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Home My WebLink About20-007� r , IDENTIFICATION NO. 2 Q -Qn--� (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 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 Last (319) 356-5497 FAX 1. Name (REQUIRED) du ,e+ 2. Address (REQUIRED) O It�N 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) _ b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: Middle RaV 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or Type,pofoffens /.1 Where 5 W i herr , ll 0c&1 5 7 a�fh ern f-0oh; e&'J ' Are Z,o -y u,�✓s/�. �rrc ry What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? ut unease uire-,T 08ei � eQ M When What happened to the charge? Circle one) oC nvict Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) l_Q s f W Years 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 haye is ued to me by the Iowa De artm nt of Transportation a v id Driver's license number issued on /-& -/ expiring on 12 •u Z7 . 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 provisio f TRI c�4__.__ �: , erode. (Needs to be signed in front of a Notary Public) Signature of Applicant '�~�' ` _ Date_Z:2�7— ZQ nJ STATE OF IOWA ) y COUNTY OF JOHNSON ) "' Subscribed and sworn to before me b�„; e u - n Yi da y - �� y of Jt7 _ WENDYS.MAYER 1n._..0 . . c I jan 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 v license Z� �� T7 20 ?0 Signal bf 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 Date Celer[MIDRN ADCEAPPL92018amended DOC 04/2018 Fro.Jan• 21. 2020„ 3; 12PM,,,,1eDCI IOWA ,,. 3666187 0111x/2020 11aeNo' 650463 P. 1/7"" STATE OF IOWA Criminal History Record Check j ;Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, l" Floor 215 E. 7ie Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fos I am reauestine an Iowa Criminal 14iatnm Re-nrd rhe ..lr n..• 41 DCI Account Number: H ooh -j (irepp0oabk) From: City of Iowa Ci City Clerk's Office 410 E. Washington Street Iowa City, IA 52240 N Phone: 319-356-5041 Fax: 319-3565497 ry r Last Name (maadmo.y) First Name (Mu&ta )Middle Name (mum Date of Birth (mwwid Grader mendsloty) So/ci/al SecurityNumber (reeommodw) /Z (" �f° 99ale []Female"7 7— W41ver Informaffon: Without a signed waiver from the subject of the regaert n complete criminal history record may not he releasable, per Code of Iowa, Chapter 692.2, For complete criminal history record information, as allowed by law, always obtain a waiver sl nature from the subject of the request. Waiver Release: I tMby give pcmtission for the above « 4twatiM omcial to ua,duct an Iowa aimival hkloty rx?d check colla arc Division of []imine] . Invaligetion (DCI). Any aiminel hislwy.ftts conremin6 k matin Y n ben sed as allow bylow. Waiver Signature;a��-- U I (Dcl on only) As of ,' r,1A a search of the provided nine anckA.r}t¢ (i -birth ievealed: ST TE OF IOWA/DPS (j ❑ No Iowa Criminal History Record found with DCI` `, nir JAN 14 2020 h}t 1 " qIV i, F CFlIMINAL INVEST LI}L Iowa Criminal history Record attached, DCI 40�wY� �•� DCT initials 1 rr�u'runnrm�iu:,>•: oul-1 / (U6/25/1U) Received Time Jan,14, 2020 10:33AM No.5461 Jao.21.2020 3:12PM DCI IOWA No. 6504 P. 2/1 DCI:00261161 NAME: SHUPE,DAN SHUPE,DAN M SHUPE,DAN R SHUPE,DAN RAY SHUPE,DANIEL RAY DOB SEX RAC 19561222 M W ADDITIONAL IDENTIFIERS SC L HND IOWA CRIMINAL HISTORY FELONY CONVICTION DCI 00261161 PAGE 1 OF 6 DATE PRINTED - 2020/01/21 HGT WGT EYE HAIR SKN POB 509 185 BRO BRO MED IA CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19800110 AGENCY: IA0940100 FORT DODGE PD CHARGE NO- 01 IA STATUTE IA716-5 CRIM MISCH 3RD DEGREE TRK#: L17418901 COURT DISPOSITION AGENCY: IAO94015J WEBSTER CO DIST COURT COUNT NO- 01 IA STATUTE: IA716-5 CRIM MISCH 3RD DEG CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17418901 SENTENCE PROBATION 1Y SUSPENDED 90D 02 ARRESTED/TAKEN INTO CUSTODY 19871121 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA204-401 POSE COCAINE TRK#: L17419001 CHARGE NO- 02 IA STATUTE IA123-46 PUBLIC INTOX TRK#: 1,17419002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA204-401 POSSESSION-SCH II -COCAINE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17419001 SENTENCE FINE $250 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA123-46 PUBLIC INTOX CHARGE CLASS: MISDEMEANOR CONVICTION DISP EFF DAT 19880331 na 0 N CD o a m D = z - -C -i n N r -0 m M DISP EFF DAT 19800317 — 19800317 r DISP EFF DAT 19880331 Jan. Zl. ZULU J: ]JrM Rl IUWA TRK#: L17419002 SENTENCE PLEAD GUILTY FINE $50 03 ARRESTED/TAKEN INTO CUSTODY 19680115 AGENCY: IA0480000 IOWA CO SO CHARGE NO- O1 IA STATUTE IA908-11 PROS REVOCATION per. i TRK#: L17419101 n COURT DISPOSITION r'n O:3z AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA908-11 PROB REVOCATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L17419101 SENTENCE JAIL 50D REVOKED 04 ARRESTED/TAKEN INTO CUSTODY 19590909 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA123-46 PUB INTOX TRX#: L17419201 COURT DISPOSITION AGENCY: IAO52015Q JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE: IA123-46 PUB INTOX CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1,17419201 SENTENCE PLEAD GUILTY PAY SURCHG FINE $25 COURT COSTS 05 ARRESTED/TAKEN INTO CUSTODY 19891026 AGENCY: IAOS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 ova 2ND TRK#: L17419301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 OWI 2ND CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L17419301 DCI 00261161 PAGE 2 OF 6 DISP EFF DAT 19860405 19860405 DISP EFF DAT 19900201 19900201 19900201 No. W4 Y. 3// X - CD *m o n-� N N per. i 1n .<r n r'n O:3z N x� Jan.21.2020 3:13PM DCI IOWA No.6504 P. 4/1 DCI 00261161 PAGE 3 OF 6 SENTENCE DISP EPP DAT JAIL 7D 19900112 FINE $750 19900112 PROBATION 2Y 19900112 SUSPENDED 233D 19900112 CREDIT W/TIME SERVED 7R CR;SAE/TRMT;PD 19900112 SURCHG;022692 PROS VIOL - 233D 06 ARRESTED/TAKEN INTO CUSTODY 19920208 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 3RD OFFENSE TRK#: L17419401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 N rev Oo OWI 3RD DC7 b T CHARGE CLASS: FELONY CONVICTION ' 1 TRK#: L17419401 n N N r DC7 SENTENCE DISP EFF DAT ..,Cf m JAIL SY 19920414 7G PAY SURCHG �� N FINE $750 19920414 - r 07 RECEIVED 19920511 AGENCY: IA052015M OAKDALE IMCC CHARGE NO- 01 IA STATUTE IA321J-2-C OWI 3RD TRK#: L17419501 (OWI HOUSING) INMATE #: 026564 CHARGE NO- 02 IA STATUTE IA321J-2-B OWI 2ND TRK#. L17419502 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2-C OWI 3RD CHARGE CLASS: FELONY CONVICTION TRK#; L17419501 SENTENCE DISP EFF DAT JAIL 5Y 19920511 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J-2-9 OWI 2ND CHARGE CLASS: MISDEMEANOR CONVICTION Jan.21.2020 3:13PM TRK#: 1,17419502 SENTENCE JAIL CONCURRENT COURT DISPOSITION AGENCY: IA016015J COUNT NO- 03 DCI IOWA DCI OD261161 PAGE 4 OF 6 DISP EFF DAT 233D 19920511 W/CT 01;SENTENCE DISCHARGED 19920511 CEDAR CO DIST COURT IA STATUTE: IA321J-2-C OWI 3RD CHARGE CLASS: FELONY CONVICTION TRK#: L17419503 SENTENCE CONSECUTIVE SENTENCE W/CT 01 JAIL 5Y CUSTODY AGENCY: IA077015G ADULT PAROLE SVC A 19921109 PAROLED CUSTODY AGENCY: IA052015M OAKDALE IMCC E 19940506 PAROLE REVOKED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19950105 PAROLED CUSTODY AGENCY: IA052015M OAKDALE IMCC D 19950901 PAROLE REVOKED VIOL PROG ADMIT CUSTODY AGENCY: IA077015G ADULT PAROLE SVC E 19951107 PAROLED VIOL PROG CUSTODY AGENCY: IA052015M OAKDALE IMCC F 19960509 PAROLE REVOKED CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC G 19970124 PAROLED CUSTODY AGENCY: IA052015M OAKDALE IMCC H 19970509 PAROLE REVOKED FOLLOWING FINAL REVIEW HEARING CUSTODY AGENCY: IA077015G ADULT PAROLE SVC 1 19970714 PAROLED W/IMMEDIATE DISCHARGE 08 ARRESTED/TAKEN INTO CUSTODY 19940127 AGENCY: IA0160000 CEDAR CO SO DISP EFF DAT 19940506 19940506 No, 6504 N c- P, 5/7 Jao.21.2020 3:14PM DCI IOWA No. 6504 P. 6/1 DCI 00261161 PAGE 5 OF 6 CHARGE NO- 01 IA STATUTE IA321J-2 OWI -3RD TRK#: 004722201 COURT DISPOSITION AGENCY: IA016015J CEDAR CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J-2 ONI 3RD CHARGE CLASS: FELONY CONVICTION TRK#: 004722201 SENTENCE DISP EFF DAT PLEAD GUILTY 19940506 JAIL SY 19940506 COURT COSTS 19940506 09 ARRESTED/TAKEN INTO CUSTODY 19960103 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401(3) POSSESSION-SCH II -COCAINE TRK#: 013266201 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESSION SCH II-METHAMPRETANINE COURT CASE ID: 06521 SRCR040178 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 013266201 SENTENCE DISP EFF DAT JAIL 88D 19960408 FINE $250 19960408 10 ARRESTED/TAKEN INTO CUSTODY 20000906 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA714-1-1 THEFT 2ND TRK#: 100010901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(2) THEFT 2ND DEGREE - 1978 COURT CASE ID: 06521 FECRO55571 CHARGE CLASS: FELONY CONVICTION TRK#; 100010901 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 24D 20040806 FINE $750 20040806 SUSPENDED PRISON SY 20040806 PROBATION SY 20040806 CD 5 c'1 D � n —G r rn o ;::o zz :r 'v —Tl 1 m 0 NOIZYOIZSSANI 'PINIWIHO d0 NOISIAIO xd1n?JRI HOOT. 30 SONlgaS SH.L SHBAOO -.7 (MOOSE 8HS SYHZ AN80 HO WHISNOD SONNY) 8M '08HSINHOa NOLLYWHOANI NO aSSYS •'8I CHOOSE SIHS NOISYJIa I.LN80I 3AISISOd Hoa SSNIHaH80NId ao soNHsBY BH.I NI ® CV yS C:: O W Lu J '(Bi)LiT'ZCZ UOT1099 J N C..7f-- apo0 mmol oq quensand palT; aq gsnw UoTgmOTTdde uv 'Aum IT 'ep.zooaa _N ?—C-> alTuannC IeTquapT;uOo 90 asealaz ayq gsanbaa oq aapa0 uI 'paOOaz OTyn E3^ggTm papTAOad aq -40u= spa00aa 8TTUannC IeTquapT;UOO .Cum pus IeTluapT;uo0 —� C� o aq IITgs AVW SZTTuannC 20; spzo0az lenaoe ayq 'agTs OT141 uD ONVITene o ST UOTgeWZO;UT aWOS yBnoyq U3Aa 'aaAamO}l �WOO'3apUa;;OXaBEMOT'MMM��:djgq N :AagsT6aH 20pua;;0 xaS emOI ayq uO punO; oq us0 80eua;;O x98 aTTuannF UTegaaO 20; 9UQTg0TAUo3 EUT=GDUoo egep AaOISTy IeuTwTxD 'AIIEUOT3TPPY ' (W L5IV ZEZ uoTgoas opoo enrol oq quuneand palT; aq I$= UOTgeOTldde ue 'A.ue ;T 'spaooaa alTuaAnC IeTIm9PT9UO0 ;0 asealaa ayq geonbaa o1 aepao ul •uoTquETgsaeuj IeuTwcaO ;0 UOTeTATO aq7 Woa; UOTgswao;uT BTg1 uTuggO of quoTDT;;ns qou sT UOT2ezT1Oglne asealaa p9u5TS Y 'asaOdeaa STRI uT papnlouT aq IOU= 'Aum ;T 'epao091 1an00 9TTuannC TeTluapT;UOO 'TeTnu9pT;uc0 aam spaODaa alTUannC loom 'Met mmol s8pU0 •e]ep 4203BTg IeuTwTaO OTlgnd apnlouT ATuo ueo asuodsaa aTyy 'IOO eqa Aq 08TOUSBe nuawa0ao;ua mel-uou oq pasealaa aq Aluo ueo qnq pzonaa oTTgnd a ST uOTasDT;T7uapl 10 neaang 'UOTga6Tg92nu1 IeucWT20 ;0 UOTBTATC eMOX aya Cq pauTmgUTew p2002a 9Tg1 '11TA5 ;0 UOTIVOTpuT ue qou ST UOTITeodBTp gnog7TM gsaaae UV 9080b00Z As NOSIHa 9 SO 9 HOW 19TT9Z00 IOO Ut 'd bM'ON vm01 Iia wdb[:E OZOZ•lb Apr ARTS Page 1 of 1 C4010WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov Driver & kbWAffoatlon flrviols PO Box 9201 1 Des hones. IA 50906-9201 Phone: 515244-91241 Fax 5152391837 Certified Abstract of Driving Record Inquiry Date: 1/14/2020 DL/ID #: 958AL2175 (IA) CDL Permit Class: None Iowa Department of Transportation Customer #: 4773745 Class: D CDL Permit Issue None Date: Name: Shupe, Daniel Ray Audit #: 1533483 CDL Permit None Expiration Date: Address: 1813 LOWR HWY 6 RD NW Issue Date: 01/06/2017 CDL Permit None TRLR 81 Endorsements: Expiration 12/22/2023 CDL Permit None Date: Restrictions: P.t 0 City/State: OXFORD, IA 523229246 Endorsements: Chauffeur 3 ID Status: ^� --EXP 0 Mailing 1813 LOWR HWY 6 RD NW Restrictions: Corrective Lenses DL Status: VALj �ry Address: TRLR 81 Restriction None CDL Status: Alppf( y �� Mailing OXFORD, IA 523229246 Supplement: CDL Permit Status:M- W,. N r� City/State: —1n IV Date of 12/22/1956 CDL Cert Status: -!(q -Vi r 1 Birth: fTi Sex: M CDL Med Status: = fV History Information =" Convictions Citation Date Conviction Date ACD Explanation JUR County 04/30/2019 06/06/2019 M14 Fall to Obey Traffic Sign/Signal IA Johnson Name: Shupe, Daniel Ray DL/ID: 958AL2175 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: Shupe, Daniel Ray DL/ID: 958AL2175 (IA) 1/14/2020 Driver & Identification Services Iowa Department of Transportation htty://172.29.254.55/drivers/reDorts/customerhistorv/certifieddrivingrecord.acnx 1/14/91)90