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Home My WebLink About14-126 Authorization Number I`I - 12- Lo I = 1 (Office Use Only) mi"Aram. 4:71111,laytikiE.t. CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (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 1. Name (/LA First Middle Last ei ��S Ar ka_• i 2. Mailing Address L /2 J (1tK��'� • 4- 3. Telephone: Home (C? f ) (021 - y J5 Other: 4. Prior experience in trans ortation of passengers: /'�( �moo S I GQ( � Ci°°y— z o IrAit_.c �o We_ S +a (cel(Zoo 9 - Qom, 2_0 ( 0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Q Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /TO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Yea Type of offense nn Where When See O0 . ( 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Vey Type of offenses When bi�t_C 20 ( 3 -C-c* Pc( o-€ lJ s o9r--f- 9. Have yoti ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) o 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 REQUIRED SIGNATURE AND NOTARY) 03/2014 derWtaxidrivbadg ,, I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number / 137t, 0 n i Q . 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) / / `� /lq Signature of Applicant ��L�1�5 �� Date I ( 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. ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) irLA Scribed and sworn to before me by C—h G rA e 5 C . �` ,-tom& _ . . On this \-1 day of Notary Pu is in and for the State Iowa 7 t 30-1 ************************************************************************************************************************************************ 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). C(0/i'-( Signature of P ice C /......----r gnee 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. k - '; ., -f-LY :,//74// z Signature of City Clerk or designee D Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2"(width) and 5'/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derkltaxidrivbadgeapp2014.doc 03/2014 t u „t of --." State of Iowa ,a'g E '",,, `'-r "-e�� Division of Criminal Investigation e's°, " ,"v ,'ti,. .W� �} >1�� 215E7`hSt g � a i '� r IOWA,`1` DesMYoinesIA 50319 " * '';';'-:,- '6,,.. o xue uy t a Fh.515-725-6066 Fax 515-725-6080jd• ' ,',." " ,,y?'` -4771111/4"t\ ! B,7-rt n p4 Iowa Criminal History Record Check 4� -40 ii Walk-In Request ' Your name V kjd L_ ( Cc_, Address 73 i - •.e City/State/Zip Tekm. e2-1-1 '�2 �' 2 o Fill in all shaded areas. Phone# 3 4 •-- .. -?3c Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) CIwk, Cycles C;le5tL( a Date ofBirth Fec/xa Nacintiento(mandatory) Gender Genero(mandatory) SocialSecurity Number(recommended) (0 / 62 /71c Ma1e OFemale M- (S -2435 Waiver Si.nature Firma(If the request is on yourself,please sign. If the request is on someone else,write N/A.) i �c UJ--- N Results ( DCI USE OY As of `5- 1l { j ``( , a name and date of birth check revealed: • ❑No record found p^'Record attached, DCI# Cr \ YO-7 ta� DCI initials d C----.._ Receipt Number of requests I x $15.00 per last name=Total amount$ l 5 _O O Method of payment: cash ❑money order ❑check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Oe Credit Card Number# _ _ Exp. Date IOWA CRIMINAL HISTORY DCI 00761807 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/05/01 DCI:00761807 NAME: CLARKE,CHARLES CREIGHTON DOB SEX RAC HGT WGT EYE HAIR SKN POB 19791026 M W 511 200 BRO BRO IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20051015 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401(5) POSSESS SCHEDULE I TRK#: 101681201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR074024 CHARGE CLASS: NON CONVICTION TRK#: 101681201 SENTENCE DISP EFF DAT APPEAL DATE DEFERRED JUDGEMENT 20060223 PROBATION 1Y 20060223 20060823 DISCHARGED FROM 20061016 DEFERRED JUDGEMENT 02 ARRESTED 20071101 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA716.5 CRIMINAL MISCHIEF 3RD DEGREE - 1978 TRK#: 1A002PE01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA716.6 (2) CRIMINAL MISCHIEF 5TH DEGREE COURT CASE ID: 06521 AGCR080744 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A002PE01 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 1D 20080425 JAIL 1D 20080425 03 ARRESTED 20080509 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA715A.6(2) -C UNAUTHORIZED USE OF CREDIT CARD < $1,000 TRK#: 1A0044C01 COURT DISPOSITION DCI 00761807 PAGE 2 OF 2 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A.6(2) -C UNAUTHORIZED USE OF CREDIT CARD < $1,000 COURT CASE ID: 06521 AGCR083213 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0044C01 RESTITUTION SENTENCE DISP EFF DAT SUSPENDED FINE $625 20080801 FINE $625 20080801 SUSPENDED PRISON 2Y 20080801 PROBATION 1Y 20080801 PRISON 2Y 20080801 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA714.2 (5) THEFT 5TH DEGREE - 1978 COURT CASE ID: 06521 AGCR083213 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0044CO2 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 1D 20080801 JAIL 1D 20080801 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 • a,., wvvwIowadot v SMARTER I SIMPLER I CUSTOMER DRIVEN- -, - - .__ mOffice of Driver Services PO Box 9204 I Des rabines,IA 5006-9204 Phone:515-244-9124 i 800-532-1121 [Fat:5.15-239-1837 www.iawadot.gov Certified Abstract of Driving Record Inquiry Date: 5/1/2014 DL/ID #: 113AC8690 (IA) Customer#: 2148463 Name: Clarke, Charles Creighton Class: D ID Status: VAL Address: 23 1/2 S DUBUQUE ST APT Audit#: 7065888 DL Status: VAL 1 Issue Date: 06/25/2013 CDL Status: None City/State: IOWA CITY,IA 522403954 Expiration Date: 10/26/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 23 1/2 S DUBUQUE ST APT Restrictions: NONE Restriction None 1 Date of Birth: 10/26/1979 Supplement: Mailing City/State: IOWA CITY,IA 522403954 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/02/2010 • 03/14/2011 iS92 'Speed 'Johnson IA j X09/2011 `01/24/2011 `592 Speed Uohnson IA • ..,4/16/2011 05/23/2011 1M14 Fall to Obey Traffic Sign/Signal _!Johnson IA i 07/01/2011 :08/08/2011 .864 No Insurance Card Johnson SIA_ • 05/29/2012 09/21/2012 ES92 Speed `]ohnson u IA 05/05/2013 06/25/2013 592 Speed !Cedar !IA 05/05/2013 06/25/2013 1864 No Insurance Card Cedar IA i 05/05/2013 06/25/2013 I ilmproper Use of Registration _ Cedar 'IA j 05/05/2013 06/26/2013 B51 No Driver's License `:Cedar IA 1 01/23/2014 02/19/2014 F04 {Seat Belt Violation ?Johnson 'IA I Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number AIR 01/21/2014 J784285 /IA j Sanctions Type Effective EndACD Explanation Occurrence JUR JUR Suspended 101/18/2013 !05/29/2013 !D51 Non-Payment of Child Support IAS �� SIA Suspended j02/19/2013 ;06/20/2013 1D51 Non-Payment of Child Support IA JA Name: Clarke,Charles Creighton DL/ID: 113AC8690 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 Id 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: BIC ayyy >—AVE.. p�oya