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Home My WebLink About15-287CITY OF IOWA CITY 110 East Washington Street Iowa City, Iowa 52210-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. _ IS, — 2g (Office Use Only) APPLICATION FOR TAXICAB I 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 Middle Last 2. Address (REQUIRED) q au ry ��g c v ter} i T�rwv-C, --La,/o 3. Contact Information (REQUIRED) Email: IfinG"�Shlc(ev Cell Phone: 31`7.5 -IV -3,P& All written ommunication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) 614 5La 0,;L U b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: -. , +c> c -„,A V� C -, St WCY k -P�- (I o-� �v�c3 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? €. 5 Type of offense Where When :SY'Aa "� 1 6 C P117. T-1 I i'V-o I S 1 -77 What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead GG liu It-- Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense/ `� Where When �Er,d"Lo 0es5fk-y, IUCuf-r) Lt,o-C. 1 'b-sbl- What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?( o Type of offense Where When G� 9. Have you ever applied to be an Iowa City taxi driver using a different ni yes, please provadathe DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CiRTIFIEWn 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 I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i X - D o r4 issued on it ot, etclS" expiring on aila5rDo ao I understand that if 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 of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date r STATE OF IOWA ) COUNTY OF JOHNSON $u scribed and sworn me by n fi � (_ on this day of -41;t �-i r�t�orn befo nei_rl i=;, Ti ---7 Notary 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 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 //C,,od�ee). Expiration date of Chauffeur's license V ( Z > 44Z I 36 5 - Signature of Police Chief orZlsignee I IDate 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. Signaof City Clerk or designee Date -3 1 _ � J Office Use Only --+ Ci m� Approved application DCI report r� Z r State certified driving record Website update car ClerkrrAXIDRIVBADGEAPPL92015amended.Doc 03/2015 C410WADOT jnlAi-Zr�nt- SM, APHR I Sid, PLEEF I CUSTOMET; ON `J '!'.3Ctit Office Of Driver Services PO &ox. 9204 •;Des Aloins,. (490306-5204 Phone_ 51t-244--4124 { 800-532-1 t2i € Fax: 515-239-1837 w:k'.v.tti'A':tiof.gov History Information Convictions Citation Date Conviction Date ACD Explanation _ __ County JUR hzone 01/17/2014 101/23/2014 592 Speed (10 mph & under in 35-55 m _ P ) Johnson IIA I Name: Snyder, Janet DL/ID: 554XX0048 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: ..........*T&.4 4 11/6/2015 Certified Abstract of Driving Record Inquiry Date: 11/6/2015 DL/ID #: 554XX0048 (JA) CDL Permit Class: None Customer #: 3971082 Class: C CDL Permit Issue None Date: Name: Snyder, Janet Audit #: 9261010 CDL Permit None Expiration Date: Address: 9 DUNUGGAN CT Issue Date: 07/17/2015 CDL Permit None Endorsements: Expiration Date: 04/25/2020 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522402831 Endorsements: NONE ID Status: EXP Mailing 9 DUNUGGAN CT Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing IDWA CITY, IR 522402831 Supplement: City/State: CDL Permit Status: ELG Date of Birth: 4/25/1951 CDL Cert Status: None Sex: F CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation _ __ County JUR hzone 01/17/2014 101/23/2014 592 Speed (10 mph & under in 35-55 m _ P ) Johnson IIA I Name: Snyder, Janet DL/ID: 554XX0048 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: ..........*T&.4 4 11/6/2015 IOWA z D. 0. T.�i�� ........... p�ry�� Office of Driver Services Iowa Department of Transportation Name: Snyder, Janet DL/ID: 554XX0048 Ffvcv.23, 201ho M PM, .1 Div of Criminal Investigatrcn Nn 1650 1/2 —- ------._-. 11/19/2016 17:n. 032/ v. oozio02 STATE' OF 101WA Request Fom 1XI Account 1Jo111ber (if apulicoblc) TO; Iowa Ilivision ofCrintinal IO2stigotion From: Cit = of Iowa C'ity 4 uppm a Operations B n rens u, t" Floor_._ ---- 215 L. 7" Street Ctty Cleric's office 410 r. Washinvton.Street Dee It40ines, loKa 50319 — _ (515) 725-6066 loeva City, IA 52240 2.45 5041.1 ax 1 ant re uestin an };.anti -12111 n» late of Birth hnanda � -aS- /R5) Phone: 319-356-5041 _ rax: 319.356-5497 -- First 1Elmale Wewaile. I `7 — IL4 ( - 3 ) I —� rrurver rn-forinartolt: Withoat a signed w2lver front tilesublect of the request, a emnplete crlrtl!net hislory record nlay not be releasable, per Code of Iowa, Chapter 692.2, ror complete eriminal history record information, as ollorecd by taw, ahvays obtain a IYAiver signature from the subiect of the reonw Waiver Release: i con ccollpg nl¢ IAaI is maialai ped by IIIc DCI III Ly be releosed a3 allan'ed by 15w, Waiver Signature: �o`va Cril>tl�nal Hi�tory� Itecorcl Check Resu�t,s / (OCT llsc on1y7 As of ,(� / �'�/L � a search of the provided mule and date of birth revealed; L f No low'a Crtmi„al History Record fowrd with DCl rT..I I'1 U l�J hAva Criminal History Recuid attached, DCI # 'v c� , ur,-, ..;1 Y= V7 DC111711 181S_ DCI -71 (08/25/10) ry Pecelved Time Nov, 17. 2015 41VM No. 2904