002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE IA724.4(3) (B) CO ARNED/KNIFE BLADE 5" TO 8" - 1989 COURT CASE ID: 06521 SRCR090215 TRK#: 1A008Y001 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20100728 PROBATION 1Y 20100728 UNSUPERVISED PROBATION,INFORMAL PROBATION REVIEW 02/01/11. COURT DISPOSITION AGENCY: IA052015J JORMSON CO DIST COURT COUNT NO- 02 IA STATUTE IA15SA.21 UNLAWFUL POSSESSION OF PRESCRIPTION DRUG COURT CASE ID: 06521 SRCR090215 TRK#: 1A000Y002 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $315 CIVIL PENALTY 20100728 PROBATION 1X 20100728 UNS094E7I5E0 PROBATION,INFORMAL PROBATION REVIEW 02/01/11. 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 May. . 6. 2013 2:41PM Div of Criminal Investigation No. 2226 P. 4/4 COVERS THE SUBJECT OP YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION • Sfre)