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HomeMy WebLinkAbout19-015���III1•Jlp� CITY F IOWA CITY 4 10 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 3S6-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. 'q 0 (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 fr First Middle 2. Address (REQUIRED) -7, vN 7�k1l6y j y S4- A-7 -ac- 3. aC3. Contact Information (REQUIRED) Email: I • wJ 6. rry n Cell Phone: 3i9 3 31 8'7 3(p (All written com nicd ion sent via email) 4a. Driver's License expiration date (REQUIRED) ;)- 1 /-5 /o10vi b. Taxicab Business Name (REQUIRED) y -e 1lht.l C a 'IF 5. Prior experience in transportation of passengers: M G r & r) `5 (it I CA -16 I _ • - - - 11 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? �ss Type of offense Where When What happened to the charge? Circle one) Convicte Dismissed Deferred Suspended ead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? 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?__ Tvce 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) .I�- 04/2018 r 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 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number 35 q /-t 69 y , issued on t-) I -U 115 expiring on 2 r5/ to >� . 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date_�� •++�»Hti:���a��e�+ire+rka�at�+H��ew�tweWwtshe:��rt�Nm+tee++eta+:+r�+ey���,eya��+e�a��ere�N+e�r�i���:a�»�rxt+.ewe�r�+x��Heew*ar�� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by I) ic,u. lie i� on thisday of 7%clar rvr,. 1.-vq. eS) 0•'4` { WENDY S. tlAAYER commiawn Nwrim 729428 Notary Publid in and for the S( a of to a - 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 Driver's license /� tu� / Signa a Chief or designee 2x�.11 '�F I 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 GerkfTMDRNfl GEAPPL92018amentled.DOC 04/20 ' 21.2119 2:12PY Dcl :OWA 0211AM19 1426 Yellow Gab STATE C [OWA CrinthalTrisioiy'Recoed Check Request Farm To: Iowa DhUlou of Crlminxllnvesti0atim Support Qperw{iguslbnreau. l" Flo o r =5 L 7° Strad Uro K6166, tdwa 50319 {sts} ..+6a5k (515) "$-Qs0 Fax 1 ata reaucsttn`e as lowwft4rniiul Pisinn kaedyA CP" -k An T-ilM193482708 P.0031003 DCI Aeceunt.I.rumbcx: _9967 -F --- ,if ,if epl togs) Prom; 1fcUowCab oftawaOty R.O. Doi 428 ow i City, iA $22" (319} 338-477'1" Fart (319)339.7302 Llst'Nlameiv x?SrsCTCainst �_. hClddleNanicrsoaa«maod.a� ;'Date Of-Mi2httara4,,o,* Cenda' SacialSoarti '?raasber ec. :;1 ~% It QFrmale Waber-110{p J}lptIOf, Si aldfp 4; svt"M*' ivorfromtJkrsu(ifecfofthaxsqWgJrzin*l historyrecnidmayVat 6ereltnssblt pit Coda of lbwai'Ckaptar 5911: For c m ete criminsl bdstus,Y rscord ioforaiad=o ,as allowed by54w, u+�sys oiiwinswv ratoMt-omthesobiteofthe req„ert; iYcl�ttRe#erttei�cetsRern�tss;sr:gw�tr#a'4aiwnoeo;tscw•rp+nm(��� yWoRip';OR M�, A.wd"Aaiia'my rua concwniea lix Via! liked by An OLITM. (a1►wad c'r ,pd .b i�atDa z'3tgrra uYa _. laina7 bstory Regord•, Chea, Ras 09 � toctusluty) u As of a aseareitof the pxavidri r nuc and date ofblrth rolatod < rn O y © No Iowa CrimhtaINLRTory Remrd fb d wflh DCI p .r -n IZI Iowa Czimlim Vistory Recwd aaach4 DCl.W C„a ] l C) o DCI -47 (f78P2511{a) P... ;v,4 Tim. %. 11 WO 1'99PiA NA d71A' >:.22. 2119 2: QPM 6C; ;CW4 IOWA CRIMINAL HISTORY M79DXMEANOR CONVICTIONS ONLY DCI.00622510 NAME: eARRY,WTI,LIAM DEXTER DOB SEX RAC HGT WGT CYB 19670215 M N 509 220 DRO ADDITIONAL IDENTIFIERS CCH RECORD A -- DCI 00622510 vA13E IOF ' DATE PRINT'ED- 2019/02/22 HAIR SRN DOB BRO MED MD 01 ARRESTED/TAEXN INTO CUSTODY 20000612 AGSIICY' 1AD520000 JOHNSON CO 50 CHARGE NO- O1 IA STATUTE LA321J-2 OWI TRRl1: 042151601 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO. 01 IA STATUTE: IA321J.2(A) OPER VCR WH INC (OWI) / 8ER WISD / IST OFF - CRARGE CLASS: MISDEMEANOR CONVICTION TRRd: 0421574DI SEvrTMME DISE EFF DAT JAIL 2D 20000720 ATT DDS GA EVAL PINE $500 20000720 Ari 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 butcan only be released to nan-law enforcement agencies by the DCI. 4c, 64013 7hie response can only include public criminal history data. Under Iowa :aw, met juvenile records are confidential. Confidential juvenile court records, If any, cannot be included in thin response. A signed release authorization is not sufficient to obtain this infortnation from the Division of Criminal Investigation. In order to request Cha release of confidential juvenile records, if any, an application muec be filed pursuant to Iowa Code section 232.147;16). Additionally, criminal history data concerning conviction* for certain juvenile sex o:fensee can be found or. the Iowa Sex Offender Registry: http://www. iowasexof fender com../ . Howaver, even though some information is available on this nice, the actual records for juveniles may st_ll 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 Codo eeCtion 232.147(ia). IN THE ABSENCE of FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD TS ^, _ BASED ON :NFORYRTION FURNISHED. WE CANNOT CONFIRX OR DBNY ':NAT :'HE RECORC COVSRS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL IKVESTIC-ATIC14 —71 0401 A DOT SMARTER 1 SIMPLER I CUSTOMER DRIVEN Wi^/i^'i0wadogov D" & Idenuftation Services PO Box 9201 I Des Milnes, IA 5030E -92W Phone 515-244-9124 Fax 515-2391837 Certified Abstract of Driving Record Inquiry Date: 2/14/2019 DL/ID #: 435AA6946(IA) Customer #: 3350447 Name: Barry, William Class: D ID Status: EXP Dexter Address: 720 N DUBUQUE ST Audit #: 9658988 DL Status: VAL APT 7 Issue Date: 12/22/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/15/2022 CDL Cert Status: None 522451925 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 720 N DUBUQUE ST Restrictions: Corrective Lenses Restriction None APT 7 Supplement: Date of Birth: 02/15/1967 Mailing IOWA CITY, IA Sex: M City/State: 522451925 History Information Convictions Citation Date Conviction Date ACD Explanation Coun ]UR^ 07/27/2018 08/12/2018 S92 Speed (10 mph & Linn — IA �@ under in 35-55 mph zone) Name: Barry, William Dexter DL/ID: 435AA6946 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: Barry, William Dexter DL/ID: 43SAA6946 2/14/2019 Driver & Identification Services Iowa Department of Transporation