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Home My WebLink About19-026IDENTIFICATION NO. I I— I' Z Lc 1 l 1 (Office Use Only) � air, APPLICATION 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 (3 19) 356-5040 (319) 356-5497 FAX First Middle Last f 1. Name (REQUIRED) PU ' 4c -,j C4/9't e 2. Address (REQUIRED) So I IU /)e yuc Sc 4o7e Twee la S7 > i5' 3. Contact Information (REQUIRED) Email Cell Phone: 3/7 - ciao $ 85 / (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /-/-- 21-1 ZG L5 b. Taxicab Business Name (REQUIRED) 7c l/ou/ Csh off- 1c.✓4 C'/t' a,r 5. Prior experience in transportation of passengers: 7 �i� S on >tl� o c4 MAR 2 81019 City Clerk 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere) , Iowa 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? /V C) 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? ��cJ 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) 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 357JC1C c issued on 3-;0-17 expiring on q?Y-76 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) IE' Signature of Applicant�� Date 3—Zo-- / + i L L MAR 2 81019 City Clerk f1111*'***f11f1f*f#*##111fH1f*#*##fflfifllf#yi:##f#lffflfYR#1etYfllff*f***#ffHllfif#R##ffllffffyt###1ef#fflflf*H#f STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by � cr.r.�e r v •. L �J �. r �o �-� on this day of of Iowa I13 �o 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 D ' er' rise 6r 7 -47 C ignature df 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 aetkRN(IDRIVBADGEAPPL92018amended.DOC Date 0412018 Mar.19.2019 3:39PM DCI IOWA 0311412018 07:56 Yellow Cab No. 0821 fAX)319 336 27M ri STATE OF IOWA Criminal History Record Check Request Porm 14. c To: lows Division of Crllnina,t lnyesaght o"MAR 2 8 2019 Support Operatlow Bureau, I" floor. 2151? 7'a Street cloy Clerk Dcs.Moines, Iowa 50319 �, Iowa City, Iowa (515) 729-6066 (SM) 729-6080 Fax I am roouestirm an Iowa Criminal T4isMry �Rennrrl rl,wrlr ^A - P. 1/4 P.002f002 DCI Account Number, _9967-F - (irappliaable) Itrom1 Yallow Cab of Iowa City. P.O. Box 428 Iowa City, IA. 52244 (319) 338-9717 Phalle: Fax: (319)339-7302 Last Name m►ndato First Name roandatwy) Middle Name (r mmenEec pa 4 birth As of 3- I a search of the provided name and date of revealed: m. Date of Birth (mandatory) �Orender I—A—A Social•Securi, Number rooem andad) 0 D Dm Q �� y� �� .,. �bIale ❑Female [/ ,/ �✓/ •%'�� y%q.6 Waiver Information: With a elgned .Sbalver from the subject of the request, a complotte Orlmlaal history record gray not be releasable, per Code of lows, Chapter 69.2,2, For colgiplgt eritnival historyrecord information, erg allowed by law, always obtain a waiver signature from the sub ectlpf the re nest. Waiver Release:I hereby give vamission for the above roghntung official to conduct as lows criminal hltroty recout check with the Divita" of Clinical Ihvudihdan (DCI)• Any criminal binDry data nenea•'nin3 mo that is maintained by tho DCI may be Ma"od w anowca by law. Cower Criminal History Record attached, DCI # WaiverSignafuret 103Lurl njnai I3lstory Kecorg !; em xesuits (QCi uae only) ve pa 4 birth As of 3- I a search of the provided name and date of revealed: m. D 0 D Dm Q ❑ No Iowa Criminal Histo y Record found with DCI E r' -n z � o � Cower Criminal History Record attached, DCI # < ' y � DCI initial5,�_ DCI -77 (08/25110) . Mar.19.2019 3:40PM DCI IOWA IOWA CRIMINAL HISTORY DCI 00462290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2019/03/19 DCI:00482290 NAME: BURTON, CAMERON LEE DOB SEX RAC HGT WGT EYE HAIR SRN POB 19760424 M W 509 175 BLU BRO FAR IA ADDITIONAL IDENTIFIERS DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No.0821 P. 2/4 CCH RECORD *** 01 ARRESTED/TAEEN INTO CUSTODY 19940704 AGENCY: XAO520100 CORALVILLE PD CHARGE NO— 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK#e 007541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO— 01 IA STATUTE IA321J-2 OWI TRK#: 012452301 COURT DISPOSITION AGENCY! IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA321J.2 OPER VER WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 92NTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE SOH JAIL 5D REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 02 IA STATUTE: IA321-218-2 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED/TAKEN INTO CUSTODY 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 No.0821 P. 2/4 Mar.19.2019 3:40PM DCI IOWA No. 0821 P. 3/4 CHARGE NO- 01 OWI 2ND OFFENSE TRK#: 500346901 COURT DISPOSITION AGENCY: IA057015J COUNT NO- 01 IA STATUTE IA321J-2-2-B LINN CO DIST COURT IA STATUTE: IA321J-2B ORT 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE PLEAD GUILTY JAIL 7D FINE $1500 COURT COSTS 04 ARRESTED/TAKEN INTO CUSTODY 20000701 AGENCY: IA0700000 POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 000328701 COURT DISPOSITION AGENCY: IA078015J POTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 800328701 SENTENCE PLEAD GUILTY JAIL 2D DCT 00482290 PAGE 2 OF 3 DISP EFF DAT 19990825 19990625 19990825 19990625 DISP EFF DAT 20000703 20000703 An 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 but can only be released to non -law enforcement agencies by the DCI. Mar. 19, 2019 3:40PM DCI IOWA No. 0821 P. 4/4 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 Co 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 232.197(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa sex Offender Registry: http://www.iowasexof fender. com/ . However, even Chough some information is available on this site, the actual records for juveniles 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). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR PENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION L210WADOT WWWOwadotgoy SMARTER I SIMPLER I CUSTOMER DRIVEN DrNw & Idw Al kation Ssrvka PO Bat 9204 I Des Moines. IA 50306.9201 Phone 515.244-91241 Fax 515.238.1&97 Certified Abstract of Driving Record Inquiry Date: 3/26/2019 DL/ID #: 359KK2073(IA) Customer #: 4698203 Name: Burton, Cameron Class: D ID Status: EXP Lee Address: 501 N DEVOE ST Audit #: 1711941 OL Status: VAL Issue Date: 03/30/2017 CDL Status: None City/State: LONE TREE, IA Expiration Date: 04/24/2025 CDL Cert Status: None 527559208 Endorsements: Chauffeur 3 CDL Med Status: None FILED Mailing Address: PO BOX 411 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 04/24/1976 MAR 2 8 2019 Mailing LONE TREE, IA Sex: M City/State: 527550411 City Clerk History Information Iowa City, Iokva Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 3UR 104/27/2016 1918183 IA Name: Burton, Cameron Lee DL/ID: 359KK2073 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: 3/26/2019 L/0./ Driver & Identification Services Iowa Iowa Department of Transporation