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Home My WebLink About12-108CITY OF IOWA CITY 410 East Washington Street a 52240-1826 (319) 356-5040 19) 356- FAX 2. Mailing Authorization Number \a- kog (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) r—, 3. Telephone: Home ::�-)\'A Other: i _ 4. Prior experience in transportation of passengers: l t � C .V' 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type 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?__,ALL Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? a 5 e Ct '� B e [-+ • Type of offense Where 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type 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 STS/ TF CFRTIFtFD 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) -1eMtu1dnvbadg 09/2010 I I hereby cert t at I have is ed t me by the Iowa Department of Transportation a valid Chauffeur's license number �s� Ski 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) /moi a Signature of Appli t Date s fYfff##4Y##M######H+#R4RN#+itF#+#4+4#F4##RRF#RRR++tfi+i##4F++4##i44+i4F+RH4F##+i4F+i##+kt##Y++i###Y#YYff#!!f##Y##4#Y###4#44F444+YF+44#'k+FFFi STATE OF IOWA ) COUNTY OF JOHNSON ) ubscrib d and sworn to before me by a tr t C-" nr"_ On this 3 day of 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). = 3i Tgnaturwff Police Chief or designee Signature of City Clerk or designee 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. 111111#Yf#fiYf####f########Y#########+#H##+#4##+#4####4#######f##Y'Fff#f11111111111fR1fff#f#####++4#4+###Yf#1411f1HN#1f#1R1fff#f##R4##l1f111M Office Use Only Approved application DCI report State certified driving record Website update 61 "I NtaAdd b.d,app2010d 09/201( 'A Iowa Department of Transportation Office of Driver Services (Toll Free) OW -532-1421 PO Box 9244, Des Moines, IA 5113D& 9204 515-244-837 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/18/2012 DL/ID #: 012AA2859 (IA) Customer #: 3417333 Name: Griffin, Patricia Anne Class: D ID Status: None Address: 303 COLLEGE ST APT 7 Audit #: 5249781 DL Status: VAL Issue Date: 05/25/2011 CDL Status: None City/State: TIFFIN, IA 523409374 Expiration 03/29/2014 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: PO BOX 464 Restrictions: NONE Restriction None Date of Birth: 3/29/1958 Supplement: Mailing City/State: TIFFIN, IA 523400464 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 11/13/2011 11/30/2011 'F04 Seat Belt Violation 152 jIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Date Case Number IUR Name: Griffin, Patricia Anne DL/ID: 012AA2859 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: ............ 0"y 5/18/2012 - IOWA Q° D. 0. T.' Sal a 7p �9111EA 4� Office of Driver Services Iowa Department of Transportation Name: Griffin, Patricia Anne DL/ID: 012AA2859 May. 15. 2012, 2:54? Div Div of Criminal Investigation No.5044 P. 3/4 ter• Iu. L V I L II.Ivnn VILy �Ieln VILy u LVVd L.ILy NO. z1vo P. L/L STATE OP XOWA Requeft Form s I, ,• r pClrLccouncNQmbor: O IJ D Ceppitceb o) Z'e: XolvallivlafonofcrlminalYnvestlgarran SYom) nrrnv na rots CITY 5gpport Operall6m pQrOAU, V' Hoer CITY CTRM's Olml= 2XSE.7'"Sfreot 470 s. WAAHIN ON ST•Rmi'1` beaM91'rioli%Iva $0919 (515) %29.6066 TDAA CITY —TWA 925-6000 vo1c 52P40 PhonAi _ 519-456-5041 T),(S416) paYl __gT9 �SF•.�i14'7 �_ Centre Uastlp LUIXoyyaCrMae(Hi o RacordChaokon; �Q$t ll me. (nlnndnLo •3�.rTAMO andet0 Middle Name (recommepdtd �QtiFe of$Ikth (mpldelory) Cxendex rndam) SoefQT 5eaun:f NulnTLer Geconlmcndoa Male vomaya W9iV&i'XeOy1htliioyt, Without n a/jned WgfVardYom IhasebJaot of the'regeeat, a compla(o ON(a41 hIs(orr Word maynoC bLf l'oiep9abl� pcYCode okXop Q, Chapter 6912, C+or cumpleta'arletfne(history pecoYdlnib�m4t(ox, avalyowAd by Jp17, 0(p/eys • nh4a4, n..... .x,. _•.>,I•a _s..v.. ........ ... //tciv,4ir.(C6lB(rf'e.'� h c-SlIAeltan (Deb. pny rt Cul fo�va cifmtnal 6Lsto{yreooLd rhecti With LheDp6slun oPC�pnrnal MDY fiar9tc95od a9 WOV14d byfxgC �. wN..yuVVFt Lpugµ�t{y pDCl11foonly) As of �� oZ a s jQroh oftTteprovided name and dela of bhthaeveal ed: No 16WA Ciimflld Hbtor/ kiecord found w1th b CL :.., • + Al TowaL4iminalyiatergl2eCoxdatfaolled,bCZ# ul• —U bC1 Uflals 3eceived Time""May. 10. 2012 11:05AM No.4177 May.15. 2012 2:54PM Div of Criminal Investigation No.5044 P. 4/4 IOWA CRIMINAL HISTORIC DCI 00435607 COURT DISP091TION PENDING PAGE 1 OF 1 STATUS UNKNOWN DATE PRINTED- 2012/05/15 DC1:00435607 NAME: GRIFFXK,PATRICIA ANNE GRIFF19,PATTI DOE SEX RAC HGT WGT EYE HAIR SKN POB 19580329 F W 506 192 GRN BLK MED IA ADDITIONAL IDENTIFIERS CCH RECORD •*+ 01 ARRRSTED 19920307 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA204-401-3 POSS SCH I CONTR SU89-MARIJ TRK#: L41520001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA204-401-3 POBS SCH I MARIJUANA TRH#: L41530001 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19920624 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