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Home My WebLink About12-110CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-SO40 (319)356-5497 FAX 1. Name 2. Mailing Address Authorization Number / 0L — / /r� (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) Last Llldotl S t" c,�7 !+ --�- 22 Y0, 3. Telephone: Home Z�(`7 `t 3 6 S� r 1 Z Other: 4. Prior experience in transportation of passengers: \/ ec, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Oroc, kt ,�--J Where When 6. Have youbee} Fonvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? / lJ Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When 17-21 If 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? AY) 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 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) de@ taxidnvbadg 09/2010 hereby i that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number q ' F `j L A+ C j I understand that if I falsely answer any questions in this application, that this application may be denied. I uriderstand 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_.L.4 7--117 STATE OF IOWA ) COUNTY OF JOHNSON ) n/� Subscribed and sworn to before me by 4 G-PVM. -r On this 7 day of fHfRR4RR#HRRf#!HH#%%#H*t###%H*%%****%M**R%*****R%#*R*######44Hiff444f4444444H444R4*44k%#k*%%kk%M**%R*%k**%R*#4#YflR1R44444H444ii##44444 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). ?o� a- zxg��- of Pdficb CI 'e or designee Date � 7 of City Clerk or design6e Dater 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\H1ffRMf1MH\\\Hf1MH\lHl1HHf fff###f 11Hf f 111HfHH11f HlHlfff!!1f\1f4HHH\\t#!4!##f######HfflHH#lNIHHHHfl14t1f M1HHffifH Office Use Only Approved application DCI report State certified driving record Website update deMwiE adWapp2010.E 09/2010 May.16, 2012 1 I ;16AM � I I Div of Criminal Investigation No.h214. • Y. 4/14 6946'aN NV99:01 ZIOZ 'll'AVW ?1111 penlaoay STATE OF IOWA Criminal History Record Check '• _; Request Form m To: lam 11110lon of Criminal lhVCWPtlon Support Operailoae Kure n, l" Floor 1151? 7° Sheet Delmotou'lows 0319 (515)7254M (M) 125-6011D Fax DCI Account Number: N383 ^ K tu�J Frem: J%aYGS—FAXt Phone: Fat: ..- - ___..__.._....__._._._. Last Name (aade __._-_ It"Nam; ;;t ) Middle Name Ileo r' �n'� _ffAurIW Date ofl firth Gender L.%41 Social Number an p WajYerlr(formdiopJ Wl ant a 312ned watrer tram the lub)eet of the request, a complete crtmlud bhtory record MAY net be reteeeable, per Code of lour, Chapter 697..4. For ypmplatc orimind hhtory record Information, as hlloned bylaw, always obtain a welveralpalpre tram the subject of the nquaL WidwrRelease: tbacbyn,epi,o1aloamrdrabo"Mgoatinanmcidmcar", 1awavlM10dM a WA rdel.oicwhhdeni.4lonorcdm1W ImcWr+Vaa(�7. kncdminuhl:roy a.ncwandne mo eaMaioad t7 au oCtmgbe mloduWoaodMl.w. WafYorSign4l'Ure: -. . lowa Criminal Record Check -Results plat me Only) As of search of the provided name and date of birth revealed; r.) ❑ No Iowa Criminal History Record found with DCI :c . Iowa Criminal Flistory Record attached, DCI N • ' � 1 DCl initials DCI -77 (09125110) n May.16. 2012 11:17AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCY 00734122 HISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2012/05/16 1CI:00734122 NAME: GEMMR, AMY GEMH,AHY APRIL RALITSRNA,AMY APRIL DOB SEX RAC RGT WGT EYE HAIR SKN POB 19810426 F W 505 130 BRO BRO CA ADDITIONAL IDENTIFIERS PRCD L EAR PRCD R EAR SC LF ARM CCH RECORD ti+ 01 ARRESTED 30040927 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401(5) POS9ESS CONTROLLED SUBSTANCE IV ALPRAZOLAM TRK#: 101306501 CHARGE NO- 02 IA STATUTE IA124-401(S) POSSESS CONTROLLED SUBSTANCE / SCHEDULE IV TRK#: 101306502 COURT DISPOSITION AGENCY: IA052015J JORNS09 CO DIST COURT COUNT NO- 03 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 VECR070113 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101306501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20050408 JAIL lOD 20050408 PROBATION lY 20050408 REVOKED 20050408 COURT DISPOSITION AGENCY: IA052015J JORNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA124.401(5) POSSBSSION OF A CONTROLLED SUBSTANCE COURT CASE IP: 06521 PECR070113 CHARGE CLASS: MISDEMEAWOR CONVICTION TRK#: 101306502 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20050408 PROBATION 1Y 20050408 JAIL 101) 20060420 REVOKED 20060420 02 ARRESTED 20051025 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA124.401-5 No. 5124 Y. 5/14 May.16. 2012 11:17AM Div of Criminal Investigation POSSESS CONTROLLED SUBSTANCE SCHEDULE I TRK#: 101691002 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE YA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 AGCR073800 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101691004 LICENSE REVOKED No.5224 P. 6/14 DCI 00734122 PAGE 2 OF 2 SENTENCE DISP EFF DAT JAIL SOD 20060420 FINE $250 20060420 03 ARRESTED 20060507 AGENCY: IA0620100 OSKALOOSA PD CHARGE NO- O1 IA STATUTE IA321J-2 OWI 1ST OFFENSE TRK#: 076365901 COURT DISPOSITION AGENCY: IA062015J MAHASKA CO DIST COURT COUNT NO- 01 IA STATUTE ' IA321J.2(A) OPER VBH WH INT (OWI) / IST OFFENSE COURT CASE ID: 00621 OWIN105552 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 076365901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT JAIL 4011 20061106 FINE $1000 20061106 AN ARREST WITHOUT DISPOSITION ISNOT 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 Iowa Department of Transportation ► j Office of Driver Services (Toll Free) OW -532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1637 Certified Abstract of Driving Record Inquiry Date: 6/7/2012 DL/ID #: 947AA0537 (IA) Customer #: 3969886 Name: Gemme, Amy April Class: D ID Status: EXP Address: 851 RUNDELL ST Audit #: 5170241 DL Status: VAL Occurrence ACD Issue Date: 04/21/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 04/26/2016 CDL Cert None citation. 522406255 Date: JUR Status: 10/09/2011 651622 IIA Endorsements: 3 CDL Med None Type Effective End ACD Explanation Occurrence JUR JUR Status: OWI Test Failure Mailing Address: 851 RUNDELL ST Restrictions: Corrective Lenses, Lek Restriction None Outside Mirror Supplement: Date of Birth: 4/26/1981 Mailing City/State: IOWA CITY, IA Sex: F 522406255 History Information Convictions Citation Date Conviction Date ACID Explanation County JUR _ 05/10/2005 04/20/2006 —_ u A33 Drug/Drug Related Conviction 52 IA 05/07/2006 11/06/2006 A20 Operating While Intoxicated 62 IA 10/02/2011 112/29/2011 IS92 ;Speed 52 IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 05/07/2006 :OWI Test Failure IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/09/2011 651622 IIA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 05/18/2006 '11/13/2006 A98 OWI Test Failure dA IA Revoked 06/05/2006 ,12/01/2006 A33 Drug/Drug Related Conviction 4A IA Name: Gemme, Amy April DL/ID: 947AA0537 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 6/7/2012 IOWA 9 ."••... Office of Driver Servlces Iowa Department of Transportatlon Name: Gemme, Amy April DL/ID: 947AA0537