HomeMy WebLinkAbout21-049 IDENTIFICATION NO. d•1 -'0 9
r 1 (Office Use Only)
gia AO CO 111111.
APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday)
CITY OF IOWA CITY 11: 5
4 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application
Iowa City. Iowa 52240-1826
(319) 356-5040 Last First' Middle
(319) 356-5497 FAX
1. Name(REQUIRED) aei C%/, r7' /9//,y„i
2. Address(REQUIRED) Z 5 d?e, rsc/,c 4c ' �3 % ��[''; �� yG
3. Contact Information(REQUIRED) Email: )3„,.rp/Phcco G,v,A;).cor„ Cell Phonety9)
(All written ommunication sent via email)
4a. Driver's License expiration date(REQUIRED) s/y/,; f
b.Taxicab Business Name(REQUIRED) )/, j C'Ab c-3" 1 ,q 0-41
5. Prior experience in transportation of passengers: ,3 yew 4/yP fdw Cob
6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? I?te
Type of offense Where When
What happened to the charge?(Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested/charged with any traffic offenses in the last five years?
Type of offense Where When
=c cl �{,.JS(7 d Co y h, 7/I9
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? J
Type of offense Where When
9. Have„v you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
/u,
(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).
: ? ci
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number
issued on expiring on : I understand that if I
falsely answer any questions in this application, that this application may be denied. I agree that-immaking 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)
Signature of Applicant 4'yJ - aot,_ Date//3/8/
STATE OF IOWA
COUNTY OF JOHNSON )
1Subscribed and sworn to before me byc' (4 &'.H\c) A\c.,.� 1P i ps on this o2 day of
,vek/ -
vVENDY S.Mer 72 NotaryPublic in a for the State of low
i� f nmmiccinn NumhAf 7Zg4ZS
. o/mis
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 ) / G( 9e_
el / /
Signature of ce Chief or designee Da e
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.
Si nat re of Ci Cler o esignee Date
************************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Clerk/TAXIDRIVBADGEAPPL92018amended.DOC 04/2018
- • •12ct.,28,_2021._.2:23PMw cab DCI IOWA (0/031ea L0, 9653 P. 1)02i0o2
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STATE OF IOWA .1 , ,<,.
Criminal History Record Cheek
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r ..,'AI:._.. Request Form , '
' DCI AcaoontNmnber: 9961dP
(if applicable)
Mail or Pax,completed forms to: Send results.to; '
/owaDlvvatonorCrfmoaalPntvostigatioa Name 'yellow oil 1p _---
Support Operations)3ureaa;1�`Floor
215 IL 761 Street ,address Pf,O.Boar 428
Deg'Melnes,Iowa 30919
(319)723-306d Iowa Cttrr Iowa 62244 .
• (515)12S-6084 Fax . •
Phone (319)3384111 • '
Fax 319-359.4142 '
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DCI initials `y',4'`'t`ivr: Se „��,",,
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DCI-77(updated 06.26-2018).
. Page i of 2
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' Oct. 28. 2021 2:24PM DCI IOWA No. 9653 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:
http://www.lowasexoffender.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).
olowA DOT
SMARTER I SIMPLER I CUSTOMER DRIVEN i0wado .gov
Whiff 8 Idant1 C tion Sarw1c s
PO Box 9204 I Des Moines.IA 50331X-O1
Phone 515-244-9124'Fax 515-239-1637
Certified Abstract of Driving Record
Inquiry Date: 10/29/2021 DL/ID#: 627XX6064 (IA) Customer#: 2375713
Name: Phelps, Gilbert Allan Class: C ID Status: None
Address: 2254 S Riverside Dr Audit#: 4717773 DL Status: VAL
Trlr 53
Issue Date: 06/06/2020 CDL Status: None
City/State: Iowa City, IA Expiration Date: 05/14/2028 CDL Cert Status: None
522465852
Endorsements: Motorcycle CDL Med Status: None
Mailing Address: 2254 S Riverside Dr Restrictions: Corrective Lenses Restriction None
Trlr 53 Supplement:
Date of Birth: 05/14/1958
Mailing Iowa City, IA Sex: M
City/State: 522465852
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
08/27/2019 09/18/2019 S92 Speed Johnson IA
Name: Phelps, Gilbert Allan DL/ID: 627XX6064
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:
of HT ur. r,., 10/29/2021
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t,�L�4i DO[ Iorwa Department o'f Transporation