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Home My WebLink About19-071.. CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 3S6-5497 FAX IDENTIFICATION NO APPLICATION FOR TAXICAB / MOTORIZED I (Police Department review must be made between 8 Last First ,1a- LD -1 (Office Use Only) rn VE!ItICLCDRIVER p.esn, Mo day —Friday) — 0 Middle 1. Name (REQUIRED) UA-szY -pa"', A 2. Address (REQUIRED) '1�\ 3. Contact Information (REQUIRED) Email cI Y.W 3l t0(�:1. VAe, CO NI J Cell Phone: 1-kIIII (AII written communication sent via email) 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) t el uo t^ au 5. Prior experience in transportation of passengers: 2'4— 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? — What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Gul Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? lA n Type of offense What happened to the charge? (Circle one) Where When 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? 4:0 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) PAGE 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 ep ment of Trans portat' n a valid Dr's s license number 4$$ L L OO q2 issued on expiring on �- . understand that if I falsely answer any questions in this application, that this app icet on may be denied. I ree that mag this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to expLrke_' ar-Zand all+ecords and documents relating to this application, and I further agree that, if authorization to be a taxicab drivers granted, fo'comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in frant-of e,Notar"gblic) Signature of Applicant Date 'I 2'i t — NINNRNNNN11ffI}11NNf ilfflNfNf flN1fNN1N1Nf ff f1N1NNNNtN4NN4NN1NtkfNfNNN1ff f1f f 1f}#k�tfif-ffflffflNNNftNiNlNff-I STATE OF IOWA ) COUNTY OF JOHNSON ) Su scrib and sworn to before me by J)tW rQ �. Sty on this day of _ „,V -inin 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 resk dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of 'v ' li Chief or designee g 1-(26- Zoz7 G9-1 y-/7 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. or Office Use Only Approved application DCI report State certified driving record Website update Date Oe*Nn iDRIVBa GenPPi9201e .ma ,DOC 04/2018 '�JIOWA DOT wwW.ioWedntgov Inquiry Date: Name: Address: Clty/State: Mailing Address: Mailing city/state: Convictions SMARTER I SIMPLER I CUSTOMER DRIVEN Conviction Date ACD Explanation iCounty Drlvef 8 ldsetiikatkn satvRes 12/21/2012 06/24/2013 PO Box 92041 Des IAoines. IA 503064M Operating While Intoxicated Johnson Phone. 515-244.9124 1 Fax 515.239-I,M IA rc� rn ...�_d Certified Abstract of Driving Record > c> N �— t 9/5/2019 DL/ID #: 488LL0092 (IA) Customer #: ern -4846052 T , 1 Wilson, David Keith Class: C ID Status: 1TVAL 1 468 Peterson St Audit #: 3562151 DL Status:IAL_ Issue Date: 01/23/2019 CDL Status: Non;' Iowa City, IA Expiration Date: 01/06/2027 CDL Cert Status: NonEr 522455147 Endorsements: NONE CDL Med Status: None 468 Peterson St Restrictions: NONE Restriction None Supplement: Date of Birth: 01/06/1977 Iowa City IA 522455147 Sex: M History Information Citation Date Conviction Date ACD Explanation iCounty JUR 12/21/2012 06/24/2013 A20 Operating While Intoxicated Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Ex lanatlon JUR lCounty 112/21/2012 A98 OWI Test Failure IA Johnson Sanctions Type Effective EndACD Explanation Occurrence JUR JUR Revoked 102/12/2013 108/10/2013 A98 I OWI Test Failure IA IA Name: Wilson, David Keith DL/ID: 488LL0092 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: Wilson, David Keith DL/ID: 488LL0092 9/5/2019 Driver & Identification Services Iowa Department of Transporation N O_ C n w0 rn r- rn M o: *x sQ - ay)Syp. 12.2019 11,00ACab DCI IOWA ffX03183380w8892 .4 STATE OF IOWA COminal History Record. Check. Request Form J To: Iowa Division orCrlmival 1nVesoption Support Operations liurestl, 1" boor 215 F, 7n Street Des Moines, Iowa 50319 (315) 725.6066 • . (515) 725-6080 Pax �• i . I am requesting an Iowa Criminal History Record Check on! N.. ;./42!002 ACI Account Number: —996`7'-F ' itfepplil7abtc) �. From: Yellow Cab of wm Oiiy P,O. Box 428 Iowa City, IA. --=44 (319)338-9777 — Phone: Fax. (319)3S9-7301 La®t NaMe nwtlate ' 'First Name maadamey) ' Middle Name treoommend Date of Birth (solwaroty) +Gender (lo odemry) �rSocijdSwurlty N=bsK ooeataNeoded) 01nt�f 19� << I,�MaIe ❑Remale y8 �qy- 1bi Waiver Alor Mahon. Without a signed Waiver fro:c the sub)eet of the request, a complete erlminal history record Lazy not be releasable, per Code of Iowa, Chipter 6?2.2. For complete criminal historygecoro furorm4lion. ss allawed by law, Always obtain a Waiver SignatUre from the sub ect df the request Waiver XZE.IeasC: I hereby give permissiou forthc� strove requestingaMehl to eendm m Iowa criminal hiatoty tswtd oheok whh the Dlvblon of CrlmIml InvcatlsiAosl NG.), Any cilminal h)stmy den wnoamirig me shot is maintained by dw DCl may be =) tsad as allowed by taw. Waiver $lgnature:.� As of –b' I ��' a searizIrof the provided name and date of bft,revealad: . No Iowa Criminal Histo y R=ord found with DCT Iowa CriMinal Hisioty Record atta.0h4'DiCT # I)CI initiab DCI -77 (06/25110) Received Time Sep, 5. 2019' 2:44PM No.7890 a;11' 5ep.12.'019 11:00AM Hl IOWA No. 8892 P. 2/4 IOWA CRIMINAL HISTORY DCI 00968499 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2019/09/12 DCI:00968499 NAME: WILSON,DAVID KEITH DOB SEX RAC HOT NGT EYE HAIR SKN POB 19770106 M W 509 155 BLU BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC ARM SC L WRIST 0 .o CCH RECORD 01 ARRESTED/TAKEN INTO CUSTODY 20121028 t")� AGENCY; IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA124.401(5) rn POSSESSION OF A CONTROLLED SUBSTANCE z< O 7D 2y, 3 TRK#; 5AOOIFG01'x .. COURT DISPOSITION .�.. AGENCY; IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06571 SRCR100990 CHARGE CLASS: NON CONVICTION TRK#: 5AOOIFG01 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT lY 20130131 PROBATION lY 20130131 DISCHARGED FROM 20141020 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20130125 ` AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- Ol IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF TRK#: 1A0001701; COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(2)(A) OPERATING WHILE UNDER THE INFLUENCE 1ST OFFENSE COURT CASE ID: 06521 OWCR100678 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IAOOG1701 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 2D 20130624 FINE $1250 20130624 03 ARRESTED/TAKEN INTO CUSTODY 20130201 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA708.2A(2)(A) Jep.12.1019 11:01AM RI IOWA DCI 00968499 PAGE 2 OF 3 DOMESTIC ABUSE ASSAULT TRX#: NK001YE01 COURT DISPOSITION COUNT NO- 01 IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: 09921 SMSM040208 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: NXOOlY501 SENTENCE DISP EFF DAT FINE $65 20130219 04 ARRESTED/TAKEN INTO. CUSTODY 20140401 No. 8891 1. 3/4 AGENCY: IA0920000 WASHINGTON CO SO CHARGE NO- 01 IA STATUTE IA708.2A(3)(B) DOMESTIC ABUSE ASSAULT - 2ND OFFENSE N TRK#: NK002DR01' o COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT n N �.•,,, COUNT NO- 01 IA STATUTE: iA708.2(6) �I-y ASSAULT ;Cm a m COURT CASE ID: 06921 AGIN010038 CHARGE CLASS: MISDEMEANOR CONVICTION y •• TRK#: NK002DR01 _ SENTENCE DISP EFF DAT JAIL 30D 20140902 FINE $100 20140902 PROBATION lY 20140902 TO OUTREACH 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. Sep• 12. 2019 11:01AM DCI IOWA No. 8892 P. 4/4 ri his response can only include public criminal history data. Under Iowa law, ost juvenile records are confidential. Confidential juvenile court records, f any, cannot be included in this response. A signed release authorization s not sufficient to obtain this information from the Division of Criminal nvestigation, In order to request the release of confidential juvenile ecords, if any, an application must be filed pursuant to Iowa Code section 32.197(18)• Additionally, criminal history data concerning convictions for certain 11 a-6uX=3CF.f;M1d http://www.iowaSeXoffender.com/ . However, even though 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). N O IN THE ABSENCE OF FINQERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS c .:c BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION � n .� o ---s _ Y