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Home My WebLink About17-161CITY 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. —( (Office UseOnly) 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 3. Contact Information (REQUIRED) Email: S0 �U Cell Phone: S( (All wri�� tion eYn icC� (� ftp 2 4a. Driver's License expiration date (REQUIRED) a 5. 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged With any traffic offenses in the last five years? Nth 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 y�W? Type of offense Where "VtifiAn n --tC.) �J 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pr.Qv`ae ttWnam jc 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify thatI have issued to me by the Iowa Department of Transportation a vali Driver's license number Lt'-,LRZ )1 S3 issued on (Z/1 (1 h expiring on `' - l Z- I � . 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 Date f11ffHHfHffHHHfYf fHHflfIHfHIHHfH IHH'fllki'1'1fe!'Y##M1fif f f 1'11HNH111Hff hf f f 111ff f 11fHf 11fYff f 1f f 1f f 1ff 11fHH11HfHHffMf111Hf STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by )� X't ti on this day of NENDY S. Notary Public in for the tate of 106 um 28 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 �S ! 2 A� Signature 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. C . Sig ature of City Clertyor designee S / D to HflHlffYrl'1ffHHHHffHHHHIfHffH1H1f4411f f 111f1f111m11HfHfH1Hf 1HHffHfHafff'!f iH#hf f if f 1Hf f f 111Hf1k1fH1ffH1HHfHHHHH Office Use Only Approved application DCI report State certified driving record Website update CorkrrrxiDRN14oceAnaai.92014an ded.DOC 07/2016 CIowa Department of Transportation AW CAce of Drw Services (Tai Free) 800-532.1121 PO Box 9204, Des Manes, IA 503%9204 515244-9124 FAX 515.2381837 CLEAR DRIVING RECORD Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 Pursuant to Iowa Code 4321.10, 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: 11/30/2017 =1 D. 0. T. �-c Office of Driver Services Iowa Department of Transporation!t"' Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 Certified Abstract of Driving Record Inquiry Date: 11/30/2017 DL/ID #: 433ZZ2783 (IA) Customer #: 3086333 Name: Purdy, Rochelle Class: D ID Status: None Marie Address: 518 NICHOLS AVE Audit #: 1469989 DL Status: VAL Issue Date: 12/02/2016 CDL Status: None City/State: NICHOLS IA Expiration Date: 04/12/2018 CDL Cert Status: None 5276677E Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: PO BOX 93 Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 04/12/1981 Mailing NICHOLS IA Sex: F City/state: 527660043 History Information CLEAR DRIVING RECORD Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 Pursuant to Iowa Code 4321.10, 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: 11/30/2017 =1 D. 0. T. �-c Office of Driver Services Iowa Department of Transporation!t"' Name: Purdy, Rochelle Marie DL/ID: 433ZZ2783 12/01/2017 9:08 AM FAX 3193397302 1 0ov,30. 20111 9:13AM Cnb0iv of Criminal Investigation IZ0001/0001 traX)31933e2N�• 7300 P. .1/1,/002 STATE OF IOWA Criminal History Record Cheek Request Norm Tot lows Division of Crimloal Inve1t4at1olt 94pport operatlons Bureau,la•Bloor 215 8.7" Strut - Das Moines, Iowa 50.119 (515)715-6066 (SIS) 725.6080 Fax y -(Z -fit DCT Account Number: _9967-F ' drappllenbla) Fromr Yellow Cab ofiowa Clty P,O. 2ox 428 Iowa CRY, IA. 52244 Phone (319) 338-9777 , -- Faxg (319)339-7302 �LciUl2' tiler (mandarom' 0Male zfRertll f s- rraavar"JormttUa)r: without a signed waiver from the subjeaknf eha request, a eomplgto criminal history record spay not be releasable, per Code ortowo, Chapter 692.2, For AaMIJ& criminal history record InfOrm4110n, as allowed by law, always obtain awalvarslenaturarriem the subject ofthe reodatt. WdIVRr %(B/daSB:1 barcby slue pembdon tar Ne abeua roquatllnt oMd d to randur an lowaadadrul htnoy n Lord eheak wllh the Dwaff orGlminal InvnllgaMon mcf). Any 0"Inal Maoy data otnoamins ma rhos b mallnalned by the DCI may bit roloosed as allowed by Jew. O Z .. Waiver A5 of ! I' ��' T , a soaroh of the provided natne and date of birth revealed No Iowa Criminal Hlstory Record found with DCI T,F. ,-0 ❑ Iowa Criminal History Record attao ed, DCI # DCI initlel9 w� DCI -77 (0825/10) Received Time Nov. 28. 2011. 4:12PM No.0656 •f