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Home My WebLink About15-139r .fr®tai CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) f` 2. Address (REQUIRED) 1¢ IDENTIFICATION NO. / 5- 1 '� q (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 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date Middle Cell Phone: (All\written communication sWt via email) A b. Taxicab Business Name (REQUIRED) RED) Ib --W - 1 5. Prior experience in transportation of passengers:� r x- ( * t C LL T PkV'p— ✓may 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Il Tvpe of offense What happened to the charge? (Circle one) envicted,, Dismissed Deferred nd P u1 ty Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When `7 r^ Other When What happened to the charge? (Circle one) onVice ) Dismissed Deferred Suspended P - Gui tl Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? jV�7 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 ne(s) NC r a.. DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEsS tIFIEE ] DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE ClAii F REWEW You must apply for an individual Department of Criminal Investigation Report (form ,., Co (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY txq 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certfv that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 4� ''e) 0 issued on L expiring on 16 _Z, -1 - - . I understand that if I falsely answer any questions in this application, that this a plication 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 fu er agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of;Title 5,,G�apter, t f the C' ode. (Needs to be signed in front of a Notary Public) r * - G3 Signature of A licant 7 Date 9 �� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by this �t � day of i 11\:,, V 01 S ArENM$Notary Publijn and for the Statg of Iowa N COMM"t� E.v� 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 Chauffeur's license 10 [Z(Q 617 j 41 q3 Signature orPolic4 Chi f or designee o7D9 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. Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 7 /y /s to Cle,krrP IDRIVBADGEAPPL92014amended.DOC 03/2015 �V a w rC= r— Et. o .J Cle,krrP IDRIVBADGEAPPL92014amended.DOC 03/2015 Page 1 of 2 WWW' iowacot gov WARTED, I SlIMP'L-J I CUST0V_P DRNEN Office of Driver Services PO Box 9204 Des M, -: les, 14. 50306-9204 Fho-.e: 515-244-:1241:00-532-11?1 IFax: 515-239-1 S37 J'w x.!owado:.gov Certified Abstract of Driving Record Inquiry Date: 7/9/2015 DL/ID #: 431XX9040(IA) Name: Thalken-Hicks, Regina Class: D CDL Med Ann Status: OWI Test Failure Address: 621 S DODGE ST APT 8 Audit #; 9021538 06/10/2012 D53 Issue Date: 04/21/2015 City/State: IOWA CITY, IA Expiration 10/26/2017 D53 522405401 Date: IA Endorsements: 3 Mailing Address: 621 S DODGE ST APT 8 Restrictions: Corrective Lenses Date of Birth: 10/26/1965 Mailing City/State: IOWA CITY, IA Sex: F 522405401 History Information Convictions Customer #: 622326 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert None Status: Revoked CDL Med None Status: OWI Test Failure Restriction None Supplement: 01/23/2010 Citation Date Conviction Date ACD Explanation County JUR 09/08/2009 12/02/2009 A20 Operating While Intoxicated Johnson 1A Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 09/08/2009 A98 OWI Test Failure IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 09/19/2009 03/17/2010 A98 OWI Test Failure IA IA Suspended 01/23/2010 06/10/2012 D53 Non -Payment of Iowa Fine IA IA Suspended 07/20/2010 09/09/2011 D53 Non -Payment of Iowa Fine IA IA 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 Transportation, 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: 7/9/2015 •""'•••"W%y 7/9/2015 : 0,�4 D.. 0. 0. T.,9 fBR=' Office of Driver Services Al, Mol Iowa Department of Transportation Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 Page 2 of 2 7/9/2015 Jun.26, 2015 3 : 4 5 P M Div of Criminal Investlgaticr Fr ... .y �a. v.a .—•y Cl arw �.•i•�.. uiee �eo��ei No, 9852 P. 1 g6/26/2016 13tei 0136 r.UO2/002 STATE OF IOWA @ Requegt Form CriMinai Hi,S6.(11y Record Check TO; Lava Divisiu(1 Of Criminal lnrescigalien .Support Operatl4fl.9 Bilreall, I" Floor 215 L, 7n' Street DOL hon}nes, Iowa 50319 (515)725-6066 (515) 725-6080 Fax D(.1 />.coottnl Number.,__ (ifapplltaUle) From: _C� afluwa Cid_ _ City Clerk Ig Office 410I,_ Washingtrm street, -__---,•---- 1 mva (: L, IA 52240 I'Ilonec 3I9.356-5041 l;ax: 319-356-5497 all, requeslill an lows Criminal iiistoly Record Check on: Laa Name Onsndatdry)�iY3t Raare (Inendalo y> M fiddle Nat late 01 Birth (mlabedtalory)C Gender (mandatoy Sueial Security Number (recon �iV�A1C lop•¢n131e 147 3 - `� U [� Wailrer Xrrformalio(rr Without it signed waiver from tllcsubject of the request, a complete crlmival hisla y record ala) not Oe releasaUle, per Code of Iowa, Chapter 692.2. For complete criminal history record iufm motlou, as allu�rad 6y law, alHays ohfalll a Waive(' Sighs Lure from (Ile sill of the renuwcl Waiver Release: Ifcrtb), givcpp)oiSS.0n for rhe abol•e re uestin o'wial Igmnjisru criminal history record chtck,aidl Ila Division orCsinlillat In.essigalion (DCI). Any aiminal history aaynctrr wsl7ilg e ih�sris maimam�d y she Del n1a a MV es alta ctl Isa•. rr / Wail)erSigntl tve:__ - iio"ra CriminalistClreelzir(i Checl� I�esuits As of _ id a search of the rnruvided name and date of birth revealed' 1" rr t: No Iowa Criminal History Record found with DO ci lu�Nra C.rinainal Ylislory Kecold attached, DO 4_ �� —77 r)GI initials liLLll„ I�ci.77�osiz;filo)'------------------- Received Tirae Jun. 25. 2015 1 24P No. 1647 (DCI ase 013th) ry Jun.26. 2015 3 : 4 5 P M Div of Criminal Invest;gaticin IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00639840 NAME: HICKS, REGINA ANN TNALKEN,REGINA ANN THALKEN-HICKS,REGINA ANN DOH SEX RAC HGT 19651026 F W 507 ADDITIONAL IDENTIFIERS SC L CHK TAT ABDOM TAT L WRS TAT R HIP TAT R SHLD DCT 00639848 PAGE 1 OF' 2 DATE PRINTED - 2015/06/26 WGT EYE HAIR SKN POB 160 BRO BRO FAR CA PHOTO AVAILABLE: Y No. 9852 P. 2 CCH RECORD *** 01 ARRESTED 20010310 AGENCY: IA0520200 IOWA CITY PD CHARGE 140- 01 IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE/SCHEDULE I TRK#: 100180901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCRO58209 CHARGE CLASS: N0N CONVICTION TRK#: 100190901 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010817 PROBATION lY 20010811 COMMUNITY SERVICE 20H 20010817 DISCHARGED FROM 20021022 DEFERRED JUDGEMENT 02 ARRESTED 20090908 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE TRK#: 1A0090B01 COURT DISPOSITION AGENCY: IA052015y JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / 19T OFFENSE COURT CASE ID: 06521 OWCROSS327 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IAOOI0801 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT No. 9852 P. 2 Jun.26, 2015 3.45PM Div of Criminal Investigation No.9852 P, 3 JAIL EINE Dcl 00639848 PAGE 2 OF 2 2D 20091202 $1250 20091202 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELRASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCT, IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION m