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Home My WebLink About12-020First iddle Last 1. Name LLQ 2. Mailing Address ♦ C. ta 3. Telephone: Home -q LP Other: 4. Prior experience in transportation of passengers: / f Q /��6 y4a, on 0-!E L 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?k)(3 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Tvoe of offense Where When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /U a 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) den .,dnvbatlg 09/2010 Authorization Number /d. --da r 1 (Office Use Only) �•`.Ww®r��l CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday- Friday.) Iowa Cit l0 2240-1826 (319) 356-5040 Q 19) 356-5497 FAX First iddle Last 1. Name LLQ 2. Mailing Address ♦ C. ta 3. Telephone: Home -q LP Other: 4. Prior experience in transportation of passengers: / f Q /��6 y4a, on 0-!E L 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years?k)(3 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Tvoe of offense Where When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /U a 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) den .,dnvbatlg 09/2010 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number 14-C�' Xi[ � 0 'S / . 1 understand that if I falsely answer any questions in this application, that this application 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 Signature of Applicant 1YV 0 A14 Date ( %-o- +++aa+++««««««aaa++a++a+aa++a++++++aa+++aa++aa+aa+aaa+aaaa++aa+aa+aa+a++aaa+eaa++aaa++++++a+m+++++ao+a+++++++as+aa++++aaa++aa++aaaaaaaaaaa++++ STATE OF IOWA ) COUNTY OF JOHNSON ) Su scribed and sworn to before me by f t tG�r_ t ti �� On this 2�ay of "'n"` s Kewe k.7UTTL ry Public in and for the State of Iowa My Com i i E p: 1 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). or of City Clerk or Date /— 3/— /.?— 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 der midnv geaW2010,d 09/2010 Jan.10. 2012 9:54AM Div of Criminal Investigation v%111 J• c v I L I, J R III, V It r V 1 6 Is V l t r U1 l u w a V I t y • , I I� ; STATE OF 1O WA CriminalMsto>ryRecord Check RequestForm TO Iowa Division of Criminal rrivesuggaon Support ol,ara(lons Bureau, l" Itlooe 215 E. 7'4 Street Deahlolnos,%WA 50319 (515) 729-6066 (515) 725-6080 h'9Y[ Choolc on: M ttir Y No. 9233 P. 7/9 No. im 1. DCTAcconntNumber; -� oa dL — F (ifappllceblo; $rola: CITY Oir IOWA Gin CITY CLI;w g Omen 410 P. WASHIMON RZ=T Yhone;. 319-956-5041 17nxl 319..3465447 An;s 5o cfal Saollrlta 1Vtlmb er WaPa"' fOrfnalion; without a signed Waiver from IhesabJeet of the request, a complete 011afnal history reoard may not ho roleasgble, per Code orYawal Chapter 692.2 -Far gorn ploto'criminAlhistoryrecord inrarmntlon, as allowed by iayi' plNayg ff n (pC(), p,Iya,ry,rinel hlaeory deraoonromfngmo•Ihaelsmalntolnad Iho imey6o tetNlodNnitolved bylnly, �[liVeY IiignaluYC: .Iowa Criminal Histoky Record Check Results , (eclurooaly) As of_ IO —I 69— . a seavah of the provided name and ditto of bllth•revealed. IBJ No Yolya Q11141pa1 History xtecord found w1t11 bCT CI Yowa oiim➢nal YTistoryReoord attached, DCI# DCI 2eceived Time Jan. 3. 2012 4:34PM•No.4930 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, !A 5030fr9204 515-244 9124 FAX: 515-239-1837 Inquiry Date: 1/3/2012 Name: Hulme, Mary Annis Address: 1603 CROSBY LN City/State: IOWA CITY, IA 522405815 Mailing Address: 1603 CROSBY LN Mailing City/State: IOWA CITY, IA 522405815 Name: Hulme, Mary Annls DL/ID: 428XX5051 Certified Abstract of Driving Record DL/ID #: 428XX5051(IA) Class: C Audit #: 4691499 Issue Date: 09/22/2010 Expiration Date: 10/07/2015 Endorsements: NONE Restrictions: NONE Date of Birth: 10/7/1960 Sex: F History Information CLEAR DRIVING RECORD Customer #: 4718071 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Pursuant to Iowa Code §321.10, 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: "'.'.•:�/'/'�� 1/3/2012 IOWA*' D. 0. T....10 V C401V �F QaR S` rl Office of Driver Services Iowa Department of Transportation Name: Hulme, Mary Annis DL/ID: 428XX5051