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Home My WebLink About12-096r !'_' 1_4� �r'lll� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name Authorization Number / �' (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Firstr/{Lttlddle rA 11 (ZM ` v r1_1 2. Mailing Address 321-0 2-, �. —s- 1 C.o 3. Telephone: Home � S�j O h � -� ( Other: 3 3 3 f (,o 4. Prior experience in transportation of passengers: GS ck-roma./ C,c'L 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? e -S Where When el 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? YL() Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ''L D Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4 fD TVDe 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) clehJlaxitlnvbatlg 09/2010 I hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `I Z Z (o 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) Signature of Applicant Date 3 a f #111fHifff1f11ftff#f #f#f YN##1N#H4#ffHf#HH#HffHleftf#RMH##f#HN##f RH#Hf##Hff!##11ffNHifflf f f1f 1f flHlflfHHf#HH#HHHf #-k1#fff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by NnNrif 14.• On this 13 day of 5d - r6Z Notary Pubic 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). s Siigynat re of Police C f or de ignee / /� J k' . rr / Sign tore of City Clerk or designee ?ft Y. .70%7 I Date 5"- 3 - ia— 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. f llNNifN#HR#;;;R;#IR;RRNRIRIHffRNRHflflflffNlfHHlHINH1fNfNfRlflllRRIRRRHRRNlifRRNH;;;R;i;R;R;l1.4Nf 44H#;;R;R;;#yeNfRH#-#R;R Office Use Only Approved application DCI report State certified driving record Website update da,on dd dgee,n,ioio.d 09/2010 ion npi. L4, 20u12 3z:u)rMM D ivcy uieCriminal rk - uitiy o7 1owatui(y r �a TO- IOWAlvf910),OfC14 support oporaHdns 215 t;, 7'hSireoE ileslvXpirtas,Towa d0 (515) 726.6066 (sig) 725 6a90 voyc 6 (mmMorv) ' No. 5726 P. 5/8 No, 2340 P. 2 D ��' •° OVATE I � I illi I'b )3� W�t`r ' ]aCI tLCCoI]Rt �}ymhBr: L`v �� ^ • Qfapylfaa6 a) mfnolYnvestlgAtfon a3urona,i"lgtoor NCI(,4i°oply) '. rte, Vow f� pg IOWA CTTV a soarah a>cthe prorjidad Herne Aird data obirtbaeveaTed: GITZ C1URR's oaaxam 329 410 R 1 A�aHrurh o4r S t RT ftr , 10VA f1a3r TgF1A an 4o Phon61 __._3S9 356�"r22l�7 �ak1 9Y 4-.aS(»S/c97 FOPYMornstriioq; wlihoutn 160SAMi pet•COdooe)(MA,Q c Received Time or. 74. 9019 )! w 1Y'AiYax• 1Yortt tY105nh ject oFfhrt YeQ4es�j a cofiplofo Oj'(Ininpt h7sfory TeCorti lttap,loB 92,2,Vat co tearlminnlhistoryrecord(nrormntloh,asallowoa1y14W,Afwnys 73rld:YQN.liB�aR',f'B,•Yhuc6yglvo pecmisstoulLr rho nDoverequesnagoatotBl to conduc! on YoWaertminnlf,lsl°rycecordcheef(W,16 rh°DMsinn oPGiminaf r9rosgaaQort(tJCU.,u,ycrlMfnalhlsro�YdaWcenwmfngmemae3an�nlnmined6gdrobOYmey6orofaesodafalfmveQDyCnw. OOPM Nn_19ti9 NCI(,4i°oply) '. rte, Ag of S" a soarah a>cthe prorjidad Herne Aird data obirtbaeveaTed: i ;; Lj Nolbwaa-ImJnatMaMYItecordfoundwith bCr Yoga G'rimrnsl i'3"iscpcy ki;ecord DCrik , �ti '`'' attaohe�, �O � q (� a� bC� ipitials� - _ OOPM Nn_19ti9 May. 1. 2012 3:16PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00501902 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTE1)- b0I:00501902 2012/05/01 NAME: XUHTZ,NANCY RUTH DOB SEX RAC HGT WGT EYE HAIR SKU POB 19690617 F W S09 285 HAZ BLN FAR 1A ADDIT1014AL IDENTIFIERS GLASSES SC BREAST SC CHEST SC R PT PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 19950613 AGENCY: TA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A-2 FORGERY -MULTI CTS TRK#: 017950601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A-2 FORGERY TRK#: 017950601 RESTITUTION SENTENCE DEFERRRb JUDGEMENT PROBATION 3Y 02 ARRESTED 19960212 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA714-1(5) TNKFT-4TH TRK#: 019614701 COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA714-1 THEFT STH CHARGE CLASS: MI$DEMEAHOR CONVICTION TRK#: 019614701 SENTENCE PLEAD GUILTY PAY SURCHARGE FINE $50 COURT COSTS 03 ARRESTED 19981230 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE W/ OFFICAL ACTS TRK#: 045063302 COURT DISPOSITION DISP EFF DAT 19951221 19951221 DISP EFP DAT 19961005 19961005 19961005 No.5126 P. 6/8 May. 1. 2012 3:16PM Div of Criminal Investigation AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA719-1 INTER W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRT(#: 0450 633 02 SENTENCE FINE $250 COURT COSTS 04 ARRESTED 20070102 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE TA715A.6(2)-C UNAUTH. USE OF CREDIT CARD < $1,000 2 COUNTS TRK#: 1A000KJ01 COURT DISPOSITION AGENCY: IA052015LT JOHNSON CO DIST COURT COUNT 140- 01 IA STATUTE IA715A.6(2)-C UNAUTH, USE OF CREDIT CARD < $1,000 COURT CASE ID: 06521 ACCR076268 CHARGE CLASS: MISDEMEANOR CONVICTION TRK((: 1A000KJ01 RESTITUTION SENTENCE FINE 05 ARRESTED 20100809 AGENCY: IA0520200 CHARGE NO- O1 HARASSMENT / IST DEG TRK#: IA009YFOI COURT DISPOSITION $625 IOWA CITY PD IA STATUTE IA708.7(2) - 1989 . AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.7(3) HARASSMENT / 2ND DEG. - 1909 COURT CASE ID: 06521 AGCRO87724 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA009YFOI SENTENCE FINE $315 06 ARRESTED 20100009 A AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA706.3A(4) A99AXMT ON PEACE OFFICERS AND OTHERS TRK#: 1A069YG01 COURT DISPOSITION AGENCY: IA052025LT JOHNSON CO DIST COURT DCI 00501902 PACE 2 OF 3 DISP EFF DAT 20070402 DISP EFF DAT 20101210 No.5726 P. 7/8 May. 1. 2012 3:16PM Div of Criminal Investigation DCI 00501902 PAGE 3 OF 3 COUNT NO- 01 IA STATUTE IA708.3A(4) ASSAULT ON PEACE OFFICERS & OTHERS COURT CASE ID: 06521 SRCR087738 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A009YG01 RESTITUTION SENTENCE DISP EFE DAT TIME SERV91D 161) 20110119 JAIL 16D 20110119 FINE $315 20110119 AN ARREST WITHOUT 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 w No.5726 P. 8/8 Iowa Department of Transportation Office of Driver Services (Toll Free) 80-532-1121 PO Boat 9204, Des Moines, IA 5030&92(14 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 4/24/2012 DL/ID #: 796ZZ6219 (IA) Customer #: 1745715 Name: Kuntz, Nancy Ruth Class: D ID Status: None Address: 1 OAKNOLL CT APT 569 Audit #: 4447269 DL Status: VAL Issue Date: 06/18/2010 CDL Status: None City/State: IOWA CITY, IA 52246 Expiration 06/17/2015 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1 OAKNOLL CT APT 569 Restrictions: Corrective Lenses, Left Restriction None Outside Mirror Supplement: Date of Birth: 6/17/1969 Mailing City/State: IOWA CITY, IA 52246 Sex: F History Information CLEAR DRIVING RECORD Name: Kuntz, Nancy Ruth DL/ID: 796ZZ6219 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 bqn authorized by the Director of the Iowa Department of Transportation to so certify. , 5�''j 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: p 1"••'••y��/��p 4/24/2012 IOWA D. 0. a .0. .......... '••••'•• Office of Driver Services n`DRIVEO,<= Iowa Department of Transportation Name: Kuntz, Nancy Ruth DL/ID: 796ZZ6219 http://172.29.254.55/drivers/reports/eustomerhistorylcertifieddrivingrecord.aspx 4/24/2012