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Home My WebLink About22-006 IDENTIFICATION NO. 22 (OfficeUse Only) - t 'It Mel 1.417 APPLICATION FOR NON MOTORIZED PEDICAB DRIVER/HORSEDRAWN DRIVER CITY OF I OWA CITY (Police Department review must be made 4 1 0 East Washington Street between 8 a.m.to 3 p.m., Monday— Friday.) Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX F{r$ Middle Last 1. Name Required) �o ✓ v' �'Ohh 2. Address (Required) 1't N D_b >Fe- f /- e.11P .. 3ta_ 8) - `17117 3. Contact Information (Required) Email: }C�✓' ''a�-►o/Kal►�►t0�M' Cell Phone: 4a..Driver's License expiration date (Required): 14/1L,7"G b. Pedicab/Horsedrawn Business Name(Required) p@.(la d Po .&'e." 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? I" Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other 7. Have you been convicted of any traffic offenses in the last five years? N Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? NO Type of offense Where When 9. Have you ever applied to be an Iowa City pedicab/horsedrawn driver using a different name? If yes, please provide the name(s) 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) clerk/Non Motorized Pedicab/Horse Drawn Drive App.doc 03/2015 I hereby certfy that I have issued to me by the Iowa Dtiogrtmen of Transportation a valid Driver's license number '7461 PttL 5 79 issued on 1O/1 N 2.0 1'b expiring on 445/104 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, 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 a license is granted, to comply at all times with all of the pro- visions of Title 5, Chapter 2, of the City de. (Needs to be signed in front of a Notary Public) Signature of Applicant 7rVkAA ' Date J/ 13/9-o 5-'"' irk******i********************AAAAAA********************A AA A AA AA A AA***************************************A AAA AA A AAA*AAA A:AAA A A AA A A A*A************ T STATE OF IOWA ) COUNTY OF JOHNSON ) ? Sy,b_scribed and sworn to before me by ..nt ktX �Y1C 11urt� On this day of V `(10,A_ .2-2- ASHLEY A JAY-PLATZ Notary Public in n e State�bf to ICQmm►ssipalo.70 tooMy Commission Expires • July 14,202. a4-6 ************************** •.•.•.••..•::: *******************************************************ir************************** I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City(Title 5,Chapter 2,City Code). .�/2 3/ 2 o 2 - Si nat once Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A PEDICAB/HORSEDRAWN VEHICLE IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATCH THE DRIVER'S LICENSE EXPIRATION IF LESS THAN A YEAR. Signature of City Clerk or designee Date *******Onk**********AA AA Ak*****-k****k**************************************************A********************************************************* Office Use Only Approved application DCI report State certified driving record Website update clerldPedicab Non Motorized Horsedrawn Driver APP 2015.doc C4 lawA Dor wom. awa SMARTER I SIMPLER I CUSTOMER DRIVEN � V Driver&IdWNi(ie31AQn Servicts P4 Box 9204 I Des Moines.IA 5 O64241 Mane.515-244-9124I Fax:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/13/2022 DL/ID#: 799AK6574 (IA) Customer#: 6215621 Name: Donahue, Karter Class: C ID Status: None John Address: 1122 N Dubuque St Audit#: 3287912 DL Status: VAL Apt 6 Issue Date: 10/12/2018 CDL Status: None City/State: Iowa City, IA Expiration Date: 04/15/2026 CDL Cert Status: None 522451610 Endorsements: NONE CDL Med Status: None Mailing Address: 1122 N Dubuque St Restrictions: Corrective Lenses Restriction None Apt 6 Supplement: Date of Birth: 04/15/2000 Mailing Iowa City, IA Sex: M City/State: 522451610 —= History Information `--) ` _I rM > CLEAR DRIVING RECORD °.y� r� Name: Donahue, Karter John DL/ID: 799AK6574 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: ,no£MT OF �'!7,� 5/13/2022 1U (di?) 0,e y. Driver&Identification Services fiC�4L OOG S. Iowa Department of Transporation Name: Donahue, Karter John DL/ID: 799AK6574 IIIII ,,,,,` STATE OF IOWA "�, �` `~ M Criminal History Record Check ., Iowa ek , ` Request Form k DCI Account Number: (if applicable) Mail or Fax completed forms to: Send results to: Iowa Division of Criminal Investigation Name &irN S(\Yd.)/( I Pew( ec,d Cyr Support Operations Bureau, 1"Floor 215 E.7"'Street Address a. 5 A(e_ Sr Des Moines,Iowa 50319(515)725-6066 4 1 k RL pld S, - �L{U 9) (515)725-6080 Fax 2 jq 2 _ 1-t��j Phone 3 .1c..,�J l Fax I am requesting an Iowa Criminal History Record Check on: Last Name(mandatory) First Name(mandatory) Middle Name(recommended) Donahoe ✓4-tr J e kr, Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) y-I 6—,9,000 gmaie ❑Female LI 3-a1, ( )?- Release Authorization:Without a signed release from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law, always obtain a signed release from the subject of the request. ***This form(DCI-77)is the only approved release authorization form for this purpose:*** Release Authorization: I hereby give permission for the above requesting official to conduct an Iowa criminal history record check vi�,,��lh the Division of Criminal Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by ldw. I unddand this can include information concerning completed deferred judgments and arrests without dispositions. Release Authorization Signature: " v Iowa Criminal History Record Check Results (.....t use only) , � � o�a, , As of- a search of the provided name and date of birth revealed: < "� 0 ,� ->-1 No Iowa Criminal History Record found with DCI p �_ -n 2eftO ❑ Iowa Criminal History Record attached, DCI# r' N D 2 N 0 DCI initials C I I cn co o�of Crirni .a r • DCI-77(updated 06-26-2018) ,(5' •• L Ct • ?Page1of2 s (owa cr = .history res ltl d'•. S• a - /1/014atiOn SeP��. �nnr n n 11 t t,t n 11UU\,',