HomeMy WebLinkAbout12-054I r 1
'��®4#
�1r'lllx
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(319) 356-5040
(319) 356-5497 FAX
First
1. Name
2. Mailing Address _
3. Telephone: Home
4. Prior experience in transportation of passengers:
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday – Friday.)
Middle
Other:
Last
W- sy
(Office Use Only)
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense Where When 7
�
1
0
6. Have you 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? 'A-0
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Tvoe 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)
derk/laxitlrivbatlg 09/2010
6
I hereby certify t)tat I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number'
�i .y �{ i �. . 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) r,
Signature of Applicant "7l� �'� � � DateC���
#########1H#H###ifHHHHHIHHHIHNlHHflHflMM!#M#t4###MHHNHH1flH#M#!if#M####HHRHllM1f{#lHHI!!M######H##H#HHHf
STATE OF IOWA )
COUNTY OF JOHNSON )
Q S. �� .w �v� On this �1 da
subscribed and sworn to before me by tw�� �.. �" y of
Notary P lic in and fort 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).
Sign Lure of Police CI or desi nee
/]L/i17C
Sig ur�at a of City Clerk or designee
F,s . %%
Date
a - Z7-/�
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.
wMMM+wwwMlwlllMMM+++MMMMw+#++M++Y++w++++++eH+wHH1Mw+www#MM+M+M+#'#'f++w++w+H11wN+Y-#1wMw+f1+#1eR#++ww+wf w{#tfwHlMHwM+w M+
Office Use Only
Approved application
DCI report
State certified driving record
Website update
din &Vbedaeeoo2010.dx 09/2010
Feb.23.
2012, 8:05AN1�
Div of Criminal Investigation
. W. LL.
L V I L I. I„ ,,
V I L/ V, G 1 h V, l J V, , V" M V, LY
01 V
. Inv. LL•
-..
LVf2 11.7Y/U
LV,L2 .......�
VIV 41 IIIIIII41 1 If 9 S I Ig d I I U II
,,, V1Y,I, ,, V, AV11% V8LV
,.
• ��• �+. w��YIn
�„ �, YI,,,,%, ,,,,.�,. ,.,V„y
VI n4 V�{
No.5081
I1V. LIYI
4101``
P
I.
r.
2
J
Y
1110.
'1174 9/JY
II
7)/6
hV.'p1VJ
Ir
J
r �li4U)I)fiA��1J�d$O1f�l1QBC011'f� ��180}'i �f !l
l�vg(uce�k�+olexrY �`, ,
h^V1. ountNomGen
' I • AlPA i
7.'07 Yn�ygb1?14[oktofCe/m3nelYmve¢tl�g1(d)► N?'Plbf p[ TnL7A A1iR
Pruppoyt ONdral%N97341ofl1r,1,119idot+—^—��
40,91'New DIT$' O)MAXIO ob8d(o)�
bavblpy wy'olfia So3v
79 p ��� 610 + tr�i
VAaM
04,7aa�(af� O 9 � �OffA c7�
(X163 IM -1 '
obo hk T. A ('AVI Q c) CXW
. I 111. I.;,' I '1 AQA (J
F7.c:r .� : Ul
' S IF'r' / / $aXl viq^gltr�.a/�97
rwl� f,oNM ,
e gestGl amJ(ovrACrlmfn ( 4s{a ltoaordOltaoke S � 1
�1�IB nlrt,be(ol� • 7TIt'sC q d j►d d1'ON lAo reldMuoA�Id)
I 5...171�aYa�om�Yo
911WAMoVA-0111 ,u
amp►dfd o111q(np1hle(olyYeaorhl�roynue
(fnfAxinnlloFl g9olialvdd �iylAwi, af(rayn
doiVtunl4dtkkWGfllhvAM4lodo[ralmin0l �
InWtAq NY,
N
AVog, a a3— �a,s,sefilolio�ffwyYo�'ldodnArhal+iar�dnraafbl►th�owoA%� I,
h/ NO)bi7�('f1�/naC Xfstol�/�tAC0Ydlftd*ftyln0I `
xo'oVhCximinall)'laeozy�{ecoYdAHaohad,b0l;{�,�/ /
� ei edlTimeffeb;/22.-20,12 1L09PM-No.n�856
C�v+
j,1ue mfr)
u
,
Feb. 23. 20122
8:05A
Div of Criminal InvestigatlonY
No. 5081
P.
3
reo,LG
zu12
11;74H
�vlv)o��Ir;min�l1nves�„ga�lon�
a
NNO,M2
r.
P,
j
teo,iul
.. )Jr
tu(2
nVI
4;PirM
J.aV1„II
u(v
..(
al �rlm(nal Pnvesl(�al(op
,.I\In VI+�
4 IJ7
no,yl�y
r,
J.I/6
Y
VI IV V) IV
i1V.LIV1
I,
e
I
y I , •
1
SrATMOVIOWA
n�X,IB6(P tay Reeolyd Moak
L 140t�U,0s�J�`ot�aa
L
I \ r � b'C1'Aaooun6�llfiGorl���
'1'atl XelVgbrcHlor(0('CXllninalXhVaaU�o1(dh �Yalllr Wa clr�y •
SA�ipoY(DAeYq((ohaAGronv,J'I�fuaX - Oi'A7G O�R�2C°IY o�BxO� '”"
�1 E.7'r'r9[Ye(d lhIfl�ar,.YG®sIDTTrvicels
bnaltilplgor,TOYV>t
tOAV 1 PAYI OFi `� SpA . ' IaE'I U 1-H1.9 FORM �Ak(
Pam Ye Ilosr(r, atu%WaCdhlttlA(Jil o KacordCh on +
ASf. tIT?(0 In rfo YAC stns mfnMOM M(dd 0 AMO nomra Rda
l�Cc/'nG.o Su
,b �n A ia� pnd,te Pehflor all Soo4a1 eelmi Imloyrcao 1 In a
.. rrv1/rvv.nalAnuuvrurrw-irmnmesugteoroftpOXe((IIg1f)AdOlnkleleol'(rgfnAln(etoryYeauriJflpYrgoe
heKoieDdAG o(LierG�aAeaQXotYA�tlhq 1 Y69�/zlfoz ro nr/ro[nnlh4tlol�y000Ydinc6rhuPlok nye►lnavod 6yfaw,Affroya
ob�M aivopaf na(uru i olsup 1'ioYo
OYAW 116A rrrerYnoroEyIlro umUP(enrorlllen ripudUngyamolal(acagly/p(YeIYaA/mleeldhteprraaafddlcakVAPfPIfiopYlarorcororLnlnal
YoYrvllIlalfanWpU.ruyaPfalfml(i PatVdolaoanram(agnToP,rJUrtoGAole anotl►y6ohluYoAt�dlldlvfdbyGlw '
\
40 d,.a,asee�ahc�t�4YOV d'ddname Pard dat'®a ,wham(Va(ad;
,
0 t1'o7oWI 61
.i0ola Grlmihs(�Y(acot�git00ol'd a(laojlaaa A o�f� / 7��. '�j/
77CYfn4tjolo
Received Time Feb. 22, 012 1:Pl9PM No. 9856
'A.AA.IVPd I,Te/1tAk 11 —J') A.A N AI. AAA9
C- �—
r/>
rn -'ii N
t7,•,I
a
7-�
Feb.23. 2012 8:05AM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00517224
MISDEMEANOR CONVICTIONS ONLY Pp OE I OF 1
DATE PRINTED-
DCX:00517224 2012/02/23
NAME: GILPIN,PAM
GILPIN,PAMELA SUE
DOB SEX RAC HOT WGT EYE HAIR SKN POB
1967.1203 F W 506 130 BRO 13LN FAR IA
ADDITIONAL IDENTIFIERS
CCH RECORD ***
01 ARRESTED 19960211
AGENCY: XA0560000 LEE CO SO
CHARGE NO- 02 IA STATUTE IA700-1
ASSAULT
TRK#: 013605402
COURT DISPOSITION
AGENCY: IA056015J LEE CO DIST COURT
COUNT NO- 02 IA STATUTE IA700-2(2)
ASSAULT NO INTENT OF INJURY
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 013605402
SENTENCE DISP EFF DAT
JAIL 3013 19960514
PINE $250 19960514
COURT COSTS 19960514
PROBATION SY 19960514
CREDIT W/TIME SERVED 19960514
NO CONTACT ORDER 19960514
AN ARREST 19XTHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
No. 5081 P. 4
Feb. 23. 20122 8:05AM Div of Criminal Investigation
v. LL. LVI IIIV11 VIa) VIYIn VI a) VI 1VWQ Vlly
•�IGu•LL• LV12 11:93M UIV of WIM10a1 IAYOSIIgallOa)
1D°•LI• LU IL T•Illur 'vey VIVIh V111 ul )Vdu V1%
No. 5081
P. 1
iru, LI`tI
IYo, µyr)2
h�. 4IJ7
I. J
Y. 1
f L
aij
1f
1d®queNtVotrm q
RcZtlaoountNllmhor; � �� l
• e.pPrr�atlq
xo: Yo1raAlVb)oNotCphntnal7naatit�sl(oh 81'01111 CY'Y'Y' of TOVA orev' r
Support Oddra((OwAgrauu,III B)onr 01:Tx oY8 l"q olmICH
219..9,JMS(Yood AID x__ TrAM tYG7'AiP RTRMU
kawUgfuasQram/A 50399
(sis)739.606� rowA cY�v' roYaA. X40
(3]5� 726` 6111111 f+Aw
Vione;
tYAX: aYo—aK6.-447 _� ,
IOhl It4110tingarLXoyyaCrhniAalkris(otyReaotdChaolconl
1 LuatNaiYaA & .11.&, • .MVQ6VAYAA 1A9M11YAVAVMA i... ...i,.�
I>`ao�$11t� n►ndeldry GIOri2ler d+lsetd SoNt8�3eoU119Ey�]UM6o aeomlhonded
a 3. lob . 303 a o.
1�7V1.'are 'emare
roof-AffOnNaildM Wifh0utI10lip oaWAMW,*L; haSuIva etofthaYe pdAFgcomp)e(ec(4mtoit is toryYoaaYdl,Y0P)10$
nieaspGTa,�1eYCodo6MWA)CAgplor697.7yL+oreo ft orinl[Ila UttaIoxyrdeOrd lablMatto%aAa)TAIVOatgfAvy)Af)yAyg
JI.VryRya.ulJlJlulµ.a.u"11UX V 43,UVV,&ti u..,Ltot;, JOloBW 6& ,
A�Cl Uloen)y)
Oro
r'
a;
11jC.i
co
CA
NOjbVVAQiM Ind 14.istotykecordf0j)ffa j%1)CX
+_!
_p
1
� YovPaGSiminaiXdis�oxy,ttecordareachcd)A41'# �/ 7o2a
`� =
�'
O
�'�
a a
bc$3niffals�
Received Time-Feb.22.A� 2- 1:09PM-No.9 6
T:..._-,t.A 11 11 1 e.AAol) u_ AAA9
a
CA
Iowa Department of Transportation
Office of Driver Services (Toll Free) 809332-1121
PO Box 9204, Des Manes, IA 50398-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/15/2012
DL/ID #:
830YY1331(IA)
Name:
Alawneh, Pamela Sue
Class:
D
Address:
1453 DICKENSON LN
Audit #:
4735920
Restriction
None
Issue Date:
10/09/2010
City/State:
IOWA CITY, IA 522409163
Expiration Date:
12/03/2012
Endorsements:
3
Mailing Address:
1453 DICKENSON LN
Restrictions:
NONE
Date of Birth:
12/3/1967
Mailing City/State: IOWA CITY, IA 522409163
Sex:
F
History Information
Convictions
Customer #:
212457
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
;nation Date Conviction Date ACD Explanation County 3UR
)1/24/2011 ,02/17/2011 iS93 iSpeed 62 ;IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident DateCase Number JUR
_......._. ..........._ _..._--- _...
78/22/2009_ _'522060 ;IA
71/24/2011 614926 IA
Sanctions
rype Effective End_ ACD Explanation Occurrence 3UR_ JU_R
suspended 10/14/2008 ;10/14/2008 m 1)51 ,Non -Payment of Child Support u __ JA _ . IA
Name: Alawneh, Pamela Sue DL/ID: 830YY1331
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
2/15/2012
IOWA ' 2''',
}%
0.
.......
Office of Driver Services
uftBIVER,'=
Iowa Department of Transportation
Name: Alawneh, Pamela Sue DL/ID: 830YY1331