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Home My WebLink About18-092CITY OF IOWA CITY 410 East Washington Strccl Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO./P7)'D Q c2 (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 2. Address (REQUIRED) 2/14( 104 3. Contact Information (REQUIRED) Email:. 4a. Driver's License expiration date b. Taxicab Business Name (REQU First Middle K Cd A4 Cell Phone: (All written communication sent via email) r 5. Prior experience in transportation of passengers: Al" 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Ali' Type of offense Where AL419 C �1 M r 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? NO Type of offense What happened to the charge? (Circle one) Where When 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? NGI 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) NQ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 rt' than I have issued to me by the Iowa D partent of Transportatio a valid Driver's license number 7 y / 2- S issued on expiring on / .2 / 2 Z S I understand that if I falsely answer any questions in this application, that this ap licat" n may be denied. I a re 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 fuR�hpr agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisiop, of itle 5 hapter2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican h Date STATE OF IOWA ) COUNTY OF JOHNSON ) this _�'n- day of Affi I have reviewed this application, DCI report, and the State certified driving record of this applica01:qd hF det rtrilned that there is no information which would indicate that the issuance would be detrimental to the safe�bielthgj welt f resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). o �r M m a ZS' l 9-30-/A a' 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. 1 gnature of City Clerk oresignee Date }Nflf 111fN}NlNNlNIfMNN#1f}}!11!!11l1H/N4N1Nfl11Nff1fN4NlNlNflH4N4#'*14M1N1f111fHffNNfN4N11NlN1NlNN/NflfNNNNf Office Use Only Approved application DCI report State certified driving record Website update 0e&j,M1DR 4MDGEAPK9201Uff6aaaOM 04/2018 Aug,27- 2018 10:47AM Div of Criminal Investigation 68122/2018 1226 Yellow Cab .STATJE OF IOWA Crfbilngl HhWry R6c6rd Cheek T.01' XoWz DIVisjou of CjjjnWaj.jMVWk,&tj0Q P'4*tpPtPuQ#9 . A' fu i" u, r 7' Street I ain remmOwannn-L.v, No. 0638 P. 112 (FAX)319 338 2708 P.0021002 DO AocountNuinkr: —9967=f from. CRb ork'ymoty. - TO. Box 42r 10WR City, M 52-174— Pho'nu (319) 3 1&9777 FW (31-4) 339-1302 AM Name ('djj t *- - :'. ':ltctiilillu Z-15 .1 -rce- Je r('c.k Da hi d.f AM No N tOn .-7 Waipirr IWO* be rettgsable-, per Wei chaptermi For"= . *Nict or . cdwinal-bistoM.-pecoroin *wthe d WNW, always �,Ue . � : . Wallver Adt, 0f9.'1bX4yjjy 0-60 for. Ir 1AVM01dalowc b 00 it tili.. As of 7f Id, ) Jk'6-"'-asdArchath6Pr0V!&0 . d-tA114t OWd dAte Of birth reveWed-, rtlf� ��r r 14Q iOW& Cr Bast History Record found Wfth DCI 0 - I'VOU10 Record at6dh,4- - DQ #� DCI WdQ9--2!L— b M -77 (004$1 A 0) Vct%u4V4 Z-15 .1 Aug.[/. I016 1U:4/AM Div of Criminal Investigation No. 0638 P. 2/2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this Information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18), Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry, http.,Ilwww.lowasexoffender.com/. However, even though some information is available on this site, the actual records forjuveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, If any, an application must be filed pursuant to Iowa Code section 232.147(18). e� c? m c -� C:) � s � � F 0, W10WA00T SMARTER VVMJo adot gov RTER I Slh'I�LEIi I CUSTphRER URI1'EIT DrW4f & IdeMiflaalBiyls Setvioes PO Box 9064 I Des Maines, IA 503BfMW Phone: 5M244-9924 I Fax: 513IX39.1837 Certified Abstract of Driving Record Inquiry Date: 8/22/2018 DL/ID #: 178AN2895(IA) Name: Pulley, Lamar Class: C rn Frederick Xo Address: 2027 9TH ST APT 9 Audit #: 1782895 Issue Date: 05/02/2017 City/State: CORALVILLE, IA Expiration Date: 12/12/2025 522411522 Endorsements: NONE Mailing Address: 2027 9TH ST APT 9 Restrictions: NONE Date of Birth: 12/12/1979 Mailing CORALVILLE, IA Sex: M City/State: 522411522 History Information CLEAR DRIVING RECORD Name: Pulley, Lamar Frederick DL/ID: 178AN2895 Customer #: 6496003 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: alone CDL Med St 5: - rfs 933one —s� , y Cc Restri melit �.} Supplemefi�:� CR done 0 p..r 1 rn Xo 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: Pulley, Lamar Frederick DL/ID: 178AN2895 8/22/2018 Driver & Identification Services Iowa Department of Transporatlon