HomeMy WebLinkAbout16-228I
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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. /J -o— 'ZZB
(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
First
3. Contact Information (REQUIRED)
4a. Driver's License expiration date (REQ
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers: JiJr-)Irl �)-,
Last
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
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? I
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?
Type of offense Where When
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9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prpuide thaAame(fr
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND TATE CER
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICErHWFWEV
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
1 hereb th I ave is ued to me b the Iowa D rtment of Trans ortart�iopyn valid Driver's license number
s issued on t (o expiring on 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 provisio of Title 5, Cha , of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by t ri ci kw jCj_ -Du Nyl on this In day of
�2 L� 0 tom:
acne NM Notary Public i nd for the STate of to
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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 ate of is li nse 2/Z d/ Z
/a//1/ 4
Signatur_ of 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.
%LdLCit44' 9l
sign ure of City Clerk or designee
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Office Use Only
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Approved application
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DCI report
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State certified driving record—
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Website updateC
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ClinkrrAXIDRN94DGEAPPL92014amended.DOC
07/2016
oe/Aug. 9. 20164 1:06PMCeb Div of Criminal Investigation (FAX)319338TNo.0098 P. I/l/002
STATE OF IOWA
�� II����`�•�Criminal History Record Request Vorm
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DCI e••
To: Iowa Dlvlslon of Criminal Investigation
Support Operations Bureau, V Floor
215 E. 7111 Street
Des Moines, Iowa 50319
(515)125.6066
(515)725.6090 Fax
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From1 Yellow Cab of Iowa Cry
P.O. Box 428
Iowa City, IA. 52244
(319) 338-9177
Phonet
Faxt (319)339-7302
Lost Name (mandatory)
First Name mendeto '
Middle Name (rewmmcnded) '
Date of $Irth (mandato )
Gender(mandatory)
-Social. Security Number rocommelnd,d)
CJS J .[ `Q
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❑Male ff;emaIa
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Waiver Information: Without a slgned walver from the sub)act of the request, a eompigto grlminal history record tray not
be releasable, per Code of lova, Chapter 692.2. For SOMR101a criminal hlstory.reeord Information, as allowed by law, always
obtain a waiver signature from the sub ect of the request.
Walver Release: I hereby give perminlon ror the above requeslIng osMclel ro conduct An Iowatrhnlnal history roeord cheat( with the Dlvbtan orcdminel
Invalisallon (DCO, Any erlminel history 1111111 eonaem(ng m i Is almelncd bu t e Del me Nod N ellawed by law.
Waiver Slgnafurelt—
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Iowa Criminal History Record Check Results
As of !4 a search of the provided name and date of bltth rovealed;
No Iowa Criminal History Reoord found with DCT
❑ Iowa Criminal History Record attached, DCT #-___. IJ
DCllnitials �Qj U
DCI -77 (08/25/10)
Received, Time Aug, 5. 2016 10:50AM No. 1005
(DCI use only)
,
C,J10WADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN www.1°vvadotgov
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-9204
Phone: 515-244-91241 SGD-532-1121 I Fax: 5155-239-1837
www.iowadotgov
Certified Abstract of Driving Record
Inquiry Date:
10/1/2016
DL/ID #:
848AK0516 (IA)
CDL Permit Class:
None
Customer #:
6277560
Class:
C
CDL Permit Issue
None
Iowa Departme Department ,.
o
Date:
O
Name:
Dunn, Lawanda
Audit #:
8481774
CDL Permit
None
Name: Dunn, Lawanda DL/ID: 84BAK0516
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1
Expiration Date:
Address:
1960 BROADWAY ST APT 5C
Issue Date:
09/26/2014
CDL Permit
None
Endorsements:
Expiration Date:
02/26/2022
CDL Permit
None
i
Restrictions:
City/State:
IOWA CITY, ]A 522407025
Endorsements:
NONE
ID Status:
VAL
Mailing
1960 BROADWAY ST APT 5C
Restrictions:
Corrective Lenses
DL Status:
VAL
Address:
Restriction
None
CDL Status:
None
Mailing
IOWA CITY, IA 522407025
Supplement:
CDL Permit Status:
ELG
City/State:
Date of Birth:
2/26/1965
CDL Cert Status:
None
Sex:
F
CDL Med Status:
None
History Information
CLEAR DRIVING RECORD
Name: Dunn, Lawanda DL/ID: 84BAK0516
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:
s IOWA.
10/1/2016
®f OAIVE�°r
ServicesTransportation
Iowa Departme Department ,.
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Name: Dunn, Lawanda DL/ID: 84BAK0516
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