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Home My WebLink About20-052r t �a• + My�U��®Iola ; CITY IOWA CITY 410 East Washington Street Iona City, Iona 52240.1826 (319)356-5040 (3 19) 356-5497 FAX t. Name (REQUIRED) _ IDENTIFICATION NO. 20- OS,)- (Office SS(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) Failure to complete the "required" information will result in denial of the application Last First Middle 2. Address (REQUIRED) —I? - 3. / Z 3. Contact Infonnation (REQUIRED) Email: Cctnmc., b�� ✓ti., /976 . // c<-, Cell Phone: 3/9- 9 JC9 7f85 (All written communication se t with 'a email) 4a. Driver's License expiration date (REQUIRED) o Z 5 b. Taxicab Business Name (REQUIRED) Yt /Iay C-4 u r' Zw j f, 5. Prior experience in transportation of passengers:%a'i hP b4,1 i s 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Pi7iF. Type of offense Where When Convicted Dismissed Deferred Suspended Plead Guilty Other ' Have„„// you been arrested /charged with any traffic offenses in the last flue years? V 1Cl Type of offense What happened to the charge? (Circle one) Where When 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? NO 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) 11TH 10.1 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 352 ,t )r_ Z o 7 > issued on L -? - Z c expiring on �Z- Zy 2-_ S 1 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 a 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 Applicantt �L �� t Date 2:,, 4f tf N4af ff f f of f{saMf 4f f4Raff f!f 4RNf lwwlflf 4wff fMfk4f ffltai4f44ff4kf 4ffN4Hf f{4fi44w4f 4{4f{4M4hltf ff RwlffHwff a{awH{{{f lwHlf 4f {Hff f If4wf STATE OF IOWA 3 d COUNTY OF JOHNSON Subscribed and sworn to before me by on this day of Iowa 4RIfMMR4lRf444fK4fRY#MR444RtRRf4RYYRR{yR4yfY{t{f' 4444# 4t#!4#Rf#y4R4444144444f44{#f4#44;4#4fffR4y 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 licenseb Z-/ Zy <' s Signature o`iief or designee Jl v >- 2 - Date xN AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE E LISTED BELOW. Signa re of City Clerk or ignee /\) b( iJ Date ff4f#i#ki#tYRffiRHlffR#f14#Rh 4Rhft#fl44aHYHf4fMfff444hiflff 4if 41f #4iffR4ftlffaffafwa{�«.a a a a � ... .......... Approved application DCI report State certified driving record Website update Office Use Only CiR,arrnwDPro DDe.RPPLnoie a.DDc 0412018 %awvwml 6gC}ulhhd1,,W,%ktuh *0* opwaftat ZZIML §'►ftow.. . OIA CAR GiCl4ctamt �,. &Xtm� tti'AiHd Nom, lows fir, "N 52244 (319)33$-Bj7 X01 a a t �dPdecnemo �md aa�e oftlD Q I i Sis6de� $ ¢ard fz4i�d wi& Dc, a Received Time Oct.26. 2020 1:3UPM No.0892 IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED - 2020/10/28 DCI:00482290 NAME: SURTON,CAMERON LEE DOB SEK RAC HGT WGT EYE HAIR SKN POB 1976D424 M W 509 175 BLU HRO FAR IA ADDITIONAL IDENTIFIERS CCH RECORD +*+ 01 ARRESTEO/TAAEN INTO CUSTODY 199407D4 AGENCY: IAD520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARI.7UANA TRK#: 007541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT V0- 01 IA STATUTEt IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#! OD7541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VER WE INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL 5D REVOKED COURT DISPOSITION AGENCY: IA0520150 JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE! IA121-218-2 DRIVE WHILE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 012452302 SENTENCE FINE $250 03 ARRESTED/TAKEN INTO CUSTODY 19990522 AGENCY: IA0570100 CEDAR RAPIDS PD DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 CHARGE NO- 01 OWI 2ND OFFENSE TRK#: 500346901 COURT DISPOSITION AGENCY: IA057015J COUNT NO- 01 IA STATUTE IA321J-2-2-B LINN CO DIST COURT IA STATUTE: IA321J-2B OWI 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 5003469DI SENTENCE PLEAD GUILTY JAIL 7D FINE $1500 COURT COSTS 04 ARRESTED/TAKEN INTO CUSTODY 20000701 AGENCY: IA078000D POTT CO SO CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE WHILE DENIED OR REVOKED TRK#: 800328701 COURT DISPOSITION AGENCY: IA078015J POTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.218 DRIVING WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 8003287DI SENTENCE PLEAD GUILTY JAIL 2D DCI 00482290 PAGE 2 OF 3 DISP EFF DAT 19990825 19990825 19990825 19990825 DISP EFF DAT 20000703 20000703 An arrest without disposition is not an indication of guilt. This record maintained by the Iowa Division Of Criminal Investigation, Bureau Of Identification IS a public record but can only be released to non -law enforcement agencies by the DCI. This response can only include public criminal history data. Under Iowa law, moot juvenile records are confidential. Confidential 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 confidential 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: http://www.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 232.147(18). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION U'''IOWA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.itawadot,gov Drkw & idwli licadon swvias PO Sar 9201) Des MWnes. IA .".43069201 Phone'. 5IW44-9124 I Fax 515-239-103-1 Certified Abstract of Driving Record Inquiry Date: 10/26/2020 DL/ID #: 359KK2073(IA) Customer #: 4698203 Name: Burton, Cameron Class: D ID Status: EXP Lee Address: 42 Parkside Estates Audit #: 4708799 DL Status: VAL Rd Issue Date: 06/02/2020 CDL Status: None City/State: Washington, IA Expiration Date: 04/24/2025 CDL Cert Status: None 523532954 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 42 Parkside Estates Restrictions: Corrective Lenses Restriction None Rd Supplement: Date of Birth: 04/24/1976 Mailing Washington, IA Sex: M City/State: 523532954 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Nome: Burton, Cameron Lee DL/ID: 359KK2073 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. ^•a r`; y In witness whereof, I have caused my signature and the seal of the Department to be set upon this docU "t, atp4nkeny, Iowa this date:JC7E CJ Name: Burton, Cameron Lee DL/ID: 359KK2073 10/26/2020 C� Driver & Identification Services Iowa Department of Transporation ti w c� O