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Home My WebLink About19-01641 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)3S6-SO40 (319) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. (Office UseOnly)_ 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 First as I« 6ekv II Middle W. � 141h 2. Address (REQUIRED) Zrii LL C 7)"e2 nii,'e. 3. Contact Information (REQUIRED) Email: �-L F, -e ;-i, h c 1 Cell Phone: (All wn en communication sent via email) 4a. Driver's License expiration date (REQUIRED) \ / 1 I ( L b. Taxicab Business Name (REQUIRED) 7 P �� pw_ CA 5. Prior experience in transportation of passengers: M 0 In -e- 6. 2 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? (n 0 Type 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? h o Type of offense Where When J 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? M U 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) V0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 J 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 herebyy certify that I have issued to me by the Iowa D pa m nt of Transportation valid Driver's license number �I (fl S Z z 3'9-13 issued on i S td- expiring on 3 I 1-3 1 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 provisiompf Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant /&, L'.' � Date f L'1 / ) #1#If1N#'#111111f##H1f1f#Y!f#'#1ff1f4NH1#Y-I'!f!f#Yffl1N#M#f11fl1fYf1f11fffff 11HH1f! H1Hltlf#YlNf44 STATE OF IOWA ) COUNTY OF JOHNSON ) �Wbscribedl and sworn to before me by T(Ns)-ve— on this day of 2 \ .v P lic in and for the State o Iowa 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 90veeollicense 6-7-31 - Z 3 i� UZZ7-1j Sign re of Police 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. Signiature of City Clerk esignee Date fll14N#H4#1fHNH1HHHHH11fl1ffNl44N 4###111!1!!f!!!114N44NHH#HH1NHffN44f#4y#f#NHflIHNN#H#H144#H11H1HHfN1 Office Use Only Approved application DCI report State certified driving record Website update OwkRMIMN6ADGEAP 92018aniended.000 04/2018 •Feb.25.2019 4:33PM DCI IOWA 0211912019 14:09 Yellow Cab MU Of 10WA Cr minalHistay, Record' Check .. Requost FOrM rfl: Iosa� D'`i kislau.�f S37minal;rm.estfgafion. �aPPq?':��!{EEaitmpa$iireaiy.:I"Floor . �ix87" street 1,1�iC'i'aiaaoy:Iot� 5e3f9 . f�#5j �ii�:5osY1 xlkxx. I em reauratsbmenimm crbnind EPhbdm 1Teeonfl C1g1kart-. . No. 6612 Y. 1/1 ffAX)3193382708 P.0021002 bQ.AcaountNmnber. (if appliaalila) Fromm Qaf ;0fxo va.C4 rr1.. Box 429 Iowa City, rix. 52 144 (319) 30-0.77 I'hque: Pint (3d ).3.39-�30'>7r L•• ast, .. �]ne' {,.noMro : ; . . ' :., '• .:� �::, ':. a�r�11' sQi .d;l;,.... ; ...'. ... , :]�Tdl��dj�tie (cecorimaonaoll.' Pat Ui7 .' •' Oe '..` .' '.:•:. .Gender To ry. '.:.,.. •. ;."..r: 1." GI,fl��'%ef,Y[[i li1II k •oomondod .gle t�h�emalo C(J 7 —70 6 �. -. •. •lli9[nry!'rececti-.ul5y aot Waiver3lifri»frati73its 1Ilh ill: sa>�ie� 1alyMtr p7SY RL'b'a1eG� pfta':l ¢rl�R=1:M1xdmpirrQml»el be releasable, per Codve't Iowa; Cb4igk.,697 z; For a em lata crBmSnal Motoryreaan ^I gd6 nt9tloq' {s allowed hp je uui aPways A6iaf " wai' ir°sm'ihe ' fef ttie nrst. ": K'9�P.?�'A4�e; I.b9�1tY�irs P,amtidj�nroclhedage'X44¢/ungul�Cwl;rcrrmduU,an•1'owayrimiooFBivaryYecorAchealcwRhahr YhbJhba.ofCrlminel imas6pAtion DE77•MY4r etX4ntidotlt4mfhjat: IY��MtdMed•6ythe nctmayb;Al*9i4 uowediy kw..' ' 1�'alii>1ri SiaaaiiG'es JKCC&rn L4&C[ft tCESlIILS. pcuse only) Asof �5 I ,:asChs itl.flsaproY�dC&nai C dt teo ill�tregealeci: STATEOFIOWAJDPS FEB 19 2019 NQ Iowa, C4ming Mstory Record fo=d with DCI DI Y OF CRIMINAL INVEST ❑ Iowa.t)9mfp4 iN'fbi�. .Record %mclied, }ACX #• DCI WtWs =147 (005/10� Rerrivad Timer Frh 19, 9014 9-04PM Nn.5F90 Feb.25.2019 4:33PM DCI IOWA No.6672 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 he 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: httn://www.iowasexoffender.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 confldential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). �J1OWADOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN 9 Driver d asndfieaowt Barrios PO Box 9204 1 Des Mones. LA 50306-92D4 Phone: 515.244-91241 Fax 515.239-1637 Certified Abstract of Driving Record Inquiry Date: 2/27/2019 DL/ID #: 965ZZ3973 (IA) CDL Permit Class: None Customer #: 3269414 Class: C CDL Permit Issue None Date: Name: Maske, Gary William Audit #: 2635566 CDL Permit None Expiration Date: Address: 2922 C Ave Issue Date: 03/15/2018 CDL Permit None Endorsements: Expiration Date: 07/31/2023 CDL Permit None Restrictions: City/State: Deep River, IA 522228011 Endorsements: NONE ID Status: None Mailing 2922 C Ave Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing Deep River, IA 522228011 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 7/31/1953 CDL Cert Status: None Sex: M CDL Med Status: None History Information Accidents - Accident Involvement Indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 06/20/2016 IA 932708 ct v: o Name: Maske, Gary William DL/ID: 965ZZ3973 (IA) -:-7 �.3 Pursuant to Iowa Code 4321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do herebq rtify that I am the custodian of the records held by Driver & Identification Services, that this Is a true and accurate copy of an official recor�rrently 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, lowarthIs date: 7D I Name: Maske, Gary William DL/ID: 965ZZ3973 (IA) 2/27/2019 Dria��tifica[lon Services Iowa Department of Transportation