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Home My WebLink About15-228CITY OF IOWA CITY 410 East Washington street Iowa City. Iowa 52 240-1 82 6 (3 19) 356-5010 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. Jam) Z.-Z`a (Office Use Only) APPLICATION FOR TAXICAB 1 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 ro-( M 2. Address (REQUIRED) +-{ 0 �1 3r R T I v� �4 10 VJ� Cl):2I 3, jt Contact Information (REQUIRED) Email: +'-LACdr, i (V\$ 1'1 . C Ew Cell Phone:,319 3 aS-6 i ( (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 10 1 3 1 f 7 b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of passengers: yew ti- 'I` AcG 5n—C i 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? (,e > Type of offense / When � ,1Where ('a X11�� Ar—+c, What happened to the char ?Circle one) "F - f Convicte Dismissed Deferred Suspended Plead Guilty cher 7. Have you been arrested / charged with any traffic offenses in the last five years? \� C S� c _y AY Type of offense Where ,yWhen w CGfa i V1- C 01« What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Pled Gyl Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Ab Type of offense Where When 9. Have yo y ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) o 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) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that h ve sued to me by the Iowa Denrt ent of Transportation va d Chauffeur's license number SS d� issued on expiring on t013111') 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, 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 f Title 5, Chapter 2, of the City Code. (Needs tob:7ne d in front of a Notary Public) Signature of Applicant �Q V+! Datel S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ��r, i - _1 j jr� I on this 1 day of Public in anrjor the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant a: have Mermined that there is no information which would indicate that the issuance would be detrimental to the safety, Intfi or v"are oft �gi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). —4 'a r.v Expiration date of Chauffeur's license !/ 1 ; Signature of Poke ief or designee 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. aj-) .� Signafttre of City Clerk or designee oZ/ is D to ******X*XX*X*XX*XXXXXhtXXxxXXXXxXX****************fX******************.*ix%**kAk Gk*k**k*XXXXXX*X***)*Xx**X*Xi*•********************************* Office Use Only Approved application DCI report State certified driving record Website update Qi DRmenoG EAPPL92014an,eoda .Doc 0312015 ��, u�ihv ic.7vi Y1 Cl �r U i v vl 1,111111 IId; i rl v e s l l c d� 11 o0 IVO 7�UU Y. _...__ _._ Ds,l11/2016 S ATET f.}A' 11UWA N4 ' � °, �"rtlt��►t�f I��Estc�r�51 ��ecrJl�ci �;'CJQ�rlf � �` y Regllc;St Form 91Yv fly IOv- Division ut'Criminal in tmst igatlo11 Slfppnrl Operations lila ea o, 1" noon 21s1.'111,anLL( Des 1416neS, loWa 50319 (510 725-6066 (514)725.6590 Fax 11131 /7 3 Rccord raL 1)('7 HcciIIn1Y 1\hnnhcl: ��(•-;, - (il'npPllcbhlc) J>rUil7: CiiyUflUW C — _r . __...._.--- C:ity ('lel•Jrs orGea rn � ...._ 4J5batTJashtn (an51rFE' Iowa G�f!'S2�dG `� } Phone; 379.356 -SO -41 �'�� Fax: 319-356-5497* T", -8---'i'-X-S--'— s G)�". _...r ❑Male AFainale �eoetf, --, [worniftno)j: 4Vlthout a signed waiver from thesobjeet of the request, a compl��r m"e�islo�� cor�, no! be releasable per Cade of JoWal Chapter 692.2. For com tete criminal hlslor)• record information, as allowed by law, a lyap may obtain a waiver at nature from the sub -act of the re oast. W4iver i herrby €ive prnnisslon for the blveslie"'ll (DCQ, Ah) . wnterningbue ihe9ilsemnlgleinad 6111 a ndval An laws criminal history record check ivi0 the Uirision of C' uiroival bislmy Aale Ilminal Y DCI may be ulensed as ellowrd bylaw• 1'�lnIVC/'.f,Iy J((IfN!'e: G r As of G Ulc;l of the provided name and date ol'bilah rcvealud; ❑ No luWa Criminal Jiis(ory Record found with I)CI 1. MA Ju11a C'rimival History Xecurd attached, 1)C1 f/ J)(a Initials ^ I 1 .1 ....,,..,.____.._.....__.__.----- —IV DO -77 (58/25/IU) — — ..._.._.. __,.._...,. -.....__ _.... Received Time Sep, 11, 2015 2,25PN No. 7776 ,mow. iu, cvu �z.Ltvnvi u i v of vr!minai i n v e s i i g a i i o n IVo, � d 0 U Y. 4 DCI:00746357 NAME: WHITE,TRACY RRNSS DOB SETS RAC 19731031 F W ADDITIONAL IDENTIFIERS DISC LTHGH SC L HND 01 ARRESTED 20050321 IOWA CRIMINAL HISTORY DCT 00746357 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTE0- 2015/09/15 HGT WGT EYE HAIR SKN POB 505 190 14A2 ORO VA CCH RECORD *** AGENCY: IAD520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA155A-23 PROHIBITED ACTS TRK#: 101472401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA155A,24(2) PRESC. DRUG CONT SUB SEE 204.401 • 1989 COURT CASE ID: 06521 FECRO71878 CHARGE CLASS: FELONY CONVICTION TRK#+ 101472401 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE FINE $1000 MENTAL HEALTH EVAL/TREAT SUSPENDED FINE $1000 SUSPENDED PRISON l0Y PROBATION 3Y PRISON l0Y 02 ARRESTED 20120118 AGENCY: IA0460000 ION`A CO SO CHARGE NO- 01 IA STATUTE IA715A.6(2)-C UNADTH. USE OF CREDIT CARD UND $1,000 TRK#: 087927501 COURT DISPOSITION AGENCY: 1AD48015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE; IA714.2(5) THEFT STH DEGREE - 1978 COURT CASE 10: 06401 AOCRO10684 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ 087927501 RESTITUTION SENTENCE FINE $65 ♦ SC & CC DISP EFF DAT 20050923 20050923 20050923 20050923 20050923 DISP EPP DAT 20140113 E r� css r t[; L a I I 1 t '. I 11 u i v u I t, I l 11, 1 11 a I 1 11 V B O f l DCI 00746357 PAGE 2 OF 2 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF G[IILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION 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 THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION :.y ry a -a cn (/3 En a WWADOT 4 YV'VV%v i0krVadot,gov Office of Driver Services PO Box 9204 i Des Maines, 1.4 50306 9204 Phoney 515-144-9124 f SRO -532-1121 i Fax- 515-239-1837 Awoi.io,aadaL9ov Certified Abstract of Driving Record Inquiry Date: 9/8/2015 Dli #: 556YY2515 (IA) CDL Permit Class: None Customer #: 4912417 Class: D CDL Permit Issue None GO rn ` •3 Date: Name: White, Tracy Renee Audit #: 6671579 CDL Permit None Expiration Date: Address: 409 3RD AVE Issue Date: 02/06/2013 CDL Permit None Endorsements: Expiration Date: 10/31/2017 CDL Permit None "V - Iowa Department of Transportation Restrictions: City/State: IDWA CITY, IA 522454612 Endorsements: 3 ID Status: None Mailing PO BOX 654 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing HILLS, IA 522350654 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 10/31/1973 CDL Cert Status: None Sex: F CDL Med Status: None History Information Convictions ;(:nation Date Conviction Date 04/16/2011 05/18/2011 112/11/2014 01/27/2015 �`. ACD Explanation _.-.. 592 Speed (10 mph & under in 35-55 mph zone) 592 Speed pee County JUR .Muscatine ]A Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Acridenf Date 01/14/2015 :ase Number 839923 Jl1H IA Name: White, Tracy Renee DL/ID: 556YY2515 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. Name: White, Tracy Renee Dli 556TY2515 b +`uom in witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at AtI$eny, In this date <",^d GO rn ` •3 9/6/2015 ••* I" IOWA ' .... D...... S�@a Office of Driver Services Crg "V - Iowa Department of Transportation Name: White, Tracy Renee Dli 556TY2515