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Home My WebLink About19-031L CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) _ IDENTIFICATION NO. ) Q — v FI L (Office Use Only) APPLIt; Ah FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Departrp�rt C��r must be made between 8 a.m. to 3 p.m., Monday — Friday) 1.��YYr��t1�� 4'eq' Failure to cb(d�h 7Xb required" information will result in denial of the application SL TCr First Middle 2. Address (REQUIRED) L47606 6 M a j Pf Qy S fir 5 z Z U 0 3. Contact Information (REQUIRED) Email: (a hw✓c' i Blood 2*', A Anai I -Cc- Cell Phone: 3115368967 (All writteeL'"I n communication tent via email) 4a. Driver's License expiration date (REQUIRED) J/S/1 b. Taxicab Business Name (REQUIRED) Y P l I o'w fc � _L8: -C. 5. Prior experience in transportation of passengers: (.ICCIPP f'c P Voll dw 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Y0 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Y P 5 fo G What happened to the charge? (Circle one) W here When Convicted Dismissed Deferred Suspendedlead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? lyn 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) FAUL FUK aYre APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL IMVE'LI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW APR 0 5103 You must apply for an individual Department of Criminal Investigation Report (form available upon request). City Clerk Iowa City, Iowa I herebx rM that Ihave issued to me by the Iowa D partment of Transpo tin a valid Drivers license number I �- (' 1 issued on 1115 1 1 expiring on �/ 5/ I I . I understand that if I false) 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 Ttle 1, Chapterr24 of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant '�C j "" " — Date I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by 9 �sA "� G. on this J Al. day of in of 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 Chief or 97 OZ -0 e- Z `/- S -/1 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. DA Office Use Only Approved application DCI report State certified driving record Website update Date ae ff IDRNSADGEAPPL.9201Bart� DOC o4n018 031M:. 20 20193:�3:,08P�oob DCI IOWA ffal4sta33s No. 1023 P. 1/2Lo02 STA'T'E OF IOWN 0 5 2019 Criminal History Recor&t'��C'�� . Request Vormwa y, owes ;1 To: Iowa Division of Criminal'Invest(gation Support Operations Bureau, I` Aoor 215 E. 74' Srreet bes Moltres, Iowa 50319 (515) 725.6066 - (515) 725-6080 Fax " LI am IeclU8stm2 an Iowa Criminsl ii{eYneu,!`tie.,4 ..... DCI A000uat Number: 9967-F T (if Opp119616) Prom: Yellow Cab of Iowa City P.O. Box 428 - "-- %Wes City, U: $2244 (319) 338-9777 _ Phone; Farr (319)339-7302 Last Name (mama karst Name (mandntaryj Middle Name yeeommendod) S er �i1 aTCt'� ?. �w 5 -Vin Date of Birth (mudetor) Gender (meodeory) 'SoOal-Secuft Number jmeoommdzdy %IBI�O �QMale ❑Female : L4 Waiver Information: without a signed Waiver from the subjee; of the request, a complete criminal history record cosy not be releasable, per Code of Iowa, Chapter 692.2. For comnlete criminal history recent Infornwion', as allowed by law, always obtain a waiver signature from the'fub tot`iolthe Muest. WQYY6r ANCleaSB; 1 noraby give permission Ibr th6 fbovc mclOc9 ag otaelal to conduct an Town. cdmihal 6irlug tword ohook with the Division of Crimiael lnvc61i6uon WTI Any aiminat biswq dam oonmmfng me that is mance t DCI m esed as allowed by law. Waiver Signatures_ Check As of .j0161 y a search of the provided name and date of birth revealed: No Iowa Criminal $istoiy Record found witb ACI ❑ Iowa Criminal History I'ecord attached,•DCI # DCI iditiala_ i DCI -77 (08/25110) t 1 Received Time Mar. 15. 2019.10:20AM No.0248; (DCt one only) v c � Oa m o z a„ `o b z Mar.20.2019 3:08PM DCI IOWA No. 1023 P. 2/2 APR 0 5 1019 DISCLAIMER City Clerk This response can only include public criminal hlsto"p4 ,Wer 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 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). r rr.=. r a QJ10WAD0T APR 051019 City Clerk SMARTER 151Ai1'LER I CUSTOMER DRIVEN wv1i9ftftdou Drivsr a fdentifieation Ssrv"s PO f5cx 926s I Des Moines. IA 57366-9204 Phone 515417-9124 Fax 51 f.239-1837 Certified Abstract of Driving Record Inquiry Date: 3/15/2019 DL/ID #: 961AA1261(IA) Customer #: 5145452 Name: Shaffer, Dustin Class: C ID Status: None Glenn Address: 4760 MAIER AVE Audit #: 2817688 DL Status: VAL SW Issue Date: 05/18/2018 CDL Status: None City/State: IOWA CIN,. IA Expiration Date: 02/08/2024 CDL Cert Status: Excepted Intrastate 522408416 Endorsements: NONE CDL Med Status: None Mailing Address: 4760 MAIER AVE Restrictions: NONE Restriction None SW Supplement: Date of Birth: 02/08/1990 Mailing IOWA CITY, IA Sex: M City/State: 522408416 History Information Convictions Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Shaffer, Dustin Glenn DL/ID: 961AA1261 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: Shaffer, Dustin Glenn DL/ID: 961AA1261 FILE® 3/15/2019 APR 0 5 2019 Driver & Identification Services Iowa Department of Transporation