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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 I ..,� ,. TO: .iOlYa biYri9i0Yr Of CYimfl1p17n'((sttlgpr(oh Support Operations purapu, l',Yllogt' 215 z 714 Street DallXolaav,7owp 50519 (515) 7.394W (515) 726-6080 Far e 1-5 iu'uf'rp STATE OF1 (,) \ 1 11 �,r. �5;.y C'/`F Nu rirJ„ I'�;A ;, II Record r 1 `kr ;fi Reqzxeqt Form 7�C1Accowitl�llmbar: -l�o�-`F Qt'oppllonbio) From; --=OF IaTat; OTTV OXTY am's 017PXGE � 10 X. 'YANATIJOT09 STREET 107A. 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