HomeMy WebLinkAbout19-081IDENTIFICATION NO. I � - 6 S (
1 (Office Use Only)
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 Strcct Failure to Como/ete the "required" information will result in denial of the avalication
Iowa City, Iowa 52240-1826
(3191356-5040 Last
(319) 356-5497 FAX Fiat Middle
1. Name (REQUIRED) _ r/��lns ' 16o..r MIA
2. Address (REQUIRED) =IAN S. lei t....: J. tel. K3 C � y Sd S&jr,A
3. Contact Information (REQUIRED) Email: rt..;1, Cb,. Cell Phone:3r9-!Jt_ yyy
(All written mmunication sent via email)
4a. Driver's License expiration date (REQUIRED) 4-/Y.90
b. Taxicab Business Name (REQUIRED) ire/%.,t Oah
5. Prior experience in transportation of passengers: 940 It //e -h,
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Na
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? #s
Type ofoffense Where When
GOU51 I�QMa v S0-016 O*y C�'7 )g
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? "
Type of offense W here When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
ARI)
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 Department of Transportation a valid Driver's license number
7y>' 1/ issued on S ja_Aoit expiring on �_�yy�_. 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)
Signature of Applicant�(�r�� Date //-7-/9
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed andsworn to before me b
A) �, ?vt i Y A:. _4% P) r on this day of
5 1
V ENDv S.MAYER Notary Publitjin and for the Sf#te bf Iowa
ry fswn Expires
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
or
1'1-07-Jq
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.
Approved application
DCI report
State certified driving record
Website update
Office Use Only
11-7-1g
Date
Clerk/fAXIDRIVBADGEAPPL92018emended.DOC 04/2018
I
STATE OF Iowa
Crimbal History Record Check
Request Form
TICI Account Nwobw. 9967_'
M is or Fax com leted foes to,f .aruwbla)
fiend results to:
TOWaDivision of Cominal lnvestiPation Nu...o W -TY-..
Pers ons Burwt, in Floor
215.8.74 8trwe Address P.O. Bax 428
Des Moines, Towa 50319
(515) 725-6066 10*2 City, Tows 52244
(535) 7256086 Fax
phone 19 5384177
FIX 314-894142
As o£a
search of the provided name Drid date of both revealed:.:
No Igw4 Criminal Historylt6cord fotnld with DCI
❑ Tows Criminal
N
History Record attached, DCI #.
'
w
DCt initials f 7
DCI -77 (updated 06-26-201 s)
Page 1 oft
Received Time Oct. 31. 2019 7:59AM No, 6603
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 sinned release authorization is not sufficient to obtain this
confidential juvenile records, if any, an
section 232.147(18).
AdMim r
offenses can be found on the Iowa Sex Offender Registry:
htto.11www.iowasexoffender.com/. However, even though some information is available
on this site, the actual records for juveniles may still be conridential and any confidential
juvenile records cannot be provided with this record. In order to request the release of
confidentlai juvenile records, if any, an application must be riled pursuant to Iowa Code
section 232.147(18).
ZJW viiiADDT
SMPiRTER I SlUPLER 1 MTOMER DRIVEN blu'V'vJawadint.gov
Driver & ldeaiificaiion Services
IL Fox 9'x0,: I Des hicine<w Ut 58306-92M
Phone SIS-21-1-91711Fax 51:739-185,
Certified Abstract of Driving Record
Inquiry Date: 10/31/2019 DL/ID #: 627XX6064 (IA) Customer #: 2375713
Name: Phelps, Gilbert Allan Class: A ID Status: None
Address: 2254 S Riverside Or Audit #: 9079785 DL Status: VAL
Trlr 53
Issue Date: 05/13/2015 CDL Status: VAL
City/State: Iowa City, IA Expiration Date: 05/14/2020 CDL Cert Status: Non -Excepted
522465852 Intrastate
Endorsements: Motorcycle CDL Med Status: None
Mailing Address: 2254 S Riverside Or Restrictions: Corrective Lenses, Restriction None
Trlr 53 CDL Intrastate Only Supplement:
Date of Birth: 05/14/1958
Mailing Iowa City, IA Sex: M
City/State: 522465852
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
lCounty
IUR
10812712019
109/18/2019
S92
Seed
Johnson
IA
Name: Phelps, Gilbert Allan DL/ID: 627XX6064
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:
or 7,�
10/31/2019
Driver & Identification Services
Iowa Department of Transporation