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Home My WebLink About19-078� r "Ale CITYF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) 3. Contact Information IF IDENTIFICATION NO. �? —t57 8 (Office Use Only) APPLICATION FOR TAXICAB / MOToiiazw-pikbICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) nu19r,j �q p Failure to complete the "required" iniormatitrrr'will ►sWt(th7denial of the application CitYCLI- { Last First '`� C(TY, i�',`.`: Middle 4a. Driver's License expiration date (REQUIRED) 6-- 9-.9 0120 b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa Cell Phone: 319 S$O 27 2 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? LUQ Tvce 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? /Vo 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? AIO Tvce 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF VCRIMINAL INVESTIGATION CERTIFIED G RECORD MUACCOMPANYST COMPANY THS R APPLICATION F POLIICE CHIEF DRIVING You must apply for an individual Department of Criminal Investigation Report (form a4al" A J request). LLJ pfj 3. 0% 1 h eb th t I have issued to me by the Iowa De astm nt of Transpo do a va'Y _ Dii 67 rise number �� issued on -tY ?expiring on ,. ,t understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in making thig 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 Applicanton1 02� Daterl d— 5 STATE OF IOWA ) COUNTY OF JOHNSON ) � +� Su.�O�b tribal andZC1� + I` V\sworn to before me by l � If � '(a "0. O v�2 on this S day of nrf ,rW�( ASHLEY A JAY-PLATZ Notary Public io a e StaWBf Iowa COFAF116906A 018. ?86980 owa My Commission Expires July 14 2020 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 Drivels Ijcense Ole 2C z O �c`" < Signature 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. or d signee \ Date Office Use Only Approved application DCI report State certified driving record Website update Gert✓TA%IORN64DCEAPPL92018..a etl.DOC 04/2018 • Oct. 14, 2019 5:04PM DCI IOWA 1010812019 10:51 Yellow Cab No.4054 P. 1/2 ffAll)319 338 2708 P.0021002 STATE OF IOWA Criminal History Record Check . Request.F'orm �= DCI Account Number 9967-F 1 (if appnoable) 1yW1 9S Pax oomnleted forms to: Send results to: Iowa Divlolon of Criminal Investigation Support Operatlom Bureau, la Floor 215 R. r Street Des Moines, Iowa 50319 (315)729-6066 (515)725-6080 Fax I am raousting on Iowa Criminal HisAtoryRecord Check on: Nama Yellow Cab or Iowa 011 Addross P.O. Box 428 fovea City, rows 52244 Pbone (319)33&-9777 Fax 3193594142 ek i.'si _ dim' ,- . . �F #idle' '��ed: �•, f1 lav1P Iev► YI '�-�:::,'Fs3'' i'i�ti�•Pr dY� .:mdedj G` V ([`m�nd�. � (�j �y /- M1 ale ❑Female ��•� nla�Wraa 1 u r�nr�Aa � ° MQ?Fomyerbo5�igt r tq�rscot 'may . , n , r' 4i f ,`1QR i P� lred if+�iAwr . �i•V- � �. �tr'�� [tee � '�.1J H., i'e��e y'��•}y.�•i't1� M u 1.� _�,,• �j�.'� SJG�t ...,k* _ �ii,}R,�y� �eH.•.1 � 'J.a''J1'�tC9.}�i�I� H� !O•iP�'Ya`+CH�i xWN. { JM1 10 {y i 3 P �;�perp ®�dYO �'p�fcE�`1SGY/66dN1�M9�j+e�PYd•b'' UaylllaB��iN�odd1): Ll, MA ��., •wfotina�Sru'��F�•S�rr'�,Bbz6�7R��& 8d1 8dg c;p��py},;escawyaTiyL�r�TSaddS[aeQliJ�cu laPdb �. �i��Pl� �"rl CP '� s �. ice' s ��.,y�� Y a� "�, ,�• "jig. '��,�`" � fs , ,u <` J i7+,a. �Y+�,r-f'_ fi•M1 •'"'i., sea', �c v.. e �. se oeiy) As of (� i s search of the provided name and date of birth revealed: c C, M n o ';m. No Iowa Criminal History Record found with DCI o ❑ Iowa Criminal History Record attached, DCI # < b 9"/"4 Z.�:ve 71, L1'fn ACT initials 4,,,,,,,,,,,,,,,,,,„:'z DCI -77 (updated 6-26-2018) Rereived Times Oct. R. 7019 10:41AM No. 9991 Page 1 of 2 •-Oct.14.2019 5:04PM DCI IOWA No. 4054 P. 2/2 DISCLAIMER k �-4) This response can only include public criminal history data. Under Iowa law, most..'- juvenile ost. Tjuvenile records are confidential. Confidential juvenile court records, If any, cannot bd?s p included in this response. A signed release authorization is not sufficient to obtain, thlf�,`,3,02 Information from the Division of Criminal Investigation. In order to request the releas;kW confidential juvenile records, if any, an application must be flied pursuant to Iowa Corfu lRtr section 232.147(18). Oily Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. httu://www.iowasexoffender.com/. However, even though some information is available on this site, the actual records forjuvenlles 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). 4 i1 y 01 ), OA'C4: 0 WA D 0 T SMARTER I SIMPLER G CUS-11 Driver aIdergo eation setvttes. P4 ft 9M I On Wrim !A 50 Phone: 1 Fe1X' 511 ,Wq6185 Certified Abstract of Driving Record Inquiry Date: 10/5/2019 DL/ID #: 627XX9943 (IA) Customer #: 2377239 Name: Maylone, Glen Alan Class: A ID Status: None Address: 414 WATERWAY DR Audit #: 9187352 DL Status: VAL Issue Date: 06/20/2015 CDL Status: VAL City/State: IOWA CITY, IA Expiration Date: 06/09/2020 CDL Cert Status: Non Excepted 52240 Interstate Endorsements: Passenger, School CDL Med Status: Certified Bus Mailing Address: 414 WATERWAY DR Restrictions: No Class A Restriction None Passenger Vehicle Supplement: Date of Birth: 06/09/1983 Mailing IOWA CITY, IA Sex: M City/State: 52240 CDL Medical Examiner's Certificate Certificate Specifics Ex lanations Medical Examiner First Name Claudia Medical Examiner Middle Name L nn Medical Examiner Last Name Corwin Medical Examiner License Number 29261 Medical Examiner National Registry Number 8795856463 Medical Examiner Jurisdiction IA Medical Examiner Phone 319 356-3335 Medical Examiner Type Medical Doctor Medical Certificate Restriction 1 Wearin corrective lenses Medical Certificate Issued Date 09/09/2019 Medical Certificate Expiration Date 09/09/2020 Date Added to CDLIS Driving Record 09/13/2019 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Maylone, Glen Alan DL/ID: 627XX9943 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 N this date: o O -S �17 oP 71Z" 10/5/2019 Name: Maylone, Glen Alan DL/ID: 627XX9943 Driver & Identification Services Iowa Department of Transporation