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Home My WebLink About16-255IDENTIFICATION NO. lam_ Z55 1 l 1 (Office Use Only) rl.11f�_ APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319)3S6-5040 (319)356-5497 FAX Fi st Middle\ Last 1. Name (REQUIRED)v\��Y�1�1lEe- 2. Address (REQUIRED) It V� 0.c ti Cot}-�-T t v�o— Ci =a S a -a -q o 3. Contact Information (REQUIRED) Email: Cell Phone: 36'-5'W-3�F8E, ( iAITf wrtten communication sent via email) °jh 4a. Driver's License expiration date (REQUIRED) o 14 / a S / 0l0 3-o b. Taxicab Business Name (REQUIRED) {_ 2_L0LO Ct A 6 0--' L0 --,A G : y 5. Prior experience in transportation of passengers: r Ayit V : vyS �Qs<.v CA P3 o'F Zp-wA Ci-r�i 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?I� U Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? 4 t S Type of offense W here When 171101 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended cplead G il 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 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please.Koy deme nart) y DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED 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) 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 SS �} X .1h `{ 7 issued on i l- 01 - I to expiring on o� �S do �O 1 understand that if I falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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 Applicanc�;;ti _ Date 0-15-16 1 1,10}rr' LoSa' � (�Ctiv-S�" V STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �a�y} 5,A, on this /5- day of 0nJ Qw. I .r T,!qliQ WENDY S_MAYER Jam' rotary PurblicM and for the State 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 Z5 1;Z07_0 (1 �a Signa ure o Pol oe Chief or designeeDate 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. Sign-reSignku-re of City Clerk or designee Approved application DCI report State certified driving record Website update prate ClerkfFMIDRIV64DGEAPPL92014amended.DOC 07/2016 Office Use Only ; `{ r - r7 rTi ClerkfFMIDRIV64DGEAPPL92014amended.DOC 07/2016 C410WADOT wwwiowedotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Diner Services PO Box 9204 1 Des Moines, IA 50306-92D4 Phone: 515-244-91241800-532-11211 fax: 515-239-1837 www.kmadot.gov Inquiry Date: 11/15/2016 Customer #: 3971082 Name: Snyder, Janet Address: 9 DUNUGGAN Cf Certified Abstract of Driving Record DL/ID #: 554XX0048(IA) Class: D Audit #: 1403405 Issue Date: 11/01/2016 Expiration Date: 04/25/2020 City/State: IOWA CITY, IA 522402831 Endorsements: 3 Mailing 9 DUNUGGAN Cf Restrictions: Corrective Lenses Address: Restriction None Mailing IOWA CITY, IA 522402831 Supplement: City/State: Date of Birth: 4/25/1951 None Sex: F History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 01/17/2014 101/23/2014 S92 HiSpeed (10 mph & under in 35-55 mph zone) Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/07/2016 1939682 IA Name: Snyder, Janet DL/ID: 554XX0048 Pursuant to Iowa Code 4321.10, I, 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 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: ria 'J `J�tyelf�il a?:' IOWA ''•.�'� 11/15/2016 •., Ir •• • •• g01t� Office of Driver Services ;'� � Iowa Department of Transportation ry rV Name: Snyder, Janet DL/ID: 554XX0048 -,.' ,t/Nov. Q. 2016*t2:52PMCeb Div of Criminal Investigation (Fax)3)93382AP'7159 P: 1...oziooz STATE OF IOWA Criminal History Record Check J Request Form; DCI Account Number: _9967-F l if opplionbp) Tel Iowa Division of Criminal Investlgoglon Support operations Bureau, I" Floor 215 2. 7" Street Das Moines, Iowa 50319 (615)735-6066 (at5)'725.6080 Fax F,romi Yellow Cab of Iowa C) P.O. Rox 428 — i Iowa city, Tr1„ 52244 PI(one: (319) 338-9777 'Fax, (319) 339-7302 ❑Male �Fetnale I 3�`%• t%"��/'% I Waiver Infoymattion. Without a signed waiver from the Subject of tho regpest, a complete grlminal history record May not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal hlStory•rocord Information, as allowed by law, always obtain u walver Signature from the subject of the requast, Waiver Rd14aSe: I hereby slvo permigslon rot the ab*ve requoallna omelal to c*nduol an Iowa erlinlnel hislory record *hook Mill 1114 olvlelon efCrlminal W0118111011 (DCO, My ulminel history Bald concomine me Mal Is matnialned . by the DCI nay be ieleaaed ax Allowed by I►w. Waiver Signature, A5 of 6 a search of the provided name and date of birth revealed: ItL No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI # DCI initialed . DCI -77 (08125/10) Received Time Nov. 4. 2016 MOAN! No.7466