The URL can be used to link to this page

Home My WebLink About20-037� r 1 CITY OF IOWA CITY 410 EaSI Washington Street Iowa City. lova 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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 2. Address (REQUIRED) L00 3. Contact Information (REQUIRED) (Al written 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: First Middle owa( G Phone: 746-575 -95J 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When MOLWI.I4etu IrluIth gh.46 - :. 2IYcI- W hat happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedle Guil Other 7. Have you beenarrest d /charged with any traffic offenses in the last five years? A /d Tome of offense W here W he 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 Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) r f Q (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) U 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 here rtiy that I have issued to me by the Iowa Department of Transportation a valid Ddvers license number b ffM bd85 issued on 1[0 -,u -IS expiring on /PZ --od dod( . 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 tines with all of the provisAnj�f Title 5, Chapterf2, pf the City Code. (Needs to be signed In front of a Notary Public) Signature of Applicant ( x* --z i ffA&U�— Date N— o`( —4�6& INflftNf *RNN1f1f f ffYNfNNf*ff f **fftNNY*Hf tYNftf {*f If NY*I{ffNff IN{NfittNlffff*{*N*If *1NHNNNNNINNt'YNfittf t*NN*NNf fN 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 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 i Z6 '✓ Z) t r r Signature of o Ice 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 CWWTAXIDRM ADDEAPR8201B& dad.DOC 04/2018 o9l05t1, 2020._3:_47PMCap DC! IOWA ffAM193302No. 7769 P. 1_/2-002 'STATE OF IOWA Criminal History Record Check Request Form DCI Account N=ber. 9967-F f=R to ofK,pwo) Send reaelts tv' Iov�- Dvidoa of Crk&ai Iawstiption Name YeUdW b of Iowa city Sbggort OPe 09111 $Mraaa,14 Floor Dea,� ahkes,Iow& $0319 Addrso F.O.I3ox428 (515) 725-6066 Iovra CI , fovea 52244 (51sj'.725-6080 Fax —#- Phoaa 3� Fwc 319,359 4242 I am re Fxgtie. MinT7_' u.rr.r..w�. s\..'-=:^�rr�r.�.)ev�: 17rc�.i{=�i 'siT-•}�'i/ 5,41 n' i 4 r '91 r a:.Y rAi 5ase �d As of l' O' l . ap _gyp a search of tha Provided name and date of birTb revealed: VNO %wa Crimipgl M,,, Re0ord fO=d with DCI 0. Iowa Criminal HWkry Record attached, DCI # DCI initials MI -77 (upr 06 262o1E) Received Time Sep. 29. 2020 10:370 No, 7089 Page 1 on CL z a a N' N z 't +� -. 0 o g; co p; co 0 Page 1 on Oct. 1. 2020 3:48PM DCI IOWA No. 7589 P. 2/2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most Juvenile records are confidential. Confidential juvenge 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 conffdentlal Juvenile records, If any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry. htto://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). �,1OWA DOT wwwiowadoG ov SMARTER I SIMPLER I CUSTOMER DRIVE14 9 Omer & Identification 3410M PO Box 92041 Des Moines. IA 593069204 phone 515-244-9124 1 Fax 515-239-1897 Certified Abstract of Driving Record Inquiry Date: 9/29/2020 DL/ID #: 986AM6085 (IA) Customer #: 6353283 Name: White, Clarence Class: C ID Status: VAL JUR Andrew Suspended Registration 09/04/2018 D53 Address: 725 N Front St Apt Audit #: 3332100 DL Status: VAL 4 Way Issue Date: 10/26/2018 CDL Status: None City/State: North Uberty, 1A Expiration Date: 12/02/2021 CDL Cert Status: None 523179242 Endorsements: NONE CDL Med Status: None Mailing Address: 725 N Front St Apt Restrictions: NONE Restriction None, 4 Supplement: Date of Birth: 12/02/1981 Mallinp North Uberty, IA Sex: M CRy/State: 523179242 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/27/2018 04/02/2018 Improper Johnson IA JUR Suspended Registration 09/04/2018 D53 12/05/2018 01/07/2019 N01 Fail to Yield Right of Johnson IA Iowa Fine Way Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/05/2018 1084255 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 07/12/2018 09/04/2018 D53 Non -Payment of IA IA Iowa Fine Name: White, Clarence Andrew DL/ID: 986AM6085 Pursuant to Iowa Code §321.10, 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: Name: White, Clarence Andrew DL/ID: 986AM6085 9/29/2020 Driver & Identification Services Iowa Department of Transporation