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Home My WebLink About14-135,4 �tI11Wr�� CITY OF IOWA CITY, 410 East Washington Street Iowa city. low Szz40-1 Z6 (319) 356-5040 (319) 356-5497 FAX 1. Name i7 r 3. 4. Authorization Number ` APPLICATION FOR TAXIIMOft (Police Department between 8 a.m. to 3 Mailing Address a %2 L�0 � ).C - Telephone: Hom�n ( :�,C Prior experience in transportation of passengers: (Office Use Only) D PEDICAB VEHICLE DRIVER ;w must be made Monday — Friday.) Last 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where, When 9. Have you ever applied to be an Iowa City taxi driver using a diff ergnt name? If yes, please provide the name(s) Vl✓,��\VU- t-EvCL_� 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) derWII Iddvbadg 03/2014 I herebyzCertify that have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Lf '� W� 47j . I understand that if I falsely answer any questions in this application, that this application m y be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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,@nd-documents relating to this application, and I further agree that, if a license is granted, to comply at all_tir .Qs with all of/the proves 6ns of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA ) COUNTY OF JOHNSON Su scried and sworn to before me by i Qui h 0.I On this OT "�— day of 77— i _,�FT— KE11E IK —n Ti E Netary 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 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). Signat fPcir& Chief or designee J � Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signatu of City Clerk or designee '7/e/ice ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Ce,Wte dr;vbadgeapp2014d« 0312014 ,ZIIDOT wwwbWadotgov SMARTER I WAPI Iu1Rs I CUSTOMER. DRNIJN�,_a_.��.�� Inquiry Date: 7/2/2014 Name: Thalken-Hicks, Regina Ann Address: 621 S DODGE ST APT 8 City/State: IOWA CITY, IA 522405401 Mailing Address: 621 S DODGE ST APT 8 Mailing City/State: IOWA CITY, IA 522405401 Convictions .Office of Driver cervices. PO Box 9204 1 Des Moir". IA 50306-9204 Phan- 515 744-00241311 I F:ix:: 515-239-1831 -,tivAv.irs>Marlot gov Certified Abstract of Driving Record DL/ID #: 431XX9040 (IA) Class: D Audit #: 6486622 Issue Date: 11/21/2012 Expiration Date: 10/26/2017 Endorsements: 3 Restrictions: Corrective Lenses Date of Birth: 10/26/1965 Sex: F History Information Customer A: 622326 ID Status: VAL DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 01/23/2010 Citation Date Conviction Date ACD Explanation_ County )UR 09/08/2009 ;12/02/2009 'A20 ;Operating While Intoxicated '.Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR _. 09/08/2009 'A98 '.OWI Test Failure IIA Sanctions Type Effective End ACO - Explanation Occurrence JUR JUR Revoked 09/19/2009 '03/17/2030 A98 OWI Test., Failure IA ',,IA Suspended 01/23/2010 06/10/2012 ,09/09___ _.. D53 _.__... 'Non -Payment of Iowa Fine IA SIA Suspended 07/20/2010 -09/09/2011 ',053 .__. fI Non -Payment Non -Payment of Iowa Fine - -:IA .,____.. 77A Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportatlon, do hereby certify that I am the custodian of the records held by the Office of Driver 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: .......wl/'4r�y 7/2/2014 IOWA D. 0.1 i- Office of Driver Services %a " Iowa Department of Transportation Jul, 7. 2914 9:'33AM Div of Cfl'nlnal Investigation Nc, 3618 F. 5/7 Por (, N I I i U1 ( 1 To: fc*a bivisloh of Criminal Tnvestlgaflon Support Operations Bureau, V Floor 215 E. 7r' Street Des Moines, Iotrol 50319 (515)725-6066 (514) 725-6030 Parc I am roquestiof an Zowa Cd lninat Record CJteok on: mrst Name (man tiny ,. ACT AccountNiiwbm --1uo'., `S" (ifnppttoo6m) From: Clty of lowa Clty City clerlci$ Office 410 E, Washington Street aoeva Clty. 1A 62240 Phone; 319-356-5041 Y.w 319-356.9497 dle Name 0113 N . ID []MAID&female I `t1 t 25 — '5" Waiver 11formadloYd; Without a signed walvorfrom tho subject of the request, a complete criminalhistary record may not be releasable, per Code of Xowa, Chapter 692.2, ;,ior com lets erlminal history record information, as allowed by law, always obfain a st'atver sfvnatuYe fYom the sublect of the renuest - Wrrever,Refease; l hcmhy glvc permission for the abocc rrgw lnVesllgalmol(DCI). Any eriminal hismre.,loa neem re shat Is waiveF J�cri inirrel hi lOry record check with the Division of Criminal ere as allowed by l dv. Town Cit-imi>nal History Record Check Results (DCnlBsonly) AS of a search of the provided name and date of birth revealed: No loura Criminal Aistory Record found with DCT i lova Cximin&l Mstol:y Record attached, DCI O M initials Q - `T Received Time 'Ju -1' 1. 1) 0 14 12, 34 PN No, 3815 Jul 7. 2014 9:'14flYl Div of Crimiial Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI ;00639648 NAME: HICKS,REGINA ANN TBALAEN,HEGIDA ANN THALKEN-HTCKS,HEGINA ANN DOB SEX RAC HOT WGT EYE 19651026 F W 507 160 BRO PCT 00639848 PAGE 1 OF 2 DATE PRINTED - 2014/07/07 HAIR. 3m POB ERC, FAR CA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC L CHK TAT AEDOM TAT L WRS TAT R HIP TAT R SHLN CCH RECORD *** 01 ARRESTED 20010310 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE TA7.24-401 POSSESSION CONTROLLED SUBSTANCE/SCHEDUL$ I TRK#: 1.00180901 COURT DISPOSITION AGENCY; SA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCROBB209 CHARGE CLASS: NON CONVICTION TRK#: 100180901 SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY COMMUNITY SERVICE 20H DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20090908 AGENCY: TA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER V69 WH TNT (OWI) / 19T OFFENSE TRK#: lAO070BOI COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID; 06521 OWCROB6327 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A007OB01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION DISP EFF DAT 20010817 20010817 20010817 20021022 No. 3o18 F. 6/7 Jul, 7. 2014 9:54AM Div of CriTlna' Investi;ation No.3618 P. 7/7 SENTENCE JAxll PINE DCI 00639846 PAGE 2 OF 2 DISP Epp DAT 2D 20091202 $1250 20091202 AN ARREST WITHOUT DISPOSITION IS NOT AN INnICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BH RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THN ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUHJRCT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION