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Home My WebLink About16-114' r 1 ��h 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. 1 (Q— i 1 L4 (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 3. Contact Information (REQUIRED) Email:ii�c—jtccketAPtio-vuu .( 4045gACellPhon6n).3-sl-p(sv 0411 written communic'Mr5in sent via email) 4a. Chauffeur's License expiration date (REQUIRED) a b. Taxicab Business Name (REQUIRED) experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 7 Type of offense 11) L1\ Where What happened to the charge? (Circle one) Convicted DismissedDeferre Suspended Plead Guil Have you been arrested / charged with any traffic offenses in the last five years Where When I 760 Other When What happened to the charge? (Circle one) `` Convicted Dismissed Deferred Suspended Plead Guilty Other �,',,A C 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense WG Where When 9. Have 1you ' ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the r ame(s), DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED `M1 DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF Ri VIEW 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 h reby cer ify that I ave issued to me by the Iowa Department of Transportation a val'd Chauffeur's license number '�, I[1(7 issued on t�-Z1-ZD1S expiring on 2I�� lr � 1 understand that if I falsely answer any questions in this application, that this application may be denied. grey e t1 at 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 applicationurt�e'iee that, if authorization to be a taxicab driver is granted, to comply at all times with all of theprovisiens-af To 5 hapter 2, djhe City Code. (Needs to be signed in front of a Notary Public) Signature of Date to -liq I LQ STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cribed and sworn to before me byb�Sthis �� day of iAr KELLIFK. WnIF i .S. d. moo 22181g 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 ofUa City (Title 5, Chapter 2, City Code). license /17/20 7io11" Signature ofrolice Chief 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. gn ure of City Clerk or designee Approved application DCI report State certified driving record Website update Date c'l Office Use Only clerkrrAxIDRVBADGEAPPL920143n,ended. Doc 0312015 Jun. 6. 2016 3:27PM D l v of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00639848 NAME: HICKS,REOINA ANN THALKEN,REGINA ANN THALKEN-HICKS,REGINA ANN DOB SEX RAC HOT 19651026 F W 507 ADDITIONAL IDENTIFIERS SC L CHK TAT ABDOM TAT L WRS TAT R HIP TAT R SHLD DCI 00639848 PAGE 1 OF 2 DATE PRINTED - 2016106106 WGT EYE HAIR SKN POB 160 BRO BRO FAR CA PHOTO AVAILABLE• Y COURT DISPOSITION CCH RECORD - 01 ARRESTED 20010310 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE/SCHEDULE I TRK#. 100280901 i COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR058209 CHARGE CLASS: NON CONVICTION TRK#: 100180901 SUBSTANCE ABUSE EVALUATION SENTENCE D18P EFF AAT DEFERRED 1T=RM2NT 20010817 PROBATION lY 20010817 COMMUNITY SERVICE 20H 20010617 DISCHARGED FROM 20021022 DEFERRED JUDGEMENT 02 ARRESTED 20090908 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J,2(A) OPER VEH WH INT (OWI) / IST OFFENSE TRK#: IA0070BOl COURT DISPOSITION AGENCY: IA0$201SJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / 18T OFFENSE COURT CASE ID: 06521 OVICROB0327 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#. 1AD070BOl MUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT No. 56//9'''1'' P. 6/7 �'J -&v p��e L -k LA i Jun. 6. 2016 3:27PM Div of Criminal Investigation No. 5691 P. 7%7 DCI 00639848 PAGE 2 OF 2 JAIL 2D 20091202 FINE $1250 20091202 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 THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. Qf�(D IIVVISION OF CRIMINAL INVESTIGATION - rq ARTS Page 1 of 2 =iZIUWwm0owadotgov DOT SMARTER 1 SIMPLER I CUSTOMER DRIVEN ��...�. Office of Driver Services PO Box 9204 1 Des Moines, IA 50306x9204 Phone: 515-244-9124 180(f-532-11211 Fax: 515-239-1837 www.iowadoigov Inquiry 6/14/2016 Date: 1909 1/2 MUSCATINE Customer 622326 Mailing IOWA CITY, IA Name: Thalkeh-Hicks, Regina Date of Ann Address: 1909 1/2 MUSCATINE Sex: AVE City/State: IOWA CITY, IA Convictions Certified Abstract of Driving Record Dli #: 431XX9040 (IA) CDL Permit Class: None Class: 522406409 Mailing 1909 1/2 MUSCATINE Address: AVE Mailing IOWA CITY, IA City/State: 522406409 Date of 10/26/1965 Birth: EXP Sex: F Convictions Certified Abstract of Driving Record Dli #: 431XX9040 (IA) CDL Permit Class: None Class: D Audit #: 9021538 Issue Date: 04/21/2015 Expiration 10/26/2017 Date: Endorsements: 3 Restrictions: Corrective Lenses Restriction None Supplement: History Information CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: 12/02/2009 CDL Permit None Restrictions: IA ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELS Status: 12/02/2009 CDL Cert Status: None CDL Med Status: None 2itation Date Conviction Date ACD Explanation County IUR )9/08/2009 12/02/2009 A26 (Operating While Intoxicated ]ohnson IA 10/28/2015 11/20/2015 ;S92 Speed '3ohnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence _ ACD Explanation IUR )9/08/2009 A98 ;OWI Test Failure IA Sanctions I — rype Effective End ACD Explanation Coo urreti`ed'St1RL "'•IUR Revoked 09/19/2009 03/17/2010 iA98 OWI Test Failure - jIA 'r 7, : A --- Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 L Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department ofiransportation, 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. http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 6/14/2016 ARTS Page 2 of 2 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: "•.w/'4 6/14/2016 .�4f,19 D.. 0. T.;: 9f DEIVER °a Office of Driver Services Iowa Department of Transportation Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 http://172.29.254.55/drivers/reports/customerhistoryleertifieddrivingrecord.aspx 6/14/2016