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Home My WebLink About18-102r IDENTIFICATION NO. —'/D (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) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX First Middle Last 1. Name (REQUIRED) jj:lCACk 2. Address (REQUIRED) `i'j o M2:V pf n 3. Contact Information (REQUIRED) Email:bf wN n MCell Phone 630 9�1y 1 1 (All written mmunicatio a via email) 4a. Driver's License expiration date (REQUIRED) 3Z3AP7,-Sg6 b. Taxicab Business Name (REQUIRED) t t✓Nw cfL 5. Prior experience in transportation of passengers: �) z 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ti 0 O r O What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty ;Pher /y 7. Have you been arrested / charged with any traffic offenses in the last five years? N Tvce of offense Where: W?o�_ cn J What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Others �N/A 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? � (� 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 names) N I_ NOT 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 Driver's license number 3Z3A P 23$(� issued on J -JL -_ d expiring on _IU-Zb— (g I understand that rf 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 , ' DateOar- - 1f11111111fyyffllfYfflf 11ftyHllfyfff111(111111;1ffI,1N1h1fl1fyflff.}11111111}411}�yff}yfNlf�lfllflf#111Nf11lkf-111(1 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M N 116:Lj M &Z:ii6 it on this ( day of I have reviewed this application, DCI report, and the State certified driving record of this applicant.and Faye defenI ined that there is no information which would indicate that the issuance would be detrimental to the safety,WealtFRr wel)afe of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). cn Expiration date of Driver's license 71g fo-Pc J/ Y V' Signature—,of Poli c let or designee /P //, /,1; ate 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. Of Office Use Only Approved application DCI report State certified driving record Website update Date GerkaA%IIX2N94DGEAPPL92018amenEetl.DOC 04/2018 C40%4 410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov. Driver & Identification services PO Sox 9204 1 Des lJoines. IA 50306-9204 Phone: 515.244.9124] Fax 5152391837 Inquiry 9/26/2018 Date: Customer #: 6818968 Certified Abstract of Driving Record DL/ID #: 323AP2386 (IA) CDL Permit Class: None Class: C Name: Browning, Maurice Mack Audit #: 3232386 JR 440 N Madison Ave Unit 4 Restrictions: NONE Address: 440 N Madison Ave Unit 4 Issue Date: 09/26/2018 Mailing Expiration 07/09/2025 City/State: Date: City/State: North Liberty, IA Endorsements: NONE History Information CLEAR DRIVING RECORD Name: Browning, Maurice Mack JR DL/ID: 323AP2386 (IA) CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None VAL None ELG None None Pursuant to Iowa Code 4321.10, I, Darcy Doty, 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 gqiteny, 523177806 Mailing 440 N Madison Ave Unit 4 Restrictions: NONE Address: Restriction None Mailing North Liberty, IA Supplement: City/State: 523177806 Date of 7/9/1992 Birth: _ Sex: M History Information CLEAR DRIVING RECORD Name: Browning, Maurice Mack JR DL/ID: 323AP2386 (IA) CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None VAL None ELG None None Pursuant to Iowa Code 4321.10, I, Darcy Doty, 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 gqiteny, Iowa this date: cs O w _ D -d MEN] Oo rq C-) rW� EP o "0 W 9/26/2018 —ln CD 0 Driver & Identification Services c.n 1 000�� Iowa Department of Transportation —I Name: Browning, Maurice Mack JR DL/ID: 323AP2386 (IA) Oct. 3. 2018 9:42AM 10101/2018 11:51 Yellow Cab Iam Div of Criminal Investigation r L ) No. 6592 P. 1/3 OtAX)319 338 2708 P.0021002 STATE OF IOWA Criminal History Record Check Request Porm To: lows Division of Criminal Inveatl'gation Support Operations Bureau, 1`.loor 21S & 7'" Street r Des Molnes, Iowa 50319 . (515) 725.6066` ' (515) 725-6080 Fax e DCl Aocount Number: 9967.E (If ePPlloabia) Brom; Yellow Cab of Iowa City P,0. Box 428 Iowa Cita, IA--5-22-44- 019) AA52244 019) 338.8777 Phone: Pax: (319) 339.7302 N Vale�FetnAle3 z i- 906 rr ..area anlarmatlon.' Without s signed ivalver from the subject of the rsg1te9% a compJgte crlm Nil histosyt record may not be releasable, per Code of lows, Chapter 692.2. For o e e erlminal his tory.record III(orm crbu al hts� re I� wsys Obtain a waiver si nature from the sub eef:orthe r uast Waiver Re1CaSe; I hereby give pamiseloa tbrthd'ebodaroquestin ofticiel to Condo —' invicedgidar,(DCI).•Anyedminelbblolrydamcon g asnIewacriminalblttoryMo,do5ooka+fdt'the sionofGlleubd eeming mo that it mehaained by the DCI may be Massed d Allowed by law. ' Waiver Slgnature•/39 o vr� A�YJLLILJµ. 6m ,vct use only) loc As of e searctu of the provided name end dale of birth reveal i No Iowa Criluinal Histaiy Reootd found with DCI �= ( `''tea r rn Iowa Critainal Iliptory'Record attached,'I)CI # DCI aidals DCI -77 (08/25/10)