The URL can be used to link to this page

Home My WebLink About20-028l IDENTIFICATION NO. Q' oZU _ - 1 (Office Use Only) allC%"III: ,++ �®F i APPLICATION FOR TAXICAB I 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 Cily. Iowa 52240-1826 13191356-5090 Last First Middle (319) 356-5497 FAX ``[[�� ' \ 1. Name (REQUIRED) S ssW as Q'A � b%% ^� U QAv 2. Address (REQUIRED) ] ��% h 1 ; ,k4 'Q tv` _ ' �3 C Q . 7o 3. Contact Infomiation (REQUIRED) 4a. Driver's License expiration date b. Taxicab Business Name (REQU Call Phone;'r'k�- Z J' -sq .yE) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?0 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? NN Tvce of offense Where When What happened to the charge? (Circle one) _ Convicted Dismissed Deferred Suspended PleaduG illy Other 8. Has your drivers license or chauff license been suspended or revoked in the last five years? ED 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) 0412018 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). 1 hereby c [ the have issued to me by the Iowa Departmen`of Transportation a valid Driver's license number -21$ 7 �2 bissued orQ� - �1\%piring on j' 15 • 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 _jjuAher agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Tit a;Z�r 2, of the City Code. (Needs to be signed In front of a Notary Public) HiHtHiiiiii HIMNIH1HHf Hf'iiffiffHHfHf iHIHHf f [f HfMHiif IHRif [tHHf[ffYf ttHf [fH1Yif If1HHiff HHM1kHIRkRIf ifHif f fiH iiifiHf STATE OF IOWA ) COUNTY OF JOHNSON Subscribed and swom to before me by on this day of Notary Public in and for the State of Iowa HM4li#ilMifiMfllHiMiiNi:iHF 111fY�ttHHyHYMYfiHHflfffMyililYyNtHb[ifHiyi}tyf 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 Driver's license Signage of rce 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. lP �� Sao D to Office Use Only Approved application DCI report State certified driving record Website update CIOTITR IdIINBNe WRL9101BamaMM= 04/2018 05tMay.22.2020 9:53AMcab DCI IOWA ffmte33e2No. 1201 P.. "1002 FAX STATE OF IOWA Criminal History Record Check Taw Request Form o DCI Account Number: 9967-F iut__�I or FBF a'++nn u`,�xi ions to: Send results ta- Y-PAWbls) Iovfa Dlv1AOa of CAmfm0lnveatl 4*31 Support Operations Bateau, V Moor b15 r. 7'° 6txeet Du iifolnes, Iowa 9031P (50) 7294066 (519) 725.60gi1 Fax 4ws 10 p Name Ye1101yd]eb0f16w1LC1ty Addrers P.O. Box 42B IOWL Iaws 5=4 Phan _(319133&9779 FAX 319459.4143 As of—w 2.2 2020 n see"I Oftht Provided name and date ofbi{i4,:i6jtta #} 0 Iowa C dmimel Hietosy Rcoord fbuud with DQ 4) I0*04*3inal History Record attaohc4 DCI r o 0 DCIinitWs. `'�, pro .....• OO' �' �1 DM -77 (updated 06-26-2018) Page 1 Oft Received Time May. 21. 2020 12:41PM No. 1102 May.22.2020 9:53AM DC1 IOWA No, 1201 P. 2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential, Confidenttai 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 confidentlaljuvende records, If any, an application must be filed pursuant to to we Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sax offenses can be found on the Iowa Sex Offender Registry. hitn;/hvww.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 232.747(18). Inquiry Date: Name: Address: City/State: DOT SMARTER I SIMPLER 1 CUSTOMER DRIVEl1 wvvw•1°wadois gov WNW & idenitkation 3iniGs PO Bax 9NI4 I Des Wnm iA 54306-S2W Phone' 515-274-91241 Fa% 515239-1837 Certified Abstract of Driving Record 5/21/2020 Bishop, Warren Dean 1314 E STH ST MUSCATINE, IA 527614920 Mailing Address: PO Box 194 Mailing Muscatine, IA City/State: 527610004 DL/ID #: 718YY8286 (IA) Customer #: 888920 Class: B ID Status: None Audit #: 8941089 DL Status: VAL Issue Date: 03/20/2015 CDL Status: VAL Expiration Date: 12/15/2020 CDL Cert Status: Non -Excepted Intrastate Endorsements: NONE CDL Med Status: None Restrictions: Corrective Lenses, Restriction None CDL Intrastate Only Supplement: Date of Birth: 12/15/1957 Sex: M History Information CLEAR DRIVING RECORD Name: Bishop, Warren Dean DL/ID: 718YY8286 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: Bishop, Warren Dean DL/ID: 718YY8286 5/21/2020 Driver & Identification Services Iowa Department of Transporation