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Home My WebLink About12-137First nn� Middle /[ Last 1. Name L]S �C�L� ! i r (! r , e4 4Z�1 2. Mailing Address D ,O . Ick ecak ' ' 6 n - - Z is ja 3. Telephone: Home19_RU9-i9g7 Other: 4. Prior experience in transportation of passengers: LaU Jj, , 3cj(gm u "A<, d rl 0t4f . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When IqG I 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �e 5 Type of offense Where When ndAi0a � that, near 'Q�iWglje r Z/l fit,. ,)(,)IX 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 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) derkl idrivbadg D obI �OIZ Authorization Number 1,2— —/37 (Office Use Only) T.0 rlllIk MOMM=r%za CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington street between 8 a.m. to 3 p.m., Monday — Friday.) Iowa City. Iowa 52240-1826 19 356-504 (319) 356-5497 FAX First nn� Middle /[ Last 1. Name L]S �C�L� ! i r (! r , e4 4Z�1 2. Mailing Address D ,O . Ick ecak ' ' 6 n - - Z is ja 3. Telephone: Home19_RU9-i9g7 Other: 4. Prior experience in transportation of passengers: LaU Jj, , 3cj(gm u "A<, d rl 0t4f . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When IqG I 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �e 5 Type of offense Where When ndAi0a � that, near 'Q�iWglje r Z/l fit,. ,)(,)IX 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 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) derkl idrivbadg D obI �OIZ Ireby certify tJ�at I h ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license nurmber �' �� 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 p oyisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applica t Date I Z STATE OF IOWA ) COUNTY OF JOHNSON ) 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). Signatu a of Police Chief or designee 7e ,ge Sig re of City Clerk or designee %.7ril/L Date ��-ice_. 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. 1f 1ff1f1H##1f#fHfN+i#ff+##+***}i*+***f*11ff1f f1111Mf1f11f11ff11ffff#fltillf##t###1f##1!###H###'Hi#ff+ff##+###ii+#####R*+***#*i*****flrflf lfff Office Use Only Approved application DCI report State certified driving record Website update deMc idnvbadgea 2010. 09/aw 0 "t]at1 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 t FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 7/24/2012 DL/ID #: 864PP7535 (IA) Customer #: 5100894 Name: Kinyon, Saroya Marie Class: D ID Status: EXP Address: 2401 HIGHWAY 6 E APT Audit #: 5660326 OL Status: VAL 2615 Issue Date: 12/01/2011 CDL Status: None City/State: IOWA CITY, IA 522406784 Expiration Date: 02/03/2016 CDL Cert Status: None Endorsements: 2 CDL Med Status: None Mailing Address: 2401 HIGHWAY 6 E APT Restrictions: NONE Restriction None 2615 Date of Birth: 2/3/1973 Supplement: Mailing City/State: IOWA CITY, IA 522406784 Sex: F History Information Convictions Citation Date Conviction Date ACO Explanation County JUR 02/11/2012 03/22/2012 S92 Speed 31 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 04/25/1994 12/14/1994 D38 Fall to Post Security for an Accident IA Name: Kinyon, Saroya Marie DL/ID: 864PP7535 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'�4 7/24/2012 :04 IOWA0. '.' i J% iQ"I ftS = B811 Office of Driver Services %I" Iowa Department of Transportation Name: Kinyon, Saroya Marie DL/ID: 864PP7535 Jul.11. 2012, 4:31PI Div of Criminal Investigation 1, tt, Ivit L:)wrn t,tty t,Iera — t,Ity of loved t,Ity %W STATE OF IOWA Criminal ffistory Record ChecE- - Request Form To: Iowa Divlslon of Criminal Investigation Support Operatlogs)iureau, V Floor 215 im. 711 Streat Des Ivfolaes, Yowa 50319 (515) 725.6066 (515) 725.6080 b'az Iamroauestf m, anlowaC5•hnioalI3istorvRecord Checkon! No, 4130 P. 1/12 No. L901 F. L DCIAcoountMmber: lana--- Y"- (Iropplleobfe) Frow CYTY OrIOVVA CITY CITY CLERIC+S O..01CF3 410 R. 'WASIMGTON STREET IOWA CITY IOWA 62240 Pltoaol 319-356-5041 Pail: 319'336-5497 Last Nawe mandato) Firest Name (mandatory) IVliddio Name 60commended) '"C rn Date of)3irt (mandato Gender mmdolory) SOC121SCOU>'1 NU1nb5J' (recommm)idcd) _ — � [IMIlio F'elna -o - I Waiverinformallon; Without a sighed wnivor from the subject of tho request, a complete crlminoI history tocord may not be releasable, per Code of Iowa, Cllaptar 692,.2.,.)For complete criminal history recordinforinaflon, as allowed bylaw, always WWWRCIMC.- Herebygive penillsdail forl6oaboVoso01ra5tiagoHlchltoc0ndo9tanIowacriminalhistaryncordeheckwithlheDIVISIanofClmladl lnyestigatlon(M). Myeriminslhislorydn(aeona (ngniolhatfcmalniald ytt!5mayberaleaocdmallowedbylaw. Walve)' Stgnalur a. Iowa Criminal History Reco>i d Check Results (DCI asa any) As of 7- /7 ` / ?� , a search of the provided uamo and date of birth revealed! Received Time7'Jul, 12,112012 2:35PM No.9534 N CEJ No Iowa Criminal History Record found with b CX CI ro _� �• C? � r • m 'C!3'�'1 — ci R't Iowa Criminal I3istoly Record attached, DCT # n ::U SIA\f DClinitiafSS'? Received Time7'Jul, 12,112012 2:35PM No.9534 Z012 4;31PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00419526 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2012/07/17 jCI z00419526 NAME: RINYON,SAROYA MARIE DOB SEX RAC NOT 'WGT EYE HAIR SKN POB 19730203 F W 506 180 HAZ PRO FAR IA ADDITIONAL IDENTIFIERS SC FED CCH RECORD *** 01 ARRESTED 19910422 AGENCY: IA0940000 WEBSTER CO SO CHARGE NO- 01 IA STATUTE IA714-2-2 THEFT 2ND DEGREE TRK#: L39724601 COURT DISPOSITION AGENCY: IA09401SU WEBSTER CO DIST COURT COUNT NO- 01 IA STATUTE IA714-2-3 THEFT 3RD CHARGE CLASS: MISDEMEANOR CONVICTION TRIC#: L39724601 SENTENCE DISP EFF DAT PROBATION 2Y 19910429 SUSPENDED 2Y 19910429 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP 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 IDENTIPICATIOM 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 111 No.4130 P. 2/12