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Home My WebLink About21-032� r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3 56-5 040 IDENTIFICATION NO. 2 I - 032 (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 (319) 356-5497 FAX A 1. Name (REQUIRED) (nil Ia- Coad /` ar% 2. Address (REQUIRED) .SDS P^C-01el A L -C els Ii ac 5*?766 3. Contact Information (REQUIRED) Email: I' 10kMj111u e?O/L ",s Cell Phone: 3, 09 :33/-5�7o2% (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) /7- Q10-2/ b. Taxicab Business Name (REQUIRED) ye//.04-1 Co.6 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /O Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty When Other "' 7. Have you been arrested / charged with any traffic offenses in the last five years? lfzl� 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? W4�1 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) (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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number /2GB L71 Issued on oG^d.?^/7 expiring on d^/7^R/ 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 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) c Signature of Applicant !/rJ Date w —0:7/— STATE OF IOWA ) Y (¢¢ COUNTYOFJOHNSON Subscribed and sworn 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 ll �/� V '2 / —`%G�s � rstr2 fY-�- gfgnature of Police 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 -7 % /2-1 Date CIe MIDRNBADGEAPPL92018a=e ..DOC 04/2018 pyJun, 30; 2021 9:,04A:MCW DCi IOWA fAVIS=2�J)_ 29'3 1)021002 STATE OF IOW �%, Criminal History Record Check Request Form k s DCI Account Number: 9967-F ffwpOahble) Mail or Fu comWd& ftmes to: Send retulta to Iowa Division of Crlmltal Investigation Support Operations Bureau, 1" Floor 215 L 7' Street Da Moines, Iowa 50319 (SL!f) 721-606es (515) W-6080 Pal Name Ye114w.Cwe of lova Address P.O. Bo: 428 104" owl to" 32744 i Phone (3191378-9777�.._., Fax 319-3594142 Cj Iowa Criminallowa Cr urinal HUto Record Che�Che�Naa (=Wow �I��firninalr"� t/J w As of �' �' O� a search of the provided auger 4" ddteo6 it y" Baled: a ' N No Iowa Criminal History Record fotmtl c dVth PR;, criminal i a � ace — (1t,to(y 1r O z w ❑ Iowa Criminal History Record attached,w` DClinitials °j'{yrel%it'ntttVOfinaca�` O DO -77 (updated 06-26-2018) Pyo 1 oft Received Time Jun, 23. 2021 2:37PM No, 2232 Jun, 30. 2021 9:10AM OCI IOWA No. 2913 P. 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: hitpJ/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 arty, an application must be filed pursuant to Iowa Code section 232.147(18). N Cl C'] D C_ C= % 1 _ "{ C: f �rn 3m i~1 o� w CJf0WADOTwww.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Drtm & 10uNIBeatkm $MIMS PO Box 92041 Des Manes, IA 50306-92M Phone 515-245-91241 Fax 515.21837 Certified Abstract of Driving Record Inquiry Date: 6/25/2021 DL/ID #: 126BB6713 (IA) Name: Miller, Cody Alan Class: C Address: 505 LINCOLN AVE Audit #: 1853888 Issue Date: 06/02/2017 City/State: NICHOLS, IA 52766 Expiration Date: 11/17/2021 Endorsements: Motorcycle Mailing Address: 505 LINCOLN AVE Restrictions: Corrective Lenses Date of Birth: 11/17/1980 Mailing NICHOLS, IA 52766 Sex: M City/State: History Information CLEAR DRIVING RECORD Name: Miller, Cody Alan DL/ID: 126BB6713 Customer #: 4032893 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None N Restriction — None w Supplement: C ^� ^icy^ jJ y w 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: Name: Miller, Cody Alan DL/ID: 126BB6713 6/25/2021 C� Driver & Identification Services Iowa Department of Transporation