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Home My WebLink About21-018r 1 i`lira® CITE OF IOWA CITY 410 Easl Washin8lon Street Iowa City. Iowa 52240.1826 (319)3S6-5040 1319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. _p (e) (Office Use Only) APPLICATION FOR TAA��11CppR 1 MOTORIZED PEDICAB VEHICLE DRIVER (Police Delertr?WR r26le%f Mulk4 bb4nade between 8 a.m. to 3 p.m., Monday - Friday) Failure to cto�tm e' ` ix'fled" Informadon will result in denial of the a pplicatjorcj. IC1%k;\ CITY, j!J%4 l Last First Middle 3. Contact Information (REQUIRED) Email: Cgvner�h s l �, >r/7( (e�myl /,Curr Cell Phone: 3/'/- %30 -$g'S'/ (All written communication sent via email) 4a, Drivers License expiration date (REQUIR=D) ,41- 21/ - Z c5 b. Taxicab Business Name (REQUIRED) IQ iql Cali �e- 5. Prior experience in transportation of passengers: 8. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? yes Tvoe of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? V Type of offense What happened to the charge? (Circle one) LiNM-1 Convicted Dismissed Deferred Suspended Plead Guilty Other�hi,, 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? yo 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/__ 04/2016 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER cq REPORT AND STATE ceR7lPleD DEPARTMENT OF CRIMINAL INVESTIGATION (D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF, *VIEW You must apply for an Individual Department of Criminal Investigation Repot poirm available upon request). �t CITY, I hereby certify that I have Issued to me bIsthe suedlon trDZp2cmentof irinagnson 41-2nc/a z�a�lid Driv' understand that number if 1 359 be Docent to aelow ag a tions employees olf the Gly that fthis E Cityalowatlon mIn theirdisc discretion, to a ami a any a dhall records and obe a taxicab driver Imes with all oftthe to this a, and Iprovisionatof Tittle 5, Chapt 1r 2, off the City Code. (N etds tobe signed n front of arNotary Public) at all agree that, if ) Date Slgnature of Appllont„4� ,,e -- tkk##t*ttkkk#**#*A#irk##A*kAktX#XXXkkRXk#tXNt#tXX#XMX#k#!#R#Fh#kRX#kkAkFXXAfMXX#Rk#X#k#XRAA'#XXA#X*A#H#Xk###A#XA*A#*X*AXk##1XRX*#YXk#*X##*iXAXk# STATE OF IOWA COUNTY OF JOHNSON Subscribed end sworn to before me by on this day of *kXX#Fkkkkkk*kkkkk#kkkkk#'k**k*kMNkkk*.4k*iM'MkRkkk'ki'k iM#kkR#,k#Xk#k**kkXkkyk#khl.MkAkk#kkkk# 4k*kkk*kkXkkk#kkkkkkMkkkAXkkkhAR:V*AfF:YkkXXkk:4kkkkkk*ik I have reviewed this application, DCI report, and the State scrolled driving record of this applicant and have determined that would Indicate that the there Is no Information which 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), J Expiration date of Driver's license 0 Signature of policeice Chlef or designee Date 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. Office Use Only Approved application DCI report State certified driving record Website update Date of,eAA@RNBA00EAPPL0201Bonnded.000 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 hereby certify that I have issued to me by issuedon6D2Picentof i Transportation `�a 25d Driv` understand that if I nse number 713 5 2 hcation may be denied. I agree that in making this application, I falsely answer any questions In this application, that this app' Y records consent to allow agents or employcaton,sandof thfurther agree thate City of Iowa hif authorization to, Iowa, in their be discretion, taxicab drriiver s granted, to comply at all documents relating to this app 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 / �j� Date 3—�.—Z'l signature of Appiicantz� STATE OF IOWA ) COUNTY OF JOHNSON ) day of on this Subscribed and swom to before me by 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 Police Chief or designee Date 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. Signature of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update c,NTAwcan9ADcsAPPre2D1Gima ded.00c 0412018 09AWAWI'1D16:lUTUMCAb DCI IOWA (FAI,M33ez„a 8904 P. 1/ali= FAX STATE OF IO`VA Cfl&hj9 bppry:cord Check C l T "lipt Form fit 10V"A CITY,101".A bCI Accoont Number; 9967-F (i; applicable) Mail or Fax comoleted forme to: Iowa Dlvhloo of Criminal L•eedgetioe Support Operatious Bureau, 1" Moor 7,15 IL 76 Street Das Moineo, Iowa 56539 (515)725-6066 (515)725-608D Pa: Chnok ,Sind M&W Igr Nome VeAbwZab of low& Cl!y. Address P.O. Box 424 Iowa City,, lows S214r Phone 19 7 Fax 319.359.4142 l %7� U/ �rn � Ct'in Pion � l• erP, �� As of MAR 2 2 2021 , a search of the No Iowa Criminal fiiytory Record ❑Female I//F/— '?,/— v Iowa Crlmiaai Mrory Record attached, DCI DCI mitiele.CC,- DM -77 (updated 0626-2018) Received Time Mar. 16. 2021 4:01PM No, 8394 Pap 1 oft , rdlNal)mi1.#d w, 6t1Ae6;•., �' r tis : is.�9:_d.gl. X t e� •;?.+ • Iowa Crlmiaai Mrory Record attached, DCI DCI mitiele.CC,- DM -77 (updated 0626-2018) Received Time Mar. 16. 2021 4:01PM No, 8394 Pap 1 oft Mar.12.1021 10:48AM DCI IOWA No. 8909 P. 2A IOWA CRIMINAL HISTORY DCI 00482290 MISDEMEANOR CONVTCTTONS ONLY PAGE 1 OF 3P---' DATE PRINTED- 2021/03/22 DCI:00482290ttt p y + NAME: BURTON,CANERON LEE 7011 PAR 29 PM 1. 59 DOH SER RAC 14GT WGT EYE HAIR SIGs F9r#p1 Y CLERK 19760424 N. N 51)9 175 RLU SRO FAR lA#A CITY. Io IrvtA ADDITIONAL TDENTTFTFRS DISP EFF DAT 19940818 19940818 DISP EFF DAT 19950320 19950320 19970717 19970717 DISP EFF DAT 19950320 CCH RECORD ••- 01 ARREBTBD/TAKKN INTO CUSTODY 19940704 AGENCY- IA05201DO CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSSESS SCHEDULE I/MARIJUANA TRK*: 001541901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSSESS SCHEDULE I/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK*: 007541901 SENTENCE FINE $250 COURT COSTS $75 02 ARRESTED/TAKEN INTO CUSTODY 19941125 AGENCYa IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OMI TRK#: 012452301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE. IA321J.2 OPER VEN MH INT OWL CHARGE CLASS: MISDEMEANOR CONVICTION TRK*: 012452301 SENTENCE DEFERRED JUDGEMENT COMMUNITY SERVICE 50H JAIL SO REVOKED COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321-215-2 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 Mar, 22.1421 10:48AM DCl IOWA No. 8909 P. 3/4 CHARGE NO- 01 ONi 2ND OFFENSE TRK#: $00346901 COURT DISPOSITION AGENCY: IA057015J COUNT NO- 01 DCI 000/2290 M I L E IPA6B 2 OF 3 tDil MAR 29 PM 1: 59 IA STATUTE 123ffr? ftERK IOWA CITY. IOWA LINN CO DIST COURT IA STATUTE: IA321J-29 ONI 2ND OFFCN9T CHARGE CLASS. MISDEMEANOR CONVICTION TRK#: 500346901 SENTENCE PLEAD GUILTY JAIL 7D FINE $1500 COURT COSTS 04 ARRE9TID/TAKEN INTO CUITODT 20000701 AGENCY: IA0780000 POTT CO so CHARGE NO- 01 IA STATUTE IA321J-21 DRIVE NRILE DENIED OR REVOKED TRK#: $00328701 COURT DISPOSITION AGENCY: IA0780150 POTT CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.218 DISP EFF DAT 19990825 19990625 19990625 19990825 DRTVINO WITH SUSPENDED LICENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 600328701 SENTENCE DISP EFF DAT PLEAD GUILTY 20000703 JAIL 2D 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. Mar, 22.1021 10:48AM DCI IOWA No. 8909 P. 4/4 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 luthorliaiion in not sufficient to obtain this information from the Division of criminal Investigation. in order to request the release of confil"tw 2#*"e1: 5 9 records, if any, an application must be filed pursuant to Iowa Code section 737.147(10) • CITY CLERK IOWA CITY. IOWA 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 137.147(18). IN TBE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BARED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF cRIMINAL INVESTIGATION t Q# IOWA DOTA'RJJ SMARTER I SIMPLER I CUSTOMER DRIVEN rhv5l�PdOt SOV G I T Y i, _*N s 1dx11rleatlon Smk*s 10W=92MIp; fMnes.IA5MO6.92a '�Tbfiei 91'5-73�Y-3721 Fall 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/18/2021 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. Occident Date Case Number )UR )4/27/2016 918183 IA )4/26/2019 1111068 IA Name: Burton, Cameron Lee DL/ID: 359KK2073 Pursuant to Iowa Code §321.10, 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: Qp�lrsEnT 00 7gTM90 3/18/2021 O sr Driver & Identification Services Iowa Department of Transporation Name: Burton, Cameron Lee DL/ID: 359KK2073