HomeMy WebLinkAbout16-126CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED) -
2. Address (REQUIRED)
IDENTIFICATION NO. lb _I,a
(Office Use Only)
APPLICATION FOR TAXICAB 1 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
i
3. Contact Information (REQUIRED) Email:171caj�IU��_G )I CcnGellPhone:
(All written mmunication`' nt vista email) "g
4a. Chauffeur's License expiration date (RE(Q�fL`11( UIRED) _I( )- D — 1 JE
b. Taxicab Business Name (REQUIRED) 1 1l)r C-))1 Cif �
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
nLs C�Q • i.4lt- uC - � �1'L4't L
`� hr 4: c: n C�C'r ✓1 t�q Si' 't i l( (" fbi 0.1C 14-- 'fit A V
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty Other
_i
Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where When
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?y
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 name(s)
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)
3,L�o
02/2015
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
PX 3/ X `� J issued on Ca'( expiring on /( -.3- [a�_. 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 provisigytis,of itle 5, C . ap or 2, of the City Code. (Needs to be signed in front of a Notary Public) h
Signature of Applicant '/ - �< Date 14-11-1G7
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by `� b
„i ao i b
in and for
on this \ day of
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).
r
Expiration date of Chauffeur's license
Signat ASO -
re f Police 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.
ig�ofCityeCr o�ignee/ Date
Office Use Only
Approved application
DCI report
State certified driving record
Website update
7111 ///,
ClerkrFAKORNBADGEAPPL92014amended.DOC 0312015
CI0WA DOT
SMARTER I SIMPLER I CUSTOMER DRIVEN, WWW.IOWCJQ.gOV
Office at Di wer Services
PO Box 9204 I Des Moines, IA 50306 D 264
Phone: 515-244-9124 1 8D0-532-1121. I Fax, 515-239-1837
wim. owadot. go
Certified Abstract of Driving Record
Inquiry Date:
7/6/2016
CDL Permit Issue Date:
DL/ID #:
431XX8380 (IA)
Customer At:
3616708
Class:
D
Name:
Peer, Melody Allison
Audit #:
1128856
Address:
411 HIGHWAY
1 W APT 2
Issue Date:
07/06/2016
VAL
CDL Status:
None
Expiration Date:
10/02/2018
City/State:
IOWA CITY, IA
522464206
Endorsements:
3
Mailing
411 HIGHWAY
1 W APT 2
Restrictions:
Corrective Lenses
Address:
Restriction
None
Mailing
IOWA CITY, IA
522464206
Supplement:
City/State:
Date of Birth:
10/2/1982
Sex:
F
History Information
CDL Permit Class:
None
CDL Permit Issue Date:
None
CDL Permit Expiration
None
Date:
CDL Permit
None
Endorsements:
Iowa Department of Transportation
CDL Permit
None
Restrictions:
ID Status
EXP
DL Status:
VAL
CDL Status:
None
COL Permit Status:
ELG
CDL Cert Status: None
CDL Med Status: None
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
05/18/2014 if 804935 dA
Sanctions
Type Effective End ACO Explanation Occurrence JUR JUR
Suspended 09/03%2013 109/11/2013 D39 Judgment ,IA IA
Name: Peer, Melody Allison DL/ID: 431XX8380
Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 am the custodian
of the records held by the Office of Driver Services, that this is a true and accurate copy or 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:
CII"'s
;......./G�/,/
7/6/2016
a IOWA
191,Office
of Driver Services
Iowa Department of Transportation
Name: Peer, Melody Allison DL/ID: 431XX8360
F,Ju1. 6. 2016„ 3:01PM�lerI'iv of Criminal Investigationo�ro6�2o,61C.— No,1865s, P, 2/22rOO2
STATE OF IOWA
Ciiimival History Record Check
a
j Request Folin �
ISGIAccount %tumber: w 'ICT') =
w (it epplienblc)
To: Iowa Division of Crlminal Ins-esltgation From: City of lolva 0(v
Support operattow Dureall, I" Mor City Cierlt's,Office --^-""—�"--
215 E, 7"',street 410 E. Washinolon b'treel
IDes Moines, Iowa 40319 ----- ""-- '� (515) 725.6080 Fax--
Fhotle: 319-356-5041 _
Fns; 319-356-5497
I aln rooltestirto an Iowa. Criminal %iistniv P rrneA
last Neme (mandatory) FlIrst Nartle (mnndmo(y) Middle Name (mcommerded)
Date of Birth (jnandaloq) Gender (nandaim Social Security Number recommended)
Waiver Inforination., Wit ]to ut a signed waiver from the sabietc of the request, a complete crintlit al hWery record map not
be releasable, per Code of lows, Chapter 692.2. For comulete crimina) history record information, as allowed by law, always
obtain a %alver sipnalure lrom the snh ect of the re uesl.
Waiver Re eaSel t hereby give peninission tar the above regnesling official loconductw lowacriminal historyfccard checkwith the Division of Criminal
hiresligalioo(DCI). My criminal hislary data coat n ma at is mainleind6 moi eDC( may be feleased rs allmved by law,
r?lVei',slmaiP.[[fflr'e: ! t --r JA`�•'-
m Iowa Criminal Histor Record Check Results (1)t:] usa only)
As of a search of the provided name and date of birth revealed;
No Iowa crimina] History Record found with DCI
t
C' ;
® Iowa Crlminal History Record attached, DCI i#__
�?
DCI initials7703
I)Cb77(QS/25/1U) ------------ ..._._---- -.�.—.-----
Received Time Jul. 6. 2016 10:36AM No,7