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Home My WebLink About12-193Authorization Number / o2 r 1 (Office Use Only) 4 tr'lll� APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (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 (3 19) 356-5040 (319) 356-5497 FAX _7`O, First Middle Las 1. Name 1 Qwlwt (/ 2. Mailing Address y0 Flo G J t hSc vl Gt Ue S GJ pp 6�Yld S SGi 3. Telephone: Home 4. Prior experience in transportation of passengers: he ey1 +-tX / drive r -K r- 5. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? .DD Type of offense Where When iAdn7ma 1 t' Llt�si C R II ?-?/-55 /04 ULA � n CouM1q 6. Have you been convicted of operating a motor vehicle while under the years? /U 0 Type of Offense Where of alcohol or drugs in the last five When 7. Have you been convicted of any traffic offenses in the last five years? 5PT6,ed i k� —1 G ice Type of offense Where When 54>�2cit�� +I k-64 7-JI-D'F5' Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) A) r-) 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) deMaxidmbadg 06/2012 I here_by,ce i that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number Simi - -3� /C� . 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 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by_1 v0' ,,.v (ia � os On this S day of Notary Pu lic in and for the State of Iowa 713 t4 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 9-s -/a 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. Office Use Only Approved application DCI report State certified driving record Website update denvYaxitlnvbadgeapp=O.do 06/2012 Iowa Department of Transportation [ E] Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/7/2012 DL/ID #: 808YY3210 (IA) Name: Capps, Tammy Lynn Class: D Address: 4016 WILSON AVE SW Audit #: 4376129 Status: APT 4 Issue Date: 05/25/2010 City/State: CEDAR RAPIDS, IA Expiration 10/28/2012 524046382 Date: Endorsements: 3 Mailing Address: 4016 WILSON AVE SW Restrictions: Corrective Lenses APT 4 Date of Birth: 10/28/1978 Mailing City/State: CEDAR RAPIDS, IA Sex: F 524046382 History Information Convictions Customer #: 702094 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: Effective End CDL Med None Status: 04/04/2009 04/09/2009 Restriction None Supplement: Citation Date 06/16/2008 Conviction Date 07/11/2008 ACD Explanation County Speed (10 mph & under in 35-55 mph zone) 52 JUR IA Sanctions Iowa Department of Transportation Type Effective End ACD Explanation Occurrence JUR JUR Suspended 04/04/2009 04/09/2009 D37 Default In Payment for an Accident IA IA Name: Capps, Tammy Lynn DL/ID: 808YY3210 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: - ••:;7'/�''4� 8/7/2012 IOWA D. 0. T...: ........S�= Office of Driver Services _ Iowa Department of Transportation Name: Capps, Tammy Lynn DL/ID: 808YY3210 �{ Aug; 27; 2012 12:49PM ,Div of Criminal Investi;ationf '1' 110 PP. �1/1 STATE I OF IOWA C Aminal ft.tory Record Check I! � l Y Requegt Form it c DCIAorounrNumhor; To: %wa Dlvlshm of Criminal Investigation Support Operatlons Bureau, V Floor 215 F. 70'&reet Des Moines, Iowa 50319 (515) 725-6066 (sly) 72s4a90 lvax I aul requesting an fowa Criminal History Record Clieck on: From; CITY OX+XO'WA CITY CITY C)L)MX IS OFFICE 410 L, WAS) INGTON STRUT IOWA CITY IOWA 52240 phone: 319-556-5041 Fax: 319.356-5497 L2l;tName(mandalory) First Name(n,andaloty) M1ddIO Nairre(tecommcndad) a� tiqo Mte oUirth (niandatoro As of�J a searclL of the provided nama end data of birth ze�realed: ,Seenrl NUMbe1' (lecammended) _$ []Male / `9emale Walverlgfopination: Without a signed walver front tho subject of the request, a complete crIminal history record may not be roleomble, per Code of fowa, Chapter 692.2. For cornplotel oPhnlnal history record informafion, a9 altowed by law, always obtain a waiver, signature from the subject of the request, Wafver.Release; theveby give permission for Ilia above regvesting of lolal to oohdact an fowa criminal holo Vemrd dierkwlrh 1hoDlvi:ion o(Cririnal Invasllgallon HCl). Any aimfnd halorydate concemingmo that Is malnNfned by lho DClray be released as allowed by taw. Walver91guaArre: dt AUWA%L.UIULLL711. []X15 W1y 1`icG:ulu. r_.ALc.14AA Jai -UKLO (DGE70" As of�J a searclL of the provided nama end data of birth ze�realed: NoZoWaCriminalliistoryRecoxdfoundwithACl ® Iowa Criminal IlistoryRecoxd attached, DCI # DCI initials Received Time. Augg. 21. 2012 12:42PM No, 1828 I)CI-77 (axo..s/illi ITSMW USA tA 3iq-$a6 �'�4 -U-V Lzu"D-. doct-.-c I • �(� TAMMY LYNN - •af 2101 CHANDLER ST SW APT 2 '1J CEDAR RAPIDS, IA 52404 OLNV 808YY3210 s 05/25/2010 EXP 1 012 1 s ctsssD End 3 so F " Rosvj,.. 5RO �/ EycHgt �_ EycsBRO DoBDD IO/ 8/19�aF8i,7 o ml f 3iq-$a6 �'�4 -U-V Lzu"D-. doct-.-c I