HomeMy WebLinkAbout12-037� r �
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 356-5497 FAX
1. Name
First
Tv I6%A
Authorization Number 1 —,5 7
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
Middle Last
,4v. t-, .1 e A t
2. Mailing Address \(0173 S ✓ C -t i 0 VjC' at- , I A 5224
3. Telephone: Home _LS q - 3-2-4 - 2.I S I Other:
4. Prior experience in transportation of passengers: k4 Vi Ge -K Com- dh c-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When
Vw
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? K c�
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When, I d
S�c�l \ rn�dlt lutes ax}arvt `i moos. U.cko
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 Iowa City taxi driver using a different name? If yes, please provide the name(s)
—TV-, 6. TDC
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)
uan✓i.,d,robade 09/2010
I hereby certi`fyI that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
S�%� 7 t 21 9 . I 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)
Signature of Applicant
Date12-
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STATE OF IOWA )
COUNTY OF JOHNSON )
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ed and sworn to before
nAn✓1A.-01
me by I LI a- 05= . On this L day of
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).
Signa re of Policei or designee
%J A/- /VZft/
gignalure of City Clerk or designee
&1Y1,Z
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.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
clan idnw dgomW2010d 09/2010
feb.13.
2012
11:18AM
Div of
Criminal Investigation
No.8962
P.
1/3
Feb, 7,
2012
*12:16PM
City
Clerk — City of lolra City
No. 2016
P.
2
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Iowa. Department of Transportation
Office of Driver Services (Toll Free) SOQ-532-1121
PO Box 9204, [)as Moines, fA 50306-9204 515-244-9124
FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/7/2012
DL/ID #:
556YY1218 (IA)
Customer #:
2287973
Name:
Yeggy, Tricia Ann
Class:
D
ID Status:
None
Address:
3615 480Th St Sw
Audit #:
1538901
DL Status:
EXP
01/27/2007
05/01/2007
Issue Date:
12/19/2006
CDL Status:
None
City/State:
Iowa City, IA 52240
Expiration
09/15/2007
CDL Cert
None
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
8320 Boonesboro Rd
Restrictions:
None
Restriction
None
Date of Birth:
9/15/1971
Supplement:
Mailing City/State:
N Ft Myers, FL 33917
Sex:
F
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
JUR
04/16/2006
106/08/2006
!S92
;Speed
97
............. y.. ,.,.... -.
IA
06/16/2006
-_ _..__.
;08107/2006
;593
F _....--
.Speed _ .__..._--
___ MN
t _._
01/27/2007
05/01/2007
�S92
Speed
Si;
IIA
Name: Yeggy, Tricia Ann DL/ID: 556YY1218
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:
........ %4� 2/7/2012
s¢ IOWA o's ���
G 1=4 i''"'+r
of Driver
�rX fifli sV~ IbwiaeDepartme teces oflTransportation
Name: Yeggy, Tricla Ann DL/ID: 556YY1218