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Home My WebLink About13-036CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 13-3� (Office Use Only) First Middle Las( 1. Name CAm �icn / ee- u., j"_j 2. Mailing Address Ao & l La,7e T, -c e .Z 5- 2 75 S 3. Telephone: Home 0 U = Other: 4. Prior experience in transportation of passengers: li e-71- G F %a l r Ser L /G f- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? i/e 5- Tvpe of offense Where When , Ck (/v/c / % /L� AWr Xa - DOS - ,7ou 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?4C7 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? � / e 5 Type of offense Where When /�e c /C✓c d °1 C / f9 //cn �1(1,--14059 {e �9c/I %n,) Oi/ 6"' 261 - / Z 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) //nO 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) claWta drivbadg 09/2012 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 57 h E 2c >3 . 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 ApplicanV5_,_5;_� �%``� Date Z - ZS - /3 STATE OF IOWA ) COUNTY OF JOHNSON ) 1 cribed and swQZn to before me by On this 2S�K~" day of ut KELUE K. TLE mbe 22 tary Public in and for the State of Iowa 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). �SisZA -, e x, - ure of Pol ce CI or designee -.7s--13 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. ') i (', Al-, Al Signatu of City Clerk or designee gnee Taxi cab businesses are required to provide Driver Identification cards. �— L3 Date #fRRR#RR#fRR*RR#fR#R}}RR#+*ff##Y####Y##############**####+*#####+}##4##++4*+++##4##++###Y#4+#}}4+4####F#####4######}########+44####Y########*#*# Office Use Only Approved application DCI report State certified driving record Website update da dnvbadeeaaa2010.a 0912012 Feb.19. 2013 1:44PM Div of Criminal Investigation No.3678 P. 4 'Feb. B. 2013 12:47PM City Clerk — City of Iowa City No.3206 P. 2 , (iAnmmal"aldor y.Recard (check , T opest Form To; Za1Ya)a1v1a(OhOfCrhnillal.Ynvesi'fggt(ori '',_5uppartOperat(Ong7auxeuu,l'1,Nioax 2YS2;, 7'kSireeC • AsxMoirtav,7olYa 40719 ' (81s} yaa--6x66 (515) IM -6090 p'q* I ara requostlnz aal'ovm CrhnfnalFifstorvl2eoord Cheolc e ACIAocountNUmbar; �UO�-•(= ' QPepyflt86(c )'tram{ ,ITP. 00 TOA@ CITY' cm MW9 OBP.CCO • of) 'R L7A9irINmu SMH TOD•A CITY Y -k 52240 i')innoy g1q�gR —ROk.1 _�, meRdn�[at .NS�'9C1VPrrie ,d�,da(ory) ' 0 e ,-a • (mandrtol C�Ohder lendemrtl -,7 R3YeJXt{Jormayfory; pyi(hoatasf�aedFc01Yep1tomfLeaubjeciof theragaeaN, a rompJatOoY%utad(hlefoty tecoiqmgylrot beroraakhlce per Cadodgldwa,Cha�tor69z2,71oN �nglQ(Q'orlmfnaTkistoxyreeordin6stmotion,e5atlow6Aty1AY,always byrrly �f10C��1'YYt9 , ' NCluFeonb) _ As of aseu4ofz1a.Vavldcdn=uakadalod6h1hsaycale(E ' leo Xowa d1u01uaI�];istozyltecord fbbnd withX7CT - .: • ' ; Iowa aJmtna R1SfoayRO6otd arched, DOU bou'a lal Aoroivad Timo.-Fc6 R —1919-11d6D�l'rbl� 41161 711A (iAnmmal"aldor y.Recard (check , T opest Form To; Za1Ya)a1v1a(OhOfCrhnillal.Ynvesi'fggt(ori '',_5uppartOperat(Ong7auxeuu,l'1,Nioax 2YS2;, 7'kSireeC • AsxMoirtav,7olYa 40719 ' (81s} yaa--6x66 (515) IM -6090 p'q* I ara requostlnz aal'ovm CrhnfnalFifstorvl2eoord Cheolc e ACIAocountNUmbar; �UO�-•(= ' QPepyflt86(c )'tram{ ,ITP. 00 TOA@ CITY' cm MW9 OBP.CCO • of) 'R L7A9irINmu SMH TOD•A CITY Y -k 52240 i')innoy g1q�gR —ROk.1 _�, meRdn�[at .NS�'9C1VPrrie ,d�,da(ory) ' 0 e ,-a • (mandrtol C�Ohder lendemrtl -,7 R3YeJXt{Jormayfory; pyi(hoatasf�aedFc01Yep1tomfLeaubjeciof theragaeaN, a rompJatOoY%utad(hlefoty tecoiqmgylrot beroraakhlce per Cadodgldwa,Cha�tor69z2,71oN �nglQ(Q'orlmfnaTkistoxyreeordin6stmotion,e5atlow6Aty1AY,always byrrly �f10C��1'YYt9 , ' NCluFeonb) _ As of aseu4ofz1a.Vavldcdn=uakadalod6h1hsaycale(E ' leo Xowa d1u01uaI�];istozyltecord fbbnd withX7CT - .: • ' ; Iowa aJmtna R1SfoayRO6otd arched, DOU bou'a lal Aoroivad Timo.-Fc6 R —1919-11d6D�l'rbl� 41161 Feb.19. 2013 1:44PM Div of Criminal Investigation 1 IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2013/02/19 DCI:00462290 NAME: BURTON,CAMERON LEE _ DOE SEX RAC MGT WGT EYE HAIR SKN POE 19760424 M W 509 175 BLU BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: 007541901 COURT DISPOSITION AGENCY: IA05201SU JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRE970D 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWY TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE YA321J.2 OPER VER WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE SOH JAIL 5D REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE YA321-218-2 DRIVE WHILE REVOKRD CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED 19990522 DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No. 3678 P. 5 Feb.19. 2013 1:44PM Div of Criminal Investigation DCI 00482290 PAGE 2 OF 2 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA321J-2-2-B OWI 2ND OFFENSE TRK#: 500346901 COURT DISPOSITION AGENCY: IA057015J LINK CO DIST COURT COUNT NO- 01 IA STATUTE IA321J-2$ OWI 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE DISP EFF DAT PLEAD GUILTY 19990825 JAIL 7D 19990825 FINE $1500 19990825 COURT COSTS 19990825 04 ARRESTED 20000701 AGENCY: IA0780000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 800328701 COURT DISPOSITION AGENCY: IA078015J POTT CO DIST COURT COUNT NO- 01 IA STATUTE IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS; MISDEMEANOR CONVICTION TRK#{: 800328701 SENTENCE DISP EFF DAT PLEAD GUILTY 20000703 JAIL 2D 20000703 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENT CATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFO `T'AGENCIES BY THE DCI. IN TH 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.3678 P. 6 CA Iowa Department of Transportation Office of Driver Services (Toll Free) BOU-532-1121 PO Box 9204, Des Moines, IA 50308-9204 515-244-91244 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/21/2013 DL/ID #: 359KK2073 (IA) Customer #: 4698203 Name: Burton, Cameron Lee Class: D ID Status: EXP Address: 311 W DOUGHERTY DR Audit #: 5685743 DL Status: VAL Issue Date: 12/15/2011 CDL Status: None City/State: LONE TREE, IA Expiration 04/24/2017 CDL Cert None 527557749 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: PO BOX 411 Restrictions: NONE Restriction None Date of Birth: 4/24/1976 Supplement: Mailing City/State: LONE TREE, IA Sex: M 527550411 History Information Convictions Citation Date Conviction Date ACD Explanation _ County JUR _... ..._ . ........... ..... ......... _... .. . ........._. ._. .. ........ ......... , 06/29/2012 07/18/2012 NB2 ,Improper Backing 52 SIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 11/06/2008 ............. ;472240 . .. ................. ....... ... IA_..... Name: Burton, Cameron Lee DL/ID: 359KK2073 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: •:;G/�y 2/21/2013 IOWA0. x BNE�S Office of Driver Services J...... Iowa Department of Transportation