HomeMy WebLinkAbout12-0425. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /V U
Type of offense
Where
When
6. Have you b reconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where
We
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Where
When
9. Have you ev rapplied to be an low City taxi driver using a different name? If yes, please provide the name(s)
1/) AIIb-
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)
cler!Oe dnvbadg 09/2010
Authorization Number ) �)_ --1 0—
r 1
(Office Use Only)
aJt�_
CITY OF IOWA CITY
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
41 0 East Washington Street
between 8 a.m. to 3 p.m., Monday– Friday.)
Iowa City, Iowa 52240-1826
rYS all
C".i..."�) 356-SO40
(319) 356-5497 FAX .��I �S `t
rst
Mi le Last
1. Name
2. Mailing Address
�1
C
`S
3. Telephone: Home —
/ Other:
4. Prior experience in transportation of passengers:
6gpr ipur l� ,
! t � --a �w I
/
� r % -eh/!�
.r
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? /V U
Type of offense
Where
When
6. Have you b reconvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?_
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where
We
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Where
When
9. Have you ev rapplied to be an low City taxi driver using a different name? If yes, please provide the name(s)
1/) AIIb-
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)
cler!Oe dnvbadg 09/2010
I hereby ��ifjt t¢aX ugcytp me by the Iowa Department of Transportation a valid Chauffeurs license number
77�i lL((JJ � IIJJ o� . 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 tiwith all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) /J
Signature of Applicant Date
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscrs�^i�b��e'da/n��dand sworn be me by ��—�p� On this+�`' day of
KELLIE K. TUTTLE L( - ( (-C e �'
Notary Public in and for the State of Iowa
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).
a- -7
Date
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
derMl div adgeapp2010 do 09/2010
C
Iowa Department of Transportation
Office of Driver Services (Toll Free) 900-532-1121
PO Box 9204, Des Moines, IA 50306-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/10/2012
DL/ID #:
418WW8302 (IA)
Customer #:
1134124
Name:
Pappas, Teresa Ann
Class:
D
ID Status:
None
Address:
404 6TH ST APT C1
Audit #:
5733286
DL Status:
VAL
Issue Date:
01/10/2012
CDL Status:
None
City/State:
CORALVILLE, IA
Expiration
01/22/2014
CDL Cert
None
522412531
Date:
Status:
Endorsements:
3
CDL Med
None
Status:
Mailing Address:
404 6TH ST APT C1
Restrictions:
Corrective Lenses
Restriction
None
Date of Birth:
1/22/1970
supplement:
Mailing City/State:
CORALVILLE, IA
Sex:
F
522412531
History Information
Convictions
Citation Date Conviction Date ACD Explanation County ]UR
07/08/2008 ,08/18/2008 �M14 Fail to Obey Traffic Sign/Signal .52 ;IA
Name: Pappas, Teresa Ann DL/ID: 418WW8302
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:
•�
2/10/2012
IOWA
q!`
D. O. T..- s'
s
FQRg"l
11
Office of Driver Services
,�_
Iowa Department of Transportation
Name: Pappas, Teresa Ann DL/ID: 418WW8302
Feb; 14; 2012 11:18AM Div of Criminal Investigation &.3910fP. �i
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Received Time Feb. 10. 2012 11;42AM No -8804