HomeMy WebLinkAbout12-019' r 1
►. memo
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing Address
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. Telephone: Home ��J" UI 0% I �-'&XA) Other:
4. Prior experience in transportation of passengers: A>��
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
/
(Office Use Only)
6. Have yo been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense
Where
When
8. Has your driver's license or chauffeurs 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 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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
deMaxidrivbGg 09/2010
I Mr
AMn Iii5 Il e Iowa Department of Transportation questions
valid Chauffeurpsp license number
I M l ll( l understand that if I false) answer an in this application, that this
appl?caflon may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
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 a license
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) _ A „ , I _ /1A ., , - n ) 1
STATE OF IOWA )
COUNTY OF JOHNSON )
}Su oribed and sworn to before me by IV0 kl�a i�LI�jy ,( On this 2-14A day of
20I,—
� e� U -C
KELLIE K. TUTTLE Notary Public in and for the State of Iowa
r CeunniCe0iren
�ull��eh+or
MY L—_ tr- E( Les
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Sig ture of o' Hief or designee
Signbture of City Clerk or. designee
Date
Date
After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
de"widnw Wap 2010,4 09/2010
Iowa Department of Transportation
Office of Drier Services (Toll Free) 800-532-1121
PO Box 9204, Des Moines, IA 59306-92134 515-244-9124
FAX: 515-239-1837
Inquiry Date: 1/17/2012
Name: Mcdonald, Nakita Rayshan
Address: 912 BENTON DR APT 11
City/State: IOWA CITY, IA 522465228
Mailing Address: 912 BENTON DR APT 11
Mailing City/State: IOWA CITY, IA 522465228
Certified Abstract of Driving Record
DL/ID #: 013BB2889 (IA)
Class: C
Audit #: 3070549
Issue Date: 03/03/2009
Expiration Date: 03/09/2014
Endorsements: NONE
Restrictions: NONE
Date of Birth: 3/9/1989
Sex: F
History Information
CLEAR DRIVING RECORD
Name: Mcdonald, Nakita Rayshan DL/ID: 013BB2889
Customer #:
4456995
ID Status:
EXP
DL Status:
VAL
CDL Status:
None ,
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
Pursuant to Iowa Code 021.10, I, Kim Snook, 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:
- ""••;�/"4
1/17/2012
IOWA ' E
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e
10. T.
,.:
.... S =
DR]
Office of Driver Services
I
Iowa Department of Transportation
Name: Mcdonald, Nakita Rayshan DL/ID: 013BB2889
Jan. 25.
2012
12:42PM
Div
of Criminal Investigation
No. 1233
P.
1/2
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L V I L
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STATE OF IOWA
Crlim3nal.faistor y).ecord Check
Request Form
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Phone; jig_156-•5041
17aX: �7 9-456-5Li 47
Data ooffjB' iyth menden 0611dor (mmldela) Social
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Wt7W0PA'1(r01711t10Y7,WithoutnsignedwaiverfromthesubjectofMerequeaPjaeolnpjoloorlyAfnAlhIstoryrecordmaynot I
be 1'olaashble, per Coda orYau% Chapter 692.2. For complete criminal history reap rd lnforinhtf on, as allwod by 141 i1 a rtrays
Wrerver lie%lY52; f 114Cby�tVO perallcefen fDC 1T10 nboYCrequeslfag 0niv7nf to cundeol tit fo1Y l 0tlmfnAl f hlorysetald Cheakwhh theiliv Stan OtCriminal
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Wa,Veysiggatuye;
Iowa C><•>iudkial Mstor` Record Check Results _ (nel ero only)
A-1 of "� 5' % asearch ofthonrovided name ei,d data of bfrth,revealed. '
No 16wa CrImInal Hjatory Record round with ))Cl
Yam Crlmfnal Matory Reeord attaohed, DC1
• l]CYinittals
Received Time Jan. 18. 2012 9:46AM•No.6414
Jan.25. 2012 12:42PM Div of Criminal Investigation No.1233 P. 2/2
IOWA CRIMINAL HISTORY DCI 00721128
COURT DISPOSITION PENDING PAGE 1 OF 1
STATUS UNKNOWN DATE PRINTED -
2012/01/25
DCI:00721120
NAME: MCDONALD,NAKITA
MCDONALD,NAKITA RAYSHAN
DOB SEX RAC HOT MGT EYE HAIR SKN POB
19890309 F B 503 140 SRO SLK DRK MI
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE; Y
CCH RECORD ***
01 ARRESTED 20040322
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA714-1-3
THEFT 3RD DEGREE
TRK#: 053371101
COURT DISPOSITION
AGENCY:
COUNT NO- 01 IA STATUTE IA714.2(4)
THEFT 4TH DEGREE - 1970
COURT CASE ID: 06521 JVJV003372
CHARGE CLASS: STATUS UNKNOWN
TRK#: 053371101
SENTENCE
ADJUDICATED
DELINQUENT
PROBATION
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
I NTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
RCEMENT AGENCIES BY THE DCI.
ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
ED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION