Loading...
HomeMy WebLinkAbout16-108.a III ML k% • Mwl®��'l 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. IU `1 0�7;5 (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 (F b. Taxicab Business Name (REQUIRED) Middle Cell Phone: 3l6 Lft % y (All written com�mjunication sent via email) 2 tIREDI V/��/2d�6 i 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 Where When A P What happened to the charge? (Circle one) N6 Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? A/V Type of offense Where When What happened to the charge? (Circle one) /VCS Convicted Dismissed Deferred Suspended Plead Guilty Other t 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?-Axb Type of offense Where [Vhen 9, Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide then-ame(s) ' w 11 -14 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 I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number (p 3 Q ftfi 2� 9{ issued on 3 Pb? -expiring ong l & 00y7 . 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 04JZY� -- Date w %� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by l,zL,6OZh A 51T< on this Lo day of ,a A Z6/le 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 lj -� Signal lice Chief or designee Kd/2-,-)lC 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. k Signa a of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date ae,wrvaDRiva. G� PPLe2m4am.,ded.Doc 0312015 Fr 26. 2016 10:14AV �rDiv of Criminal Investigation os �0 2O � �:No.5071 s P� 5/5 1. 00P I � �"ars '> ielfietal Histlary Recalyd Check � TBegeact.St T'a��'b�a 0 OC1 Acr_.ouni Ouniber: _ _)�_Dcra_`r (Ir appji C,W,) Tn: lows Division of Criminal investigation From: _ City of lu va City Support Opera ions Bureau, 1" Floor CRy Clerk's office 215 E. 7`^ ,3ytreet910 E. 6✓askila11n Street Des Muiues, laati-a 50319 – – (SIS) 725-OL66 taus [ ity�1a 4224 _^� (51.5)725-6090 Fas ~�- -- Phone: 319-356.5041 _ )Fax: 31.9-3.56-6497 1 stn reauestina an Towa Criminal Miston, Record Check an, Last Name Onondatory) First Namedolog9 Middle Nawe (reumn,rnd=d) �7ma Date oflT�iGrth (n,anaalmy) Gender (mans to r) Social Security Number (rceommc»dca) l I �� ®Male male — Q �7 7OD ff"Ovel' rltfortnalion., Without a signed waiver from the subject of the request, a complete criminal his(ory record may not be releasable, per Code oflown, Chapter 692,2. For cam fete criminal history record information, as allowed by lair', always obtain a waiver signature from the subject of the re nest. –f��1C/V61-1i��CfSE-}i,crcbl'virrprrrnissiemforlac-ahwcrcyvcsting-M}hetdt't6CdlydlydCaMmca-ctanfi8l'ISnt r -r cor - c cc•w he C�rvlsiono nmina InveAigalion (ACI). fury criminal hismry data coacvning me tbal Is rnain1e01ed )'III n 1 Way easeedd sa allowed by law. �4.e`Gr-u if rdveb'.ii�i1(ffLl1'C:.— Iowa Criminal History Record CheckesR ults - As --;(f1Clyiui only) of1`\lip a search of the provided name and date of birth revealtd; No lows Criminal history Record found with DC1PQ r r r ® lown Criminal history Record attached, ICI # !; DCI initials_ A.P � w DCI -77 (09/25/10) Receive6 Time M5y.20. 2016 2:32PNi No. 007 iUVVA IDIOT SORTER I SIMPLEP I CUSTOMER ©RIVE" Office of Driver Services PO Box 9204 d Des Maras, to 50340-9294 Phone: 515-244-91241804-532-11211 Fax: 515-239-1837 www.[oowadot.gov Inquiry Date: 5/20/2016 Customer #: 6027595 Name: Fax, Elizabeth Ann Address: 430 N 1ST ST APT 1 City/State: WEST BRANCH, IA Convictions Certified Abstract of Driving Record DL/ID #: 523589662 Mailing 430 N 1ST ST APT 1 Address: D Mailing WEST BRANCH, IA City/State: 523589662 Date of Birth: 9/19/1989 Sex: F Convictions Certified Abstract of Driving Record DL/ID #: 639AH2534 (IA) CDL Permit Class: None Class: D Cl Permit Issue None Date: Audit #: 9876415 CDL Permit None Expiration Date: Issue Date: 03/22/2016 CDL Permit None Endorsements: Expiration Date: 09/19/2017 CDL Permit None Restrictions: Endorsements: 3 ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit Status: ELG CDL Cert Status: None LDL Med Status: None History Information :itation Date Conviction Date ACD Explanation CountyJUR _. .0/21/2014 01/28/2015 .S92 :Speed lohnsonIA Name: Fox, Elizabeth Ann Dri 639AH2534 Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, 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: Fox, Elizabeth Ann DL/ID: 639AH2534 5/20/2016 r~a 4`S Office of Driver Services _ ' f Iowa Department of Transportation>