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Home My WebLink About20-026-4 71�rIII� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. (05ce Use On ) APPLICATION FOR TAXICAB Jr MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application Last First Lo✓i 3, Contact Information (REQUIRED) Email ILotjir'��&j�0 Cell (All written communication sent via email) 4a. Drivers License expiration date (REQUIRED) aj 10 1, ( 2021 b. Taxicab Business Name (REQUIRED) NOIG -J Clb 5. Prior experience in transportation of passengers: 1,3114' Middle 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? I.l A- Tyoe 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? F.5 f FF N Type of offense Where WWhe f� What happened to the charge? (Circle one) _ •T! -0 M Convicted Dismissed Deferred Suspended Plead Guilty- Queer CD 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years?.- -1ES Type of offense Where When f) j f�ca'P OSi-A-� 7LI6- 7017 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) IJ ►w. 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). I herebycertify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number L R 12�1Cf53 issued on 125 i5 expiring on -)I(, 21 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 proviyons of Title 5, Chapter 2, gff the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant KCP r..¢.- Date b r5 I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by State v �o ��ir9 L day of W 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 Driver's license Signature of 7 ief 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 ClwkrrA%IDRIV A GEA L9201 Ba Ne .000 • 04/2018 zio [ Geoff apWpN m snirvo+aamt�!';�'+C4,d.flF`�J� 30 "K�Icr Sii9p,Iq�poed°II'. 41 Rsm-,p�1', 66.o�eq�e�n PceLL-LI - 6L Z OM"N wdll:ll OZOZ 'S •uop awll PIA1134 (8102'9z-90 Pwpft) LL -ma �# proorg 6soµs, am= a nol ❑ n P=3 P�O0g'a 4sn FI enrol o X4;0 G42P POE a=U papu&ozd aq=;o gjLmas a ' OZOZ B O Nn( JO w tblp-6SS•61¢ Iva L E I auogd Mij eµol v&oj BZ41o$'D'd �PPtl A35 *xollo RwD4vuad ocoeu :03 4lnsox p�iag d'066 ;�e4tapH31mo�y Iia x.g o9okszL (SYS) 9909.9u (CIS) 6IEOS *�eI`�o1oI�l9aQ rae�ts „L'� stz 1040ldml Mamg,uopaaodo Uoddag 11egellpsaelq pi@M7I0 aolsTt)a ¢aeol :oa paaa ruoa d 9 , ua.Io;�;sanbag , alaega paoaag d;.to;srg �euzalcl� WOR/l •d SLLZ•oN,OUR .4 001 IN MOON oZ6Z'8 'uIrm --L r �4,IOWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW.iowad0tgov Inquiry Date: Name: Address: City/State: DfhW & 11110MM11101% servltef PO Box M I Des Moines. IA 503069241 Phone -515"244-91241 Fax 515239-1837 Certified Abstract of Driving Record 6/5/2020 McKinnie-Shaw, Dajon Devontae 15877 Braile St Detroit, MI 482231103 Mailing Address: PO Box 451 Mailing Lone Tree, IA City/State: 527550451 Convictions DL/ID #: Class: Audit F: Issue Date: Expiration Date: Endorsements: Restrictions: Date of Birth: Sex: 402AR7953 (IA) C 4027953 07/25/2019 07/06/2027 NONE NONE 07/06/1994 M History Information Customer >R: 6490097 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD I Explanation I County .— 3UR 02/24/2016 103/08/2016 592 I Speed tD Mahaska —i IA Accidents - Accident involvement indicated does NOT mean the individual Wbs at fault or given a citation. Accident Date Case Number JUR 11/18/2017 1015797 IA Sanctions Type Effective End ACD Explanation Occurrence 3UR 3UR ISuspended 04 13 2016 08 30 2016 S92 I Serious Violation IA IA Name: McKinnie-Shaw, Cajon Devontae DL/ID: 402AR7953 Pursuant to Iowa Code 4321.10, 1, 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: 6/5/2020 A2zzll�!� Driver & Identification Services Iowa Department of Transporation Name: McKinnie-Shaw, Dajon Devontae DL/ID: 402AR7953 0 N S tD yg