HomeMy WebLinkAbout21-0134_wr.®.o
�d
CITY OF IOWA CITY
410 Easl Washington Street
Iona City, lona 52240.1826
(319)356.5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED) _
IDENTIFICATION NO. 2 1 " O� =�
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review mbst be made between 8 a.m. to 3 p.m., Monday — Friday)
Failure to complete the "reuulred" Information will result in denlal of the application
Last First Middle l� 6 G- 6 f- --7
3. Contact Information (REQUIRED) Email: pt (1. Wc( bar -1 (A1i t,j-c s` Cell Phone: 3 / T 331 - $73(0
(All written communbaion sent via email)
4a. Driver's License expiration date (REQUIRED) DoL
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers: or x
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
R
What happened to the charge? (Circle one) N
Convicted Dismissed Deferred Suspended 01f)6r, -n-
7. Have you been arrested I charged with any traffic offenses in the last five years? 6
Type of offense Where
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years?
Type of offense
Where
When
9. Have you ever applied to bean Iowa City taxi driver using a different name? if yes, please provide the name(s)
04/2016
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
minal Investigation Report (form available upon request).
You must apply for an individual Department of Cri
Li? ?9 y�explring on I understand that if I
issuI hereby certi t at I ha a issued to m b the I ona Department of Transportation a valid Drivers license number
-5 4
falsely answer any q application, that this application may be denied. I agree that In making this application, 1
questions a rfthe
consent to allow agents or an of the City of Iowa City, Iowa, in their discretion, to examine any and all records an
documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
limes with all of the provisions of Title 5, Chapter 2, of the City n .(Ne�be signed in front of a Notary Public)
Date 2
Signature of
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by
on this �_ day of
«#«i,zzz+ze+-+zzzzzzzzxzzz
te certified
g record of
plicant and
Ihehave
re ls vienemas application,
which wouDCI
ld I report, and the t that the ssuance w uld be etrimental toithe safety, health Q.r elfare ofreshat
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Drivers license
Signae of olice Chlef or designee
Date
tur
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE ATAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
SjatU1r9`o)fCPVjtyClerk r designee Date
Office Use Only
Approved application
DCI report
State certified ddving record
Website update
cy,rrtAXIOR ADGEAPPrezwe�«a.a.Doc 0412018
Mar.15.2021 10:13AM DCI IOWA
031rtecuci rl;nr rtvwwCab
No. 8078 P. 1/11
0*3193312AM r.uuu002
STATE OF IOWA FAX
Criminal History Record Check
Request' Form
Mall or Pax aomeleted imma to:
Iowa Mvieion of Crimloal Iuvatiption
6apport Operatic= Iaurwt41*Floor
215 Y.7* Street
Des Makes, Tows 50319
(515) 725-6066
(515) 725-6080 Fay
DC1 Account Number; 9967-F
(ifappliabb)
Seed ""its to'
Name Yellow Osb of Iowa Cq
A ddreae P.O. Boa 428
Iowa City, Iowa 52241
Y
Pbone 1310330.9777
Fax 319-3594142
DCI -77 (npdatod 06-264018)
Received Time Mar. 12. 2021 12:22PM No, 7981
Far I of
Mar.15.2021 10:14AM DCI IOWA
IOWA CRIMINAL HISTORY DCI D0622510
MISDZHZANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED -
2021/03/15
DCI t00622510
NAMEt BAARY,WILLIAM DZXTER
DOB SEX RAC HGT WGT EYE HAIR SKN FOB
19670215 M W 509 220 BRO BRO NED MD
ADDITIONAL IDENTIFIERS
CCH RECORD ***
01 ARRHSTHD/TAKEN INTO CUSTODY 90000612
AGENCY: IA0520000 JOHNSON CO SO
CHARGE NO- 01 IA STATUTE IA321J-2
Owl
TRX*; 042157401
COURT DZSPOSZTION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT No- 01 IA STATUTE: IA321J.2(A)
OPER VZH WH INT (ONI) / SZR HIED / IST OFF -
CHARGE CLASS: MISDEMEANOR CONVICTION
TRE#: 042157401
SENTENCE DISP EFF DAT
JAIL 2D 20000720
ATT DDS SA EVAL
FINE $500 20000720
No. 8078 P. 2/11
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. C7
:.c n
This response can only include public criminal history data. Under Iowa la* -{
most juvenile records are confidential. Confidential juvenile court record!! -C
if any, cannot be included in this response. A signed release authorizatiotl`?�'�
is not sufficient to obtain this information from the Division of Criminal -`m
Investigation. In order to request the release of confidential juvenile C7
records, if any, an application must be filed pursuant to Iowa Code secti0*L
232.147(10).
Additionally, criminal history data concerning convictions for certain
juvenile sex offenses can be found on the Iowa Sex Offender Registry:
httpt//www.iowaaexoffender.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
�m
�,1OWA DOT wwwiowado v
SMARTER 1 SIMPLER I CUSTOMER DRIVEN t g�
Dm« a 1derAftatlon sevloas
PO Box WN I Des Wines, IA 60306-9204
Phone 5115-2.14-9124 I Fax 515-239- 1837
Certified Abstract of Driving Record
Inquiry Date:
3/12/2021
DL/ID #:
435AA6946 (IA)
Customer #:
3350447
Name:
Barry, William
Class:
D
ID Status:
EXP
Dexter
under in 35-55 mph
Address:
720 N DUBUQUE ST
Audit #:
9658988
DL Status:
VAL--+
APT 7_
Issue Date:
12/22/2015
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
02/15/2022
CDL Cert Status:
NoriZG
522451925
Endorsements:
Chauffeur 3
CDL Med Status:
None.J
Mailing Address:
720 N DUBUQUE ST
Restrictions:
Corrective Lenses
Restriction
None—
APT 7
Supplement: _
-
DateofBirth:
02/15/1967
i,�
Mailing
IOWA CITY IA
Sex:
M
City/State:
52245192
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
CountyJUR
07/27/2018
08/12/2018
S92
Speed (10 mph &
Linn
IA
under in 35-55 mph
zone
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
JUR
07/23/2019
1125010 _ _IIA
Name: Barry, William Dexter DL/ID: 435AA6946
Pursuant to Iowa Code 4321.10, 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: Barry, William Dexter DL/ID: 435AA6946
3/12/2021
AO IC.-
OL
Driver & Identification Services
Iowa Department of Transporation
�filC�f�•t _
_
ti
q
ry
n
D,y
3
�
r-
m
W
0