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Home My WebLink About16-1721 r 1 iii=®t2 ra.alr�_ CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO ju, -1 -1 7, (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 First Middle 9 ma 11- 3. Contact Information (REQUIRED) Email: C4.tv,f_rtne _that , tu4 �i.i (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) PI 5. Prior experience in transportation of passengers: ;)La3a 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Mn Tvoe of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? NO Tyne 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? iv D 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) NO o DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE frERIFIED .i DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC"IC EF,EVIEW— You must apply for an individual Department of Criminal Investigation Report (form ayaflable upon requQst). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number I :It* Am E,SS 2 issued on g-:2.1 V expiring on 9 al t b . 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 i�a7i[ruf/flL�Q/�LC�f Date STATE OF IOWA ) COUNTY OF JOHNSON ) //,, 1 Subscribed and sworn to before me by�Q4�FLhrnc —f~ joarf&&L on this 9gday of aoz¢ %%lo..l u ,.) A"- �r w 23 1 t Nota Public in and for the State of Iowa +###+++m++++r*+++++f++r*++++++m+mm+m+++mm++++++++++++++f++mm++m+++r*r++++++mm+++++++++m+++++++f++++++++r##+*++++++r+++ 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 Driver's license !— L l Z �2,�-( Signature o olice 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. �' lam K � ✓ �'�� 9 he" Signat-Gre of City Clerk or designee Date N C� cJ+ Office Use Only Approved application DCI report State certified driving record Website update N aWkrnx1DR1VacocEAP"2014e .00c 07/2016 F/ r, U 6• 1 V• IV IV V I I• IV Illy, C, .,IV l y VI V ]filll l l d l I 11 V C S I 19 d I I U f I NO, 1 OU r, L/ T -- -.-----.-� oa/22/2016 1,:6_ .:636 ..-„2/002 am �CATi E OF IOWA C ridyrnirma➢ IH[iggory Record (Check Requesq Form To: Iowa Division of Cylminal Investigation Support operations 3urtau, I"Floor 215 r. 7'b Street Des Mottles, Iowa 50319 (515) 725-6066 (5"15)725-6080 Fag CAat a- r-7- Iq(,o e—'el vu C— DCS Accountldumber: L 3 ot)-� -- (ifspplicn6le) From: _City of lows Cfty _ City Clerk's lDfOce 410 C. Washing(ots Street lova City, IA 32240 Photse; 319-356-5041 Fal: 319-356-5497 — ❑Male Menlale J �N e [E3� —S3— z?BC�C) rrarvertnjormation, Withouts signed walver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For comalete criminal history record Information, as allo obtain a wsiver signature from tilt subject of the reoug.st. wed by taw, always if"*" ReleMe: I hereby give permission for ole above requcsting offtciel 1, conduct an lova criminal history record Cheek with uha Division of Qiminal fMVWigationtDCI). Agy crhninel hinory dare eonnerningmcthal is mai0ieimd by the DCI play be released as 6110ived by lily.. I ' MaiverSignature,� _ r . m aau ana[aa AA13lua 1Wrutil U 1—nCCK KeSUHS _ Asof� g -ab c _-__ , a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DC1 t i r� JJC1 initials- 4�0 �1 DCI -77 (08/25/10) Received Time Aug. 22. 2016 1,44PM No. 2290 Iowa Department of Transportation O!/oe d Dnvw SeivN= (idi Ftao) 800532.1121 4" PO Sox 9280, Des 111010les, A W3DBQM 515.240.9124 FNC 515MO-163I CLEAR DRIVING RECORD Name: Marcum, Catherine Jane DL/ID: 124AM6552 pursuant to Iowa Code §321.10, I, 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: 8/22/2016 IOWA �.a.�":'1 aNes� Office of Driver Services Iowa Department of Transporation - ,.;,�.. ro Name: Marcum, Catherine Jane DL/ID: 124AM6552 �. .�,,,,,, Certified Abstract of Driving Record Inquiry Date: 8/22/2016 DL/ID #: 124AM6552 (IA) Customer #: 6536906 Name: Marcum, Catherine Class: C ID Status: None Jane Address: 4274 WOODLAND Audit #: 1246552 DL Status: VAL HILLS DR Issue Date: 08/22/2016 CDL Status: None City/State: BROOKLYN, IA Expiration Date: 09/17/2024 CDL Cert Status: None 522119586 Endorsements: NONE CDL Med Status: None Mailing Address: 4274 WOODLAND Restrictions: Corrective Lenses Restriction None HILLS DR Supplement: Date of Birth: 9/17/1960 Mailing BROOKLYN, IA Sex: F City/State: 522119586 History Information CLEAR DRIVING RECORD Name: Marcum, Catherine Jane DL/ID: 124AM6552 pursuant to Iowa Code §321.10, I, 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: 8/22/2016 IOWA �.a.�":'1 aNes� Office of Driver Services Iowa Department of Transporation - ,.;,�.. ro Name: Marcum, Catherine Jane DL/ID: 124AM6552 �. .�,,,,,,