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Home My WebLink About18-051r I l S �► alb®®�� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) G IDENTIFICATION NO. 18— ( `? � 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 First Middle 2. Address (REQUIRED) !Y7 &Jest/ •/« /v ;V f 5277 C 3. Contact Information (REQUIRED) Email: Cell Phone: 314.3 zs - 76 7 / (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) it - ZX - Z-0 Z--� b. Taxicab Business Name (REQUIRED) r4f"e j C,- 5. Prior experience in transportation of passengers: , j = 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When Drip: -t 00I;Ae X -sr Cc&'C- -�1/ v^za- IS5NL �R•vl� ta..fJ..Y i..�wY ��lW S��7F SINS triw(y _. '�43 "�!—/�—/PS What happened to the charge? (Circle one) Convicted Dismissed of Suspended Plead Gu ;1) Other N Have you been arrested / charged With any traffic offenses in the last five years? A1, o 0 _Type of offense Where avt,eriE' What happened to the charge? (Circle one) p' _ Convicted Dismissed Deferred Suspended Plead Guilty Otter 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? DO 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) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Drivers license number 769Y�r'7Sfy issued on z-oT-zo%� expiring onlZ z2-2aYi 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 appli ion, and I further agree that, 'rf authorization to be a taxicab driver is granted, to comply at all times with all of the provision, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant / / Date_!! 3 O - f i .,,.._., STATE OF IOWA ) .,.. COUNTY OF JOHNSON ) Su scribvci and sw to before me by i on this day of 1 Notary Public in and for 4 State of Iowa I have re is app kation, D eport, 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 swelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). m a .n Expiration date o D' rise 11-17--77 --� a W r 0 �'-30 -/�i rr_n s �rmi Signatu f Police Chief or designee Datex La A w O 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. :! P /�� Q y-- 3 v- I Sign ure of City Clerk esignee /� Date Office Use Only Approved application DCI report State certified driving record Website update OeWMIDRAWDGFAPPL=1ean ded.DOC 042018 Apr.y4. 2018 9:55AM Div of Criminal Investigation No. 9618 P. 1/3 Fe,afn:Clty of Iowa Gry Clark 011loe ala 0555497 04/113/2019 16:14 11490 P.o62toom STATE OF IOWA Criminal History RecQrd CheckI�t ( {{{{ Request To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 B, 71" Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6000 Fox I kinrcmlestina an Yrtwa Criminal trictnnr P.rnrd rh..�4 DCI AccountNumbec Zoo (irapallcablc) From: _ City of Iowa City City Clerk's Office 410 )w. Washington Street Iowa City, IA 52240 Phone: 3194156-5041 Fox: 319-356-5497 Last: Name (ntmdatory) First Name (mandelory) Middle Name (mtammcnaee) N Date of Birth (mandatory) Gender (mandatory) Social Security mbe ecomm oinhitill L /- 2-- /7 4Male ❑Female cn o Vl?t�_ /9 n -< Waiverinjormation: Without a signed waiver from the subject of the request, a complete criminal his yRr Tecoavbnay At, be releasable, per Code of Iowa, Chapter 692.1 For complete criminal history record Information, as allowIa1�alway[� obtain a waiver signature from the subject of the request. O W S' W WalVer ZielBaSe:l hereby give pc for lbe abovcr lag oll'ci to conduct s7lmve criminal history record check with the pivision ofCrQimi alyeliltpllon (DCI). My criminal Minty data =ming- . 4K l aint y the DCI maybe released as allowed by lave, Waiver Signature: / Lj) t7 -.. -- `__--. ... ss.,, .... ..YYY.., �.yYYa• L\YJ LLatJ (1),Qpse only) As of �(� \��b a search of the provided name and date of birth revealed: ® No Iowa Criminal History Record found with DCI "" Iowa Criminal History Record attached, DCI # ,113 I ,j DCT initials—k-L DCI -77 (09/25/10) o ... :—J T:.,,. A-. 10 01110 o.oaNu tl,. NFAN Apr. ,',4, 2018 9:55AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00432978 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2018/04/24 DCI:00432978 NAME: 90ODY,RICHARD ANTHONY DOB SEX RAC HGT WGT EYE HAIR SKN POB 19711222 M W 509 170 BLU BRO MED NB ADDITIONAL IDENTIFIERS N a SC HEAD a SC L EAR r� CCH RECORD **• 01 ARRESTED/TAKEN INTO CUSTODY 19920123 AGENCY: IA0160000 CEDAR CO SO C3 CHARGE NO- 01 IA STATUTE IA321A-32 GJ DRIVING W/SUSP TRK#: L41238401 O COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA321A-32 DRIVING WHILE LIC SUSP CHARGE CLASS: MISDEMEANOR CONVICTION TRH#: L41238401 SENTENCE DIS? EFF DAT PINE $250 19920020 COURT COSTS PAID SURCHRG 19920628 02 ARRESTED/TAKEN INTO CUSTODY 19920816 AGENCY: IADS20100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J-2 Owl TRH#: L41238501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 owl TRK#: L4122$501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19930113 03 ARRESTED/TAKEN INTO CUSTODY 19951022 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA236-12 ASSAULT CAUSE INJURY -DOMESTIC TRK#: 007787601 COURT DISPOSITION AGENCY: IAUS2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708-2A ASSAULT C/INJ DOMESTIC CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007787601 SENTENCE DISP EFF DAT No.9618 P. 2/3 N a a nC-) r� �� rn C3 5� GJ � O Apr.24. 2018 9:56AM Vv of Criminal Investigation JAIL 2D FINE $250 SUSPENDED 58D 04 ARRESTED/TAKEN INTO CUSTODY 19960310 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA236=-12 ASSAULT -DOMESTIC ABUSE TRK#: 009609601 = COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA706-2A DOMESTIC ASLT CAUSE INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 009809601 SENTENCE JAIL 2D FINE $250 DCI 00432978 PAGE 2 OF 2 19960416 19960416 19960416 DISP EFF DAT 19960903 19960903 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OP 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 No.9618 P. 3/3 N o_ O :*E C-) v � �o T `1 �-� o r m M � = 0 ca 0 Al\ 1 U IQ�;C 1 U1 L C44 I WA, T Driver & identification ServicesA P.O. Box 92104, Dies Moires, Ifs 50306-9204 Certified Abstract of Driving Record Inquiry 4/11/2018 DL/ID #: 769YY7984 (IA) Date: None Endorsements: Perea Customer 747637 Class: A ID Status: None DL Status: VAL Name: Goody, Richard Anthony Audit #: 9768986 Address: 4 GLEASON DR Issue Date: 02/09/2016 Expiration 12/22/2023 Date: City/State: IOWA CITY, IA Endorsements: Motorcycle, Tank 522405838 Mailing PO BOX 187 Restrictions: NONE Address: Restriction None Mailing WEST LIBERTY, IA Supplement: City/State: 527760187 Date of 12/22/1971 Birth: Sex: M CDL Medical Examiner's Certificate CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: Ernest CDL Permit None Endorsements: Perea COL Permit None Restrictions: 3244024129 ID Status: None DL Status: VAL CDL Status: ELG CDL Permit ELG Status: 11/30/21317 ee CDL Cert Status: Non -Excepted Interstate CDL Med Status: Not Certified Certificate Specifics Explanations Medical Examiner First Name Ernest Medical Examiner Middle Name Manuel Medical Examiner Last Name Perea Medical Examiner License Number 33079 Medical Examiner National Registry Number 3244024129 Medical Examiner Jurisdiction IA Medical Examiner Phone (319) 339-3921 Medical Examiner Type Medical Doctor Medical Certificate Issued Date 11/30/2015 C' Medical Certificate Expiration Date 11/30/21317 ee Date Added to CDLIS Driving Record02/10/ an n -< W r. History Information CLEAR DRIVING RECORD http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 4/11/2018 ruga L U1 L Name: Goody, Richard Anthony DL/ID: 769YY7984 (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: Goody, Richard Anthony DL/ID: 769W7984 (IA) 4/11/2018 d9 07 - Driver & Identification Services Iowa Department of Transportation http:// 172.2 9.2 5 4.5 5/drivers/reports/customerhi story/certifieddrivingrecord. aspx T r v 4/11/2018