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Home My WebLink About12-0714. illw®r�� CITY OF IOWA CITY 410 East Washington Street Iowa City, -Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) (Office Use Only) rt�Fvi�r�st Middle Last 1. Name eL�/Is a Warne aiViler' 2. Mailing Address po, 6ex 3a5 r Iowrt 52-77 3. Telephone: Ho 3 - (oa 7 - Lj Lj UU Other: 4. Prior experience in transportation of passengers: 4,o )7 jr-, LA sn Cr r 01ACCjpq+T r: 1 0W P, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Tvpe 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? Nll - W_ (_R 1 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 1� Type of offense Where When �2r�1�C1 I9ii2L��-XA�(' 4C la:� 1a 137111 Cunv.et;m �1d511a�' 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? No - 11- �tJ!'r'' l 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) t'Ylel � gsa (�'1 Ct ri P �-l�.lske�_ 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) GerkAaxidrivbatlg 09/2010 N I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number a S9 11 . 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 4 Q Date 4**41KM414K#4#f i4KKf4*4-#*KKlK4f##'Y##Y#Y##KKf*KKY44K4KK4Kf4*K4Y-iff1134KK4KKKf4K4K41K1K*K4KK«f3K444KfKll4lf 14*!4«! STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by M• l; se MrG6.... . On this 'JL1 _ day of 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). Su e off Police Chief or designee Sig lure of City Clerk or designee 3iz iz Date -is 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 clekRaudi d0eapp2010.d 09/2010 Mar. 99. 2�u 12 Iii zri4 Div of Criminal Investigation wI.y 61erK - 611y of Iowa (,I(y d$A7@IEYAcryR•J(u3`tory R®Cord (_.heck Request Awill No. 1192 P. 6/13 No. tIUD r. ! l I a l I A-71 1,4711-96-31-70 iar—&Y warm a Rah,14Witho ABfgaeaWalrel-*otnthasubjeotofth aY64Uo&,adolop)atootWinAIhIVforyrecotdIII ayttot boroloYspblo,porCadoolQXo'p/a,Clta�teY693.2.�orco to'oYlmtnAlhtafotyr000rdinformatlon,asallowedb�Ipwi,d(ways W2iYeY-U400,;iheteDypfvopormbrfontOraonOovarequeslfngoID+Inf!odndoofBtlrowAodminnlhh(ocyteeoldeheakArt IhaUiHolonorothnlnd Ynvogtraatfan (Acb. Myorfnthl+lltt+lotydgtaoonaemtrtgntothnolsmolntglnedbytfinAOTmpy6otoleaoadn+nllotYcdhyrgw, • 1 WdlverSYBrrnlur�; ��/. nhp /Yl 9.� � � Iowa Criminal Maton.Rec z4 d Chock Resulig . NOIlgoonly) Au a search of tho provided namo and data of blithxoveale&- , No l'owa Uhnival 11,ist6xy Record f oUnd with DCX ; xowa Criminal msfory Roeotd attached, bCX * bCX 3nitlala,_., � n tC,} . nnym r pr -)5 m Received ime ar. 5. 2012 12:32PM No:0714 T CLAcoollatNurabor: 06,;L . QPeppIlc+D e) zb7 ZoWa)H0110OfCrfmfna1YhyyestfgatfOh SYoth6 0IT!r pP C01� G�TY Support QparallOtl9 )3UroaU, l'(FlooC rXTX 0I.BIM+S OFFxcA 215E.1,48teeet 410 TC WASHINGT09 5TJxti_ST bas lVjpirfos)Io+va SOD (91spgd-boa I tpw'A CxyCs xQ0-- 2Z4o (515) 72S-6060 )lAk PhonO; iia—anti—spa.1 tlsSte vy e—�5fi-5! 47 _ , iaril re uestfn an. roWaCthnfnal91,go Record� Chockon: Last, meltdeto MYst1\ime manna MlddlaName frecommAded) Mare ! l I a l I A-71 1,4711-96-31-70 iar—&Y warm a Rah,14Witho ABfgaeaWalrel-*otnthasubjeotofth aY64Uo&,adolop)atootWinAIhIVforyrecotdIII ayttot boroloYspblo,porCadoolQXo'p/a,Clta�teY693.2.�orco to'oYlmtnAlhtafotyr000rdinformatlon,asallowedb�Ipwi,d(ways W2iYeY-U400,;iheteDypfvopormbrfontOraonOovarequeslfngoID+Inf!odndoofBtlrowAodminnlhh(ocyteeoldeheakArt IhaUiHolonorothnlnd Ynvogtraatfan (Acb. Myorfnthl+lltt+lotydgtaoonaemtrtgntothnolsmolntglnedbytfinAOTmpy6otoleaoadn+nllotYcdhyrgw, • 1 WdlverSYBrrnlur�; ��/. nhp /Yl 9.� � � Iowa Criminal Maton.Rec z4 d Chock Resulig . NOIlgoonly) Au a search of tho provided namo and data of blithxoveale&- , No l'owa Uhnival 11,ist6xy Record f oUnd with DCX ; xowa Criminal msfory Roeotd attached, bCX * bCX 3nitlala,_., � n tC,} . nnym r pr -)5 m Received ime ar. 5. 2012 12:32PM No:0714 Iowa Department of Transportation Office of Driver Services (Toll Free) ODM32-1121 PO Box 92114, Des Moines, iA 50306-9234 515-244-9124 FAX: 515-239-1837 Inquiry Date: 3/6/2012 Name: MCGhee, Melissa Marie Address; 610 W 4TH ST City/State: TIPTON, IA 527721421 Mailing Address: PO BOX 325 Mailing City/State: TIPTON, IA 527720325 Convictions Certified Abstract of Driving Record DL/ID #: 875RR5919 (IA) Class: D Audit #: 5378857 Issue Date: 07/19/2011 Expiration Date: 11/21/2015 Endorsements: 3 Restrictions: NONE Date of Birth: 11/21/1971 Sex: F History Information Customer #: 5081686 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR ..�.._.,.._...- ,........,__w. ._e____�_..e__ .. _. .. _._.__P ................_..__ ..._..�._. 12/27/2011 03/25/2012 1592 iSpeed 52 mm JA Name: MCGhee, Melissa Marie DL/ID: 875RRS919 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 3/6/2012 8 *!4. IOWA 0. T.. --,e) c4ov e4.,wa,,t4 DS Office of Driver Services Iowa Department of Transportation Name: MCGhee, Melissa Marie DL/ID: 875RR5919