HomeMy WebLinkAbout15-046CH OF IOWA, CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
IDIENTVICA I ION N0,...jf Lj.'/Q
5
(Office Use (:)niy)
APIPLiCKriON FOR TAXICAB I Uy 01"OfflZED l'-IEDiCAB VEl-111CLIE DRIIVER
(Police Departnmnt I Imu.ust be made lbehveen 8 a.irn, to 3 p.m., Monday (Friday)
1. Name YR i'
..........
2. Address
3. Contact Information (REQ UIRUED) Email: 0
,Ill wrld RM LI =nunicat�
4a. Chauffeurs License expiration date (1:U -Q1 jli'"I. 1!)) t.. oh ) It
b. Taxicab Business Name fR:EQI UR:'d))
5. I::Irlor experience in lyanspartafiep of pas;sre6l'eir'&:
.. ... ... ... ... ..... --------
Cc('10 (Phone:
6. Have you ever been arrested / charged with any msdenneanors, and/or felonies �n this SV3ter or elsewhere?
:Eype of offerise Wheri"VVI.
............... . ......
.......................... . ................... I ----------------------------
7. Have
to the charge? (Qi de one)
//z / 0
-C rr Susperldec"��)e2d quAt Other .............. .
saes !in the Ilask five years?,........
When
..................
Convicted Dismissed Deferred Suspended
8. Has your driver's license or chauffeur's license been suspended or revoked in RII3e
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please
provide the name(s)
DEPARTMENT OF CRIMINAll INVESTIGATION (DCl) lRISPORT ANID STA -1-1E CEIRTIIFJ,11)
DRIVING RECORD MUST ACCOMPANY '11-1111S APPUCAIriON FOR PU iCE CHISIF REVIEW
You I aI for aim indivlduW Depantrinwit of CrimiriM InvesUgallJon Report (rorm avaiiable upon irequest).
(SECOND PAGE FOR REQUlRl:..M S1lGNA'1nJRE AND NOTARY)
02/2015
AFt:4UC.A11110u 1:�011i'llA'MACAiIII�I:Iltlm011..111=.I:tolUA11ll1�1
Page 21
NOT I M-401 "Ma NO AW111141115, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
STATE OF IOWA )
COUNTY OF JOHNSON )
and sworn to before me by ,,,,,,,pp� on this`kk. ,,,, day of
II have reviewed this application, 1DCN report, and the State certified driving record of this applicant and have deter.
mined that there its no information which would indicate that the issuance would be detrimental to the safety, health
or wellffare of residents of the City of Iowa City ('Title 5, Chapter 2, City Code).
Signat a oe Chdaf or designee Date
AFTER APPROVAL BY TH11 CITY CILERIK RII( YOU ARE AUTHORIZIF. D TO DRIVE A TAXICAB 1114 IOWA CITY FOR IMO
NU ORIF.:,'THAN ONE YEAR l::ROM THE DATE ILISTED BIHILOW..
THE EFFIMTIVE DATE y9 IL.II.. (MATCH THE CIhiA0.UFFEUR'S LICENSE EXPIRATION IIF LESSTHAN A YEAR.
Signat�M'
Clerk or designee
Office Use only
Approved application
DCI report ... ....
State certified driving record
Website update
...................... ate ,
ClerkrrAX1DRIVBADGEAPPL92014amsrK%d.DOC 02/2015
°°f°w' Peb.19. 2015 9:39AM Div of Criminal Investigation ANo.0661 [P. 1/6
111111 GV. IY• LVIJ II•J'tnul 411p 4ICIA VIIP U1 IUNd UI ly 1VU. Jojo I'.
IIII IIIII
IIII
IIII IIII
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15 ��° 1�1'��I A
(Criminal ilHi �I �§ �} r �f r .S �i �I
Request F ,,
Support Oporationa Bureau, V'Floarr
D" Mobla, Town 50319
(515) 725-6066
(615) 129-6080 Fax
y'4A
RM
City Clorlev Office
A 410T.Wa Ion Street
Phone: 319-356-5041
Fax: 319-356-5497
I
c
R,
', �Itlgm� IIS
waiver S18 11
s i
As of a search of the provided name and date of birth revealed; I
No Iowa Criminal History Record found with MY
Iowa Crhnffid Ulstory Record attached, DCT {d
Received Time7°Peb.16..02015 11:32A Na. 0577
Feb,19. 2015 9,39AM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCT 00650023
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2
DATE PRINTED-
DCI:00650813 2015/02/19
NAME: GRAPZR,ASBLZY NICOLE
DOB SEX RAC MGT WGT EYE HAIR SKN POB
19021002 F W 505 170 GRN ERO FAR :1.A.
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
TAT BACK
TAT L FOOT
TAT L SHLD
TAT R ANKL
TAT UL ARM
No, 0661 P. 2/6
CCH RECORD ***
01 ARRESTED 20010812
AGENCY: IA0920100
WASHINGTON PD
CHARGE NO- 01
IA STATUTE IA124-401-5
POOSKSSION/MARIJUANA
TRK#: 055399601
COURT DISPOSITION
AGENCY: IA092015J
WASHINGTON CO DIST COURT
COUNT NO- 01
IA STATUTE IA124-401-5
P099USSION MARIJUANA
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 055399601
SENTENCE
DISP RFF DAT
DEFERRED JUDGEMENT
20011009
COURT COSTS
20011009
PROBATION
lY
20011009
JAIL
71)
20020117
FINE
$250
20020117
COURT COSTS
20020117
RESTITUTION SERVICE
20020117
REVOKED
20020117
02 ARRESTED 20020305
AGENCY: IA0920100
WASHINGTON PD
CHARGE NO- 01
'IA STATUTE IA123-46
PUBLIC INTOXICATION
TRK#: 055423901
COURT DISPOSITION
AGENCY: IA092015J
WASHINGTON CO DIST COURT
COUNT NO- 01
IA STATUTE IA123,46
CONSUMPTION / INTOXICATION
COURT CASE ID: 08921
SMSM036477
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 055423901
SENTENCE
DISP EFF DAT
JAIL
5D
20020320
CREDIT W/TIME SERVED
20020320
No, 0661 P. 2/6
Feb.19. 2015 9:39AM Div of Criminal Investigation
DCI 00650813
PAGE 2 OF 2
03 ARRESTED 20080620
AGENCY: IA0520100 CORALVILLE PD
CHARGE NO- 01 1A STA'T'UTE IA726„6(7)
E GERM T/NO INJURY
TRK#: IA004FTOI
COURT DISPOSITION
AGENCY; IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA726.6(7)
CHILD ENDANGERMENT/N0 INJURY
COURT CASE ID: 06521 AGCR003748
CHARGE CLASS: NON CONVICTION
TRK#: IA004FT01
SENTENCE DISP EFF DAT
DEFERRED JUDGEMENT 20087024
PROBATION lY 20081024
DISCHARGED FROM 20090819
DEFERRED JUDGEMENT
No.0661 P. 3/6
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICA'T'ION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI,
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS TH8 SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
A, U,�HUrr� 0�iP'`'
%/j/'UUM
r °Ioffice, or Drival S011""Cec;PO Box W.04 I DO Mol Lk 50300 OW4
Corti fled Abstract of Driving (Record
Inquiry Date:
3/3/2015 DL/ID #:
781ZZ7885 (IA)
Name:
Graper, Ashley Nicole Class:
A
Address:
3338 BLACK HAWK AVE Audit #:
8503828
r R on
NW LOT 505 Issue Date:
10/03/2014
Clty/State:
OXFORD, IA 523229204 Expiration
10/02/2018
peed
Date:
10/2312014
Endorsements: NONE
Mailing Address: 3338 BLACK HAWK AVE Restrictions: NONE
NW LOT 505 Date of Wirth: 10/2/1982
:Sailing City/State: OXFORD, IA 523229204 Sex: F
' T E11 ., li, u
Certificate Specifics
Medical Examiner First Name _
Medical Examiner Middle Name
..._............._....._..___.._.---------------------------------....--------......-------.......... ....._....'---_.....-_......
Medical Examiner Last Name
Medical Examiner License Number
Medical Examiner National Registry Number
Medical Examiner Jurisdiction
Medical Examiner Type
e ed Da._
Medical 6erthicate Expiration Date
Date Added to CDLIS Driving Record
1045217
None
VAL
VAL
Non -Excepted
Interstate
Certified
None
Citation Date
Conviction Date
ACD
Explanation
County
JUR
06/06/201d
a, r
r R on
12/05/2011
a
peed
10/2312014
02/13/2015
!Speed
ritlifii Ti7TIPP -In III
Ncx;8�r9a^airt IO mI:a,
Care INumber AiR.
J V.gd95/2tYR0 "g471
.31 PA