HomeMy WebLinkAbout21-017IDENTIFICATION NO. ) -
_ 1 _ (Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAS VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday)
CITY OF IOWA CITY
410 Easl Washington street Fallure to complete the "reuulred";::formation will resultin denial of the application
loa•a City. lama 52240.1826
(319) 356-5090 Last First Middle
(319) 3S6-5497 FAX /
1. Namer?EQUiRED) V,114W5 ew,eop
2. Address(P,EQ'TIRED) 11e9 brlslwir.{ 61 hft k fit f-, 14 S%J YO
3. Contact Information (REQUIRED) Email: Cell Phone: N1,f1*-rlff1'
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRE--;
b. Taxicab Business Name (REQUIRED) YtllwG•G e �er.+ Gfj
5. Prior experience in transportation of passengers: 7P~1 C 42.4-wvf
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 2e2
Type of offense
Where
When
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
04/2018
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What happened to the charge? (Circle one)?l
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c
Convicted Dismissed Deferred Suspended Plead Guilty
Other__
7. Have you been arrested / charged with any traffic offenses in the last five years?
41a
Tvog of offense Where
When
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?
tie
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)
A,
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
04/2018
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).
number
I hereby certify that I have issued to me by the Iowa Department of Transportation a' valid Driver's
license that If i
;SS�OV1rYy Issued on +IT•i'"7 expiring on W
Fai answer
to allow any
questions
ein this mployeesofthe City oflic8ticn, that tlolwa OltyaIowa nbon ytheirdisc discreenieCl tion, examine any reethaCin tand ailng this recordsand
documents relating to this application, and I further agree that, ff, authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions f Title 5, Chapter 2, of the City Code. (Needs to be signed In front of a Notary Public)
Date
Signature of Applicant
#YHH#i#litk#HHHYRkY#Y##1H41HYHHf HYRHH#Yf#4#'ARH#Ff HHH#Ai##fi#!t#i#f #MYY4irik R#####hf kYH#YAf#Yfi#A#iHHH#RAY#i#X##kkHH###iR#YYY
STATE OF IOWA
COUNTY OF JOHNSON
Subscribed and sworn to before me by
on this day of
Iowa
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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 o Driver's license 6,9-eZ�
Signal a of Police Chief or designee Date
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AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN I0WAf.�TY FQ, 10
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
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Sign re of Clerk designee _ --� co
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
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STATE OF IOWA
Criminal History Reeord check'
1 0 Request Form
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Mail orFax qgmptoted fg= to:
Iowa Division of Criot{nal hvto Ration
Support DpemLiow Bw*za,10 Moor
215 E. 70 Street
Des Moises, Iowa 50319
(515) "54066
(515)725-6010 Fax
DO Accouut Number: 9967-F
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DCI initial�f�Secti0
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Mar, 23. 2D21 9:22AM DCI IOWA No.9131 P. 2/2
DISCLAIMER
This response can only Include public criminal history data. Under Iowa law, most
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.1Awww.iowasexoffender.com1. 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).
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410WADOTwww iowadot ov
SMARTER I SIMPLER I CUSTOMER DRIVEN g
Drivff & IdwAfteation Sffriefs
PO Box 92041 Des Mines. es. IA 59306520•
Phone 515-244-9124 1 Fax SIS -239-1837
Certified Abstract of Driving Record
Inquiry Date:
3/23/2021
DL/ID #:
255DD4944(IA)
Customer #:
4329777
Name:
Williams, Clifford
Class:
D
ID Status:
None -
Steven
- ::
" �
Address:
1015 W BENTON ST
Audit #:
1752853
DL Status:
VA4 j
APT 45
Issue Dale:
04/18/2017
CDL Status:
Norte
City/State:
IOWA CITY, IA
Expiration Date:
01/04/2025
CDL Cert StatYaY
Nons
522465116
Endorsements:
Chauffeur3
CDL Med Status::
Non
Mailing Address:
1015 W BENTON ST
Restrictions:
Corrective Lenses
Restriction
None_
APT 45
Supplement:
Date of Birth:
01/04/1980
Mailing
IOWA CITY, IA
Sex:
M
City/State:
522465116
History Information
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
I Case Number
IUR
01/24/2019
1094341
IA
Name: Williams, Clifford Steven DL/ID: 255DD4944
Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation,
do hereby certify that 1 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:
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7071 MAR 26 Aft 8: 12
CITY CLERK
10WA CITY, IOWA