HomeMy WebLinkAbout12-132A�+a.at._
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(3 19) 356-5497 FAX
1. Name
2. Mailing Address
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday – Friday.)
Middle
3. Telephone: Home 'itq " �C/�/'�' 72 Other:
4. Prior experience in transportation of passengers: Alin
Last
ir)_ — / 3 Z_
(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
NO
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? AI C
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
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8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /U
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)
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I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
`J �/ zA F G 7 O 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 applicationkvill
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_ MO.Yid C.ir�s i/�� Date 7-19�%2-
MQyi d C coSfi//D
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STATE OF IOWA )
COUNTY OF JOHNSON )
/a'nd sworn to before me by I r anA E - b4s r l (-o On this wt r `" ` day of
''
Tom' KELLIE K. TUTTLE
J o Commission Number 22181
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).
Date
//C
Date
NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names placed on the city website at
icgov.org.
Taxi cab businesses are required to provide Driver Identification cards.
+tftfa#1t++}a+a++++++#+aa*+###+#*t###4##11441414!411»ff141fe114*at44141144144114411t+aaft+fa*a*af14f*#fa#fa*a+a++}++a++++++aa#a++*a+++#*f*+#f+f
Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Jul.11. 2012 9:01AM Div of Criminal Investigation No.2913 P. 1/1
Jul. 9. LUIL L:Lorftl CIty l,lerx — wly el Iowa LIIy No. L9JJ P. LLL
To: Iowa Divislon of Criminal Investigation
Support Operations Bureau, V floor
215 Ts, 7A Street
Des Mollies, Iowa 50319
(515) 725-6066
(515) 725-6080 rax
I am reaueat nu an Iowa Criminal History Record Check on:
DCI Account Number: L tV (, :� --c
(if applicable)
from: CITY OF XOWA CITY
CITY CLERK'S OPPICP
4101i,)VASIIINOTON STRMT
IOWA CITY XOWA 52240
Phenol 319-356.5041
N'axl 319356.5497
Last Name mandatory)
first lame (mendalory)
Middle Name (reeommeodod)
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Y✓itll'ICl
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Dato of Birth (mandatory)
Gender (mandatory)
Social Security Number (recommended
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❑Male Vrolnale
yyl
Maiver-Tearnratton: Without a sighed waiver from the subject o9the request, a complete crimival history record may not
be releasable, per Code of Iowa, Chapter 6922, )For conifflctocriminal history record Information, as allowed bylaw, always
obtain a waiver signature from the aubectofilia re nest,
r/ aivev -RefeaV; I hereby give penniaslon for the above requesling official to conduct m Town, criminal history record check with Ilia Division of Criminal
Investigalion(DCI)• Any criminal history dale concemingme[Lads moinloine//d by lhei)CI may be scicased wallowed by law.
WaiverSignnyRPe: Ma&rro T
Iowa Criminal History Record Check Results
As of 7111 :2 a search of the plovidcd name and date of birth revealed:
or No Iowa Criminal History Recotd found with DCT
0 Iowa Criminal History Record attached, DCT
DCI
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Received Time Jul. 5. 2012 2:20PM No.2
(DCtuse onl),)
Iowa Department of Transportation
AC
Office of Driver Services (Toll Free) OW -532-1121
PO Box 9204, Des Maines, IA 503D&9204 515-244-9124
OFAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
7/3/2012
DL/ID #:
442AF6704 (IA)
Customer #:
5630265
Name:
Castillo Moreno, Maria
Class:
C
ID Status:
None
Evangelina
Address:
2018 WATERFRONT DR
Audit #:
5716952
DL Status:
VAL
LOT 64
Issue Date:
01/03/2012
CDL Status:
None
City/State:
IOWA CITY, IA 52240
Expiration
12/08/2012
CDL Cert
None
Date:
Status:
Endorsements:
NONE
CDL Med
None
Status:
Mailing Address:
2018 WATERFRONT DR
Restrictions:
NONE
Restriction
None
LOT 64
Date of Birth:
10/8/1982
Supplement:
Mailing City/State:
IOWA CITY, IA 52240
Sex:
F
History Information
CLEAR DRIVING RECORD
Name: Castillo Moreno, Marla Evangeline DL/ID: 442AF6704
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:
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7/3/2012
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Office of Driver Services
Iowa Department of Transportation
Name: Castillo Moreno, Maria Evangelina DL/ID: 442AF6704
IOWA
USA
IA
'CASTILLO Mum�"-
MARIA EVANGELINA .fy
2018 WATERFRONT OR LOT 64 T
IOWA CITY, IA 52240
IL N.442AF6704 `
Iss 0 710 31201 2 EXI 08,02 In. F `
End 3 Hyt
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