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Home My WebLink About18-036(1Qf�®d1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. l (Office UseOnly) 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 2. Address (REQUIRED) 50/ /U AP eve 5>4- L"e- iiee %g 5 t 75-T 3. Contact Information (REQUIRED) EmaiCCvnr�ao 6c,�/v.i9x ��,: /rcbY Cell Phone: 3ir9 93�-�3f S/ (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) L/- 24/- ZO2 5 b. Taxicab Business Name (REQUIRED) C', cz ic Z,, ci L 5. Prior experience in transportation of passengers: I,Ye. hep n W/ >�A // , C'A o� Awa, Cc�'�7 }c/ q�.PiOiT b IiPn�li 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? �l,e S Type 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? IVC, Tvoe of offense Where When What happened to the charge? (Circle one) Convicted 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? /vG Type of offense Where When N O C] 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please _de nanM" 0 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATt RTIgIED M('i'j DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC" F MV1EV}L, 1 You must apply for an individual Department of Criminal Investigation Report (form ava&ble LAn request). 0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I herebyy certly that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 359A�.Zcv73 issued on 3-30-/7 expiring on 4/ -2+1 -ZS . 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 � � Date G fffiflfifaliflfflfffllfl11ff1f!lrellrlrflf+rfl+*ffffffff!!llffffflf!lflfrflflafff+ef+eflfff+fffffffff«flffflfffffeffefffffflfffff1ff1111fffff« STATE OF IOWA ) COUNTY OF JOHNSON ) ,1 Aubsccrib1ed and sworn to before me by i � to � L on this A— day of VWNDY in and for the ate of Iowa 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). or designee 3 -LVI f Dat 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. ec-G.-F Sigiiature of City C rk or designee 3--30-/ X Date 0erk/iAXIDRNMADGEAPPLg201aemnWW WC 07/2016 N O f!ll11ff1Hf1ff1ff11fffff f f1f1f Hf101filflM4fflfffifffff 11111H1111M1fHHfHflfllfl HfffllHlli#fifilNf�tfllfff IJ m = lf�ff f fflffifflff Office Use Only c -)o m <T- -o O 70 3 Approved application - DCI report o State certffied driving record Website update 0erk/iAXIDRNMADGEAPPLg201aemnWW WC 07/2016 CIJ10WA Driver & Identification Servicesj P.O. Box 9204, Des Moines, IA 50306-9204 Certified Abstract of Driving Record Inquiry Date: 3/29/2018 DL/ID #: 359KK2073 (IA) CDL Permit Class: None Customer #: 4698203 Class: D CDL Permit Issue None Driver & Identification Services 7>-{ --� Date: W Name: Burton, Cameron Lee Audit #: 1711941 CDL Permit None � ox a � Expiration Date: Address: 501 N DEVOE ST Issue Date: 03/30/2017 CDL Permit None O Endorsements: Expiration Date: 04/24/2025 CDL Permit None Restrictions: City/State: LONE TREE, IA 527559208 Endorsements: Chauffeur 3 ID Status: EXP Mailing PO BOX 411 Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing LONE TREE, IA 527550411 Supplement: CDL Permit Status: ELG City/state: Date of Birth: 4/24/1976 CDL Cert Status: None Sex: M CDL Med Status: None History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date IUR Case Number 04/27/2016 IA 918183 Name: Burton, Cameron Lee DL/ID: 359KK2073 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Driver & Identification 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: Burton, Cameron Lee DL/ID: 359KK2073 (IA) 3/29/2018 N O m Driver & Identification Services 7>-{ --� Iowa Department of Transportation n—G W r <rn � ox a � Y N O Mar. 15. 2018 1: 02PM 6311212018 14:40 YeBou Cab Div of Criminal Investigation vo.ovoi F. /J ffAX)3193382708 P.0021002 STATE OF IOWA Criminal History Record Check • Request Form TO; Iowa Division of Criminal Investigation Support Operations Bureau, P Moor 215 E. 7" Street Des Moines, Iowa $0319 (5X5) 7256066 (515) 725-6080 Fax _ DCI AocountNumber: ____ 9967-F (ifapplicable) From: Yellow Cab of XOWA City P.O• Box 428 Iowa City, 1A. 52244 (319) 338-9777 Phone: rim (319) I am re uestin an Iowa Criminal Histo Kora cnecx on: Mt dle Name (rwomme�deo Laajjst Name (manduoO First Name (mandatuM Date of Birth (manano Deader (maneato Sot la1 Securi Number treconmeeaee %Male mFemale OJL�_ L Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code or Iowa, Chapter 692.2. For o ate criminal history -record inlarmation, e; allowed by law, elta'aYs obtain a waiver sl nature tram the subject of the request. Waiver Release' 1 heeeby {Ivo pv inion for the abovo wqucatins official to cobduct an lows criminal b(s(oryroeotd oheckwhit the Division ofCr(mtnal Invmdgidon (PCD. My csimital hinoy den wnceming me that UW intained by the DCi maybe roleased as allowed bylaw. Waiver Signature; may. Iowa Criminal HiStory Record Check Results (Dclasee^(» As of /, a search of the provided name and date of birth revealed No Iowa Criminal Histoiy Record found with DCT L.F CD Iowa Criminal History Recordattaohed, DCI-=ir-DCl initials rn DCI -77 (08125/10) �'SAnll AI. CA'ir Mar.15. 2018 1:03PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2018/03/15 DCI -00402290 NAME: BURTON,CAMERON LEE DOB SEX RAC MGT WGT EYE HAIR SKN POE 19760424 M W 509 175 BLU BRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD **• 01 ARRESTED/TAKEN INTO CUSTODY 19940704 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#: 007541901 COURT DISPOSITION AGENCY: IA0520ISJ 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 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL 5D REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321-218-2 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED/TAKEN INTO CUSTODY 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 No, 6081 P. 2/3 DISP EFF DAT 19950320 19950320 19970717 19970717 a CD rn rn Z DISP EFF DAT ax 19950320 N O Mar.15. 2018 1:03PM Div of Criminal Investigation DCI 00482290 PAGE 2 OF 2 CHARGE NO- 01 IA STATUTE IA321J-2-2-8 CHARGE NO- 01 OWI 2ND OFFENSE DRIVE WHILE DENIED OR REVOKED TRK#: 500346901 COURT DISPOSITION COURT DISPOSITION AGENCY: IA078015J POTT CO DIST COURT AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2B IN THE ABSENCE OF FINGERPRINTS FOR OWI 2ND OFFENSE THIS RECORD IS CHARGE CLASS: MISDEMEANOR CONVICTION BASED ON INFORMATION FURNISHED. WE TRK#: 500346901 THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY DISP EFF DAT SENTENCE PLEAD GUILTY N \ 19990625 p 7D 19990025 JAIL m FINE $1500 19990825 w 19990825 COURT COSTS 04 ARRESTED/TAKEN INTO CUSTODY 20000701 AGENCY: IA0780000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 800328701 COURT DISPOSITION TO NON -LAW 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 No. 6081 P. 3/3 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF QUILT. 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 DCS. 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 .7y,� DIVISION OF CRIMINAL INVESTIGATION N \ p m w o r- m -0 rn a o D Iv O