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Home My WebLink About16-086`III'ArmEr It� CITY OF IOWA CITY 410 East Washington Street IDENTIFICATION NO. / 10 - (Office Use ) (!IIOUJ Cab COYYI V& U APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Iowa City. Iowa 52240-1826 La—UWC- will resufhtY Q_"enial of ni4e 3�.F (fCd{6CYft (3 19) 356-5040 (319) 356-5497 FAX 1. First Middle Name (REQUIRED) ; 17 'i'hP./lr /.0 /(/ Last ' r lCxooc{�w7�% 2. Address (REQUIRED) /ysS IV, JD-) f 1 #� AJ,) fh 3. Contact Information (REQUIRED) Email: m;o/ // . a,} /ior%�� ;a /a-�gu/iov Cell Phone: (All written communication sent is 4a. Chauffeur's License expiration date (REQUIRED) j - y-oZD/ % b. Taxicab Business Name (REQUIRED) �-- 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? No Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other ?. Have you been arrested I charged with any traffic offenses in the last five years? 6,zee,,Ll T e of offense Where When reed, ti l'ek� � �r`nne[C �Z,4 F 1j r7% �v aoz What happened to the charge? (Circle one) ( Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? IV 0 Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pravdeytheo),ame(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW ." A You must apply for an individual Department of Criminal Investigation Report (form available upon regde5t). a (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 U512Iq Hl `1550 issued on /a -3o /Y expiring on 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 of Title 5, Chapter 2, of the City/ Code. (Needs to be signed in front of a Notary Public) Signature of Applicant STATE OF IOWA ) COUNTY OF JOHNSON ) or �S{2 Subscribed and sworn to before me by _�� l�� ( JIJ ot1t�,❑ rbkthis _l C day of �1 GLV` 01 ( 0, - 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 -�! (-Z -/ ��L��2vl Signature of 1' Chief or designee Date- AFTER AP OVAL 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. Signdtme of City Clerk or desig ee /�9 /�vi� Date r�3 **#***#*#**##****#F#W##******#h#*#*W*#******###****##*W*W###*W*##****###**#********F##*W*******####*WW##****x#h#WW*****#£< } *x******##*WW**x*# 1:1 Office Use Only w 4 Approved application _ o DCI report —y State certified driving record Website update o CcerwrAXIDRmeaoceaPar92014 mer,ded.00c 03/2015 F DOT �../' www iOVcadot.g0�/ SIOARTCR I SIMPUP I CJISTOMER Office of Driver Services PO Boz 5204 Des Moines, IA 50306-9204 Phone 515-244-9124 1800-532-1521 I Fax: 515-239-1837 www.iowadot.gov History Information Convictions Citation Date Conviction Date ACD Explanation County IDR 37/20/2015 12/01/2015 592 Speed Poweshiek IA Name: Taylor-Woodfork, Michelle La Nora DL/ID: 652AH4950 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: Name: Taylor-Woodfork, Michelle La Nora DL/ID: 652AH4950 12/30/2015 Certified Abstract of Driving Record N Inquiry Date: 12/30/2015 DL/ID #: 652AH4950 (IA) CDL Permit Class: None Customer #: 6044033 Class: C CDL Permit Issue None Date: O Name: Taylor-Woodfork, Michelle Audit #: 6524950 CDL Permit None La Nora Expiration Date: Address: 1455 N JONES BLVD APT 5 Issue Date: 12/07/2012 CDL Permit None Endorsements: Expiration Date: 05/24/2017 CDL Permit None Restrictions: City/State: NORTH LIBERTY, IA Endorsements: NONE ID Status: None 523179026 Mailing 1455 N JONES BLVD APT 5 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing NORTH LIBERTY, IA Supplement: CDL Permit Status: ELG City/State: 523179026 Date of Birth: 5/24/1974 CDL Cert Status: None sex: F CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County IDR 37/20/2015 12/01/2015 592 Speed Poweshiek IA Name: Taylor-Woodfork, Michelle La Nora DL/ID: 652AH4950 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: Name: Taylor-Woodfork, Michelle La Nora DL/ID: 652AH4950 12/30/2015 N Office of Driver Services Iowa Department of Transportation tia _ (w ,r O Fh,. v .•> .vM�,vn> GIB>.. .. i. u.o. •.aro .ao�er gu•�ii 01/1l/20t(a 13:dw dVV i36i r.,iO3/003 Ci ivG,c STATE OF i • I 6 dCriminal History Record Check Reillnest Form '.1 v.rurn.,a 'to: Iowa Division of Criminal investigation Support Operations Bureau, V Floor 215 G. 7"' ,5treat Des Moines, Iowa 50319 (515)725-6066 (515) 725-6030 Fax I am regaestin an Iowa Criminal History Record Check on_ DCI Accotmt Number; t) cp0 Z --F (if applicable) From: City of Iowa Cit City clerics Office 410 r. Whildne on &trees Xowa City, IA 52240 Phone; 319-356.5041 Fart; 319-356.5497 — Last Name (mandato ) First Name (mandatory) Middle Name (recammaadaa) 4 ei N� u. Date of Birth(inandaloty) Gender nrandaloly) Social Securi N—h—(recammendcd) 7 y ❑Male EYFemale 33 • ••• �•��• rraur.vrcr waenuuc a ssgneo waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692,2. Fm- templet e criminal histgry record information, as allowed by law, always obtain a vyaiver Sian store from the snbieet of the renuesi- Wil iver Reieasv: I Ilcrcby give pIrrnissien for the above requesting affsew 10 touducl an Iowa viinidei hisidry ruord check with the Division of Criminal hwesligalion (DCI). Any criminal hisloq dela eonecming me Ilia( ii; maintained by the DG may be released as ellatved by law. Walver.Sianature; Iowa Criminal Histol Record Checic Results As of - l 1l X11 �, _ a search of the provided name and date of birth revealed; No lova Criminal History Record found will, DCl r c� )(Mra Criminal History Record attached, DC14 ' bCI initials -- DCI-77 (08/25/10) Received Time Jan. I1, 2016 12:31PM No -5126 (Dcl ose�nly) r C7 ca r.� FF—..-.—.-,—' `"•- •."—.. —•— —_."..—..-.,^. 01 /'1 / 2010 13:4 / v v 3E, u r.J02/005 elfrlULU STATE i': W Cdminal History RecordRequest Form r�fyrn L-.nAY` To: lova Division of Criminal Investigation Suppm't Operations Bureau, 1" Floor 215 E. 7" Street Dee Moines, Iowa 50319 (515) 725-6066 (515)726-6090 Pax Iowa ,cord Clneck on: 1)C1 Account Number: hr� (f apylicnblt) From: Cit y of lovva Cit City Cleric's office AIO E. Washington Street Iowa Clty, YA 52240 Phone; 319-356-5041 Pas: 319-356.5497 -- e % qI ❑Malewna►e I 3.1 7 .3 V-? waiver (nfarfnaliUrc Without a signed waiver from the subject of the request, a complete erbninal history record may not be releasable, per Code of Iowa, Chapter 692.2. For con_ 1plcte "lminai Itlsrmy record information, as allowed by law, always oplain a Waiver slonature from the.sr,hleet AF el.o ..,..,e.. 9'aiverReleasetllrorebyglvc pemilesian forlhe abover,questing offietallo colldac(an loe•a criminal h6fory recrdchcck reit htvesligelion (DCI). Any criminal history dale coaecrningme lhal is maintained by the DCl mayba releasedai allo cd by law, it the Division of Criminal n I. _. n Waiver Signature. - Received Time Jan. I1. 2016 12:31PM No, 5126 Iowa Criminal Histor Record Check Results �13i, are arary - As of _ a a search of the provided name and date of birth revealed; ' a No Iowa Criminal History Record found with DCI r ❑ Iowa Criminal History Recoid attached, DCI # -rl _ DC1 initials_—_ Y DCI -77 (oV25n0) Received Time Jan. I1. 2016 12:31PM No, 5126