The URL can be used to link to this page

Home My WebLink About16-090Ak CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO - 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: � (� ZGF2 � Vl Cell Phone: �Z (AII ritten communication sent via m &hn 4a. Chauffeur's License expiration date (REQUIRED) /,g�0 Vt 133 1 b. Taxicab Business Name (REQUIRED) At � C aJo LLC - 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? Type of offense What happened to the charge? (Circle one) When `Convicte Dismissed Deferred Suspended Plead Guiiltyy nOther Have you been arrested 1 charged with any traffic offenses in the last five years? N Type of offense What happened to the charge? (Circle one) Where When 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? EZ `1 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'rtame(s)...:" DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF R1YIEilV' You must apply for an individual Department of Criminal Investigation Report (form available upbri request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby edify tha I v�y� sugd to me by the Iowa Department of Transportation a valid hauffeur's license number �'�7 5 I issued on expiring on /Z -3 1r' . 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-rbvigifdns-4�f Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature ofAppli6arll Date STATE OF IOWA ) COUNTY OF JOHNSON ) Syhscribed and s�woorn to before me by �tlu.c-Q�g {-1 CLt�v�.� on this I day of �1 I 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 Code). Expiration date of Chauffeur's license JAI h Signature e of Poli e Chief or designee 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. Signaturebf City Clerk or designee Da e 77 Office Use Only Approved application DCI report r7 State certified driving record Website update a.rvff�IDRiveaoceAPars2m4am.�ded.DOC 03/2015 State of Iowa Division of Criminal Investigation 215 E. 7"' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Wally _Tn Remoc4 Your name: �r Address: City/State/Zip:g-x T- Phone #: O Requesting an Iowa criminal history record cheek nn - Fill in all shaded areas. Last Name Apellido (mandatory) First Name Prune, -.Nombre pnandatoryI Middle Name S gwdo N .... M, (reoommended) Date of Birth F'erh, NucimienR, (mandatory) Mender Geweru (mandatory) Social Security Number irecommended) t f El male Female J er T Waiver Si nature Ftrma (It the request is on yourself; pleas, sign. If the request is on someone vise, write N/A) ) Results nsa As of 419--1L , a name and date of birth check revealed: ❑ No record found ` r_ 1 =, Record attached DCI # DCI initials Receipt Number of requests x $15.00 per last name= Total amount $ ( �, D Method of payment: cash money order check # MasterCard or Visa - (1,v4dimt,) Cardholder's name i-=, - a DCT initials -- --- ------------------------------------------------------- Credit Card # — Exp. Dale c.a DCI -83 (09/09/ 10; Revised 10/ 1/ 10; form reviewed 08/ 1 1 / 14) DCI:00517224 NAME: GILPIN,PAM GILPIN,PAMELA SUE DOB SEX RAC 19671203 F W ADDITIONAL IDENTIFIERS IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY HGT WGT EYE HAIR 506 130 BRO BLN CCH RECORD *** DCI 00517224 PAGE Y OF 1 DATE PRINTED - 2016/04/29 SKN POB FAR IA O1 ARRESTED 19960211 AGENCY: IA0560000 LEE CO SO CHARGE NO- 02 IA STATUTE IA'/08-1 ASSAULT TRY.#: 013605402 COURT DISPOSITION AGENCY: IA056015J LEE CO DIST COURT COUNT NO- 02 IA STATUTE: IA708-2(2) ASSAULT NO INTENT OF INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 013605402 SENTENCE DISP EFF DAT JAIL 30D 19960514 FINE $250 19960514 COURT COSTS 19960514 PROBATION lY 19960514 CREDIT W/TIME SERVED 19960514 NO CONTACT ORDER 19960514 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 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 TIIE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION A1% Iowa Department of Tr---%por'a t tion Ok-r- iIi' f rt yr s r rl -i • "oti I Irf 1 tvH `'I I1 11-21 NNEW I ^C S15 2�, 1S-ri Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Certified Abstract of Driving Record JUR Inquiry Date: 4/29/2016 DL/ID #: 830YY1331(IA) Customer #: 212457 Name: Alawneh, Pamela Class: D ID Status: None Sue Address: 1453 DICKENSON Audit #: 6527012 DL Status: VAL LN Issue Date: 12/01/2012 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 12/03/2017 CDL Cert Status: None 522409163 Endorsements: 3 CDL Med Status: None Mailing Address: 1453 DICKENSON Restrictions: NONF Restriction None LN Supplement: Date of Birth: 12/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522409163 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 07/30/2013 - --- 750711 IA 11/11/2014 _ 826535 IA_ 7 Name: Alawneh, Pamela Sue DL/ID: 830YY1331 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iovea Departm eof Transportation, do r hereby certify that I am the custodian of the records held by the Office of Driver Services, that this":l true and kc date copy of an official record currently in the custody of said Office, and that 7 have been authorized by the,Djr€,ctor,QSthe Iuwa,Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set uponthis dodlMent, at Ankeny, Iowa this date: �i5i1IfQ��yill 4/29f2016 IOWA r Name: Alawneh, Pamela Sue DL/ID: 830YY1331 ry r� c*3