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Home My WebLink About18-069` IDENTIFICATION NO. 1 l 1 (Office Use Only) j Ls 1i ._ APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must b de etween 8 a.m. to 3 p.m., Monday — Friday) CITY OF IOWA CITY 2018 JUL 26 rP91: 2t' 410 East Washington Street manure to com sere me'•re matron will result in denial of Iowa City. Iowa 52240-1826 x' (3 19) 356-5040 10 WA CITY.10':;.`. (319) 356-5497 FAX First Middle Last 1. Name(REQUIRED) /err ✓acL� vt �la✓/ ��/ 2. Address (REQUIRED) /a/ N 1414 ue— a)A4 "V'4 ' Sz3S3 3. Contact Information (REQUIRED) Email: u�4 "`�� i a cUc/c/eco .,, q Cell Phone: X19 SZ D ly53 (AII written communication sent via email) 4a. Driver's License expiration date (REQU b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: 7-.26 -2a 1. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Al. Tvce 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? /6z Type 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? /vim, Type of offense Where When 9. Have yoy ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 04/2018 I . . APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DO I ORT kND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLII�OA I N IFG POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Inv"f�jt'prvftep�,fiprm available upon request). u 11. C I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 95 X — 36/o issued on 6 -,2p-202 expiring on 7-2,,'-ao26 . 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 Titles, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant �� Date 7 26 -1U Q iH1HH11f1fM1fi}kH1iN111f411HHH1H111filiH1H1f11f11f4Y}lfYf11111f1;�yy}f} 11111 f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by .41 o, , P . n C M I on this .41 Le da of 7T1 rAa 2J./Pi . y I 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). Expiration date of Dri el's nse %-Zw zCy —� -7 Sign a of P lice Chief or designee Date 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. Office Use Only Approved application DCI report State certified driving record Website update Date Gen✓rAyJmN,eNOGEAM9201Ba meaDOC 04/2018 Jtl«1.23. 2018 11:59AM Div of Criminal Investigation No.7375 P. 2/3 FrOM:Cl1y of Iowa Clty Clerk O/lloa 319 MMOSA07 09/10/2018 16:06 M001 P.002/002 FILED 2010 JUL 26 AN 11: 20 ST'AT'E ®F I®WAI Criminal History Repro Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 2151x. 7" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax 1 aro remlectino an Iowa Criminal I-listnry Record Checle r.n, DCI Account Number: L-ftSx:,Y, (irappliabie) From: City of Iowa City City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319.356.5497 ttJJName tmaddal ) Last First Naine (mandatory) M ilddll�e Name pem nn endo /'f C. CVe• c4 aril a 1 rak� Date of Birth (mandatory) Gender (mandatory) Social Security Number (recommended) Q %1.2 6�iS3 )Male ❑Female 4/8?-as`0- CF.?/% Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver Release; I hcrcby give permission for the above requesting official to conduct an lone criminal history raord check wills the Division ofCrindnal Investigaliml (DCI). Any aims al history dela concerning me Thal Is ma"by by the OCT may be released m allowed by law. Waiver Signature: k Iowa Criminal History Record Check Results C,11S0only) As of _ ��- a search of the provided name and date of birth revealed: ' Iowa Criminal History Record found with DCI r ® Iowa Criminal History Record attached, DCT # DCI initials DCI -77 (08/25/10) C410WADOTWWwao w SMARTER I SIMPLER I CUSTOMER ORIYEN ,..�,,. 11t Drl Ieairit)otaft ssrvikas PO Box 9204 Dest M&7A %W. 9201 Phan 515247-912d(PaA 5,239.1837 Certified Abstract of Driving Record Inquiry Date: 7/18/2018 DL/ID #: 958ZZ3610 (IA) Customer #: 2863431 Name: Mc Cracker, Alan Class: D ID Status: None Paul Address: 401 N 4TH AVE Audit #: 2943948 DL Status: VAL Issue Date: 06/29/2018 CDL Status: None City/State: WASHINGTON, IA Expiration Date: 07/26/2026 CDL Cert Status: None 523532206 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 401 N 4TH AVE Restrictions: NONE Restriction None Supplement: Date of Birth: 07/26/1953 Mailing WASHINGTON, IA Sex: M City/state: 523532206 History Information CLEAR DRIVING RECORD Name: Mc Cracker, Alan Paul DL/ID: 958ZZ3610 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by 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: Mc Cracker, Alan Paul DL/ID: 958ZZ3610 7/18/2018 C� Driver & Identification Services Iowa Department of Transporation