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HomeMy WebLinkAbout19-024� l t CITY IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19)1 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. ) q — (tea Ll (Office Use Only) P, y" ION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police epartment 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 ih It !D dcL First u •. 3. Contact Information (REQUIRED) Email:yJh rtx 10%Ir1 442'S 6� �O-AOC7 Cell Phone: 3/q: 5 75- 2147 c/ (All writte mmunication se is email) 4a. Drivers License expiration date (REQt b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Al J 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? YcS Type of offense Where When J(]eQr�r nS` ToA,5cb9 .rA ib/,2 41201-6- edcw 7-A T What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? �� S Tvce of offense/ Where When S�aeLJA2 (A0A) ut40(Irme (owa 10�/ (? 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0 (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 certify that I have issued to me by the Iowa D pa ment of Transportati n a valid Driver's license number IS 4 7 issued on 0 5(i -7 17 expiring on J 2 1 understand that if I falsely answer any questions in this application, that this application may be denied. I tgree 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 (ll Date '� 2 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swo n to before me by _J o)A1,\ LAA_A,� on this ol 'J— day of {Vln 6-� WENDY s. MAYER Notary Public in an or the State of I a My c EXgree 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 dateof er's i nse �y- Z 3 ZG23 �3C ii Sig a 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. Office Use Only Approved application DCI report State certified driving record Website update 0erWTAX1DR1VBADGEAPPL92018amMW DOC MAR 2 0,, 2019 0412018 CA 00" 1 gJkuvv,kD0T SMARTER I SIMPLER 1 CUSTOMER DRIVEN b1tiVW.IOW8dCl1.gOV Driver L IdeatrOcation Services PO tical 93341 Des 61CIrM IA 53306.9264 Phom 5IS411-91241Fa[ 51'--72k9-1&17 Certified Abstract of Driving Record Inquiry Date: 3/12/2019 DL/ID #: 897AL9826(IA) Customer #: 6335434 Name: White, John Class: c ID Status: None Address: 2510 BARTELT RD Audit #: 1686659 DL Status: VAL APT 2D Issue Date: 03/17/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 04/23/2023 CDL Cert Status: None 522462716 Endorsements: NONE CDL Med Status: None Mailing Address: 2510 BARTELT RD Restrictions: Corrective Lenses Restriction None APT 2D Supplement: Date of Birth: 04/23/1970 MailingIOWA CITY, IA Sex: M City/State: 522462716 History Information Convictions Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 10/10/2016 03Ill D53 Non -Payment of IA IA Iowa Fine Name: White, John DL/ID: 897AL9826 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: I MAR 2 F 7019 Name: White, John DL/ID: 897AL9826 3/12/2019 C� Driver & Identification Services Iowa Department of Transporation A.«t�j - FILE® MAR 2 6 2019 City Clerk Iowa City, Iowa I rviar. Ib. ZU19 4:ZtiPM UCI IOWA 0311212019 15:15 Yelow Can No. 0588 ffAX)3193307708 STATE ON IOWA C>imbaal History Record Check. Request Form To: Iowa Division of Criminal investigation Support Operations Bureau, I" Floor 215 & 7`a street Des Moiues, Iowa 50319 (515)725-6066 (515)725.6080 Fax •t. I am T"Uestina: an Iowa Criminal Hictnrv1 PPftrri f h 4 DCI Account Number; P. 1 P.002f002 From: Yellow Cab oflowa P.O. Boz 428 Phone: Fax: (319) 339-7302 Last Name (n-w irst Name (m.ndal Middle Name oaaom;3U I• Date of Birth. dam Gender (mandatory) 7Social Security Numb[eX mTmmmded) 0� a3 /Q70_. IJativlale OFemale - I J 0270- b & --i 5L/fI Waiver XnfOrmaYfon: Without a signed waiver from the subject of the request, a complete prlmiita] history r'eeord may not be releasable per Coda of Iowa; Chapter 692.2. For complete criminal history -record information, &4 allowed by ]aw, always obtain a waiver si atu re from th6 nub ecti6f there ueat j Waiver .R6icase: l hereby Sive permission mrtho:pbove requanihi ot6aiai m mnduot m Iowa arimmal hhtory reeerd duek wldt the Divis'!= of Cmmin.l Investigation(DCI). Any alMlM)bistorydata nen '' mothathml edbbydie�Del may Mm)c daiauowd!bylaw. ` Waiver Signafur®; DCI -77 (08/25/10) n....... s r:_. u_.. rn 911t11 0. IAea1 a., nt: An Io)%a Criminal Hisior Record Check Results nee only) As of a seare)a of the provided name and date of birth, revealed: © y cin y m No Iowa Criminal History Record found with ACTCn z w Iowa Caaminal History record attaohed, DCI 9 p d ))Cl iiaitiAls MAR 2 0 7.019 DCI -77 (08/25/10) n....... s r:_. u_.. rn 911t11 0. IAea1 a., nt: An , mar. id. LUIY 4:26m UCI IOWA No. 0588 P. 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 Isnot 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://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 confidential juvenile records, If any, an application must be filed pursuant to Iowa Code section 232.147(18). MAR 2 0 2019 C-,; Clerk Iowa City, Iowa