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Home My WebLink About12-2196. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Ak Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When W/'1in_f7A b B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? kb 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) clerk jdrly adg 09/2012 Authorization Number -1,;2 — '::�- l r 1 (Office Use Only) 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 (319) 356-5040 (319) 356-5497 FAX First �I,Iddle Last 1. Name �vvl FFV�V� n4lV", vt Ke 2. Mailing Address �f��iCb L s -t- 14LLS, vi 3. Telephone: Home _�31 q �_- 7 S 3 S Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? tiy 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? Ak Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When W/'1in_f7A b B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? kb 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) clerk jdrly adg 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 'i%7 WW 8/ 3 8 . 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 � e Q Q. ,�w,r vcR,y _ Date—"/' 9 11 a- YY4*#*##*f #f#ffiff4fYHHHHh!*H#4f##H1f lHHffHHHffINfYki#Y#Y#HYH4H#Hf#HH#t#*ffflfHHflff f fMfflf f f 11f4f ifHiflHY#!R f*YYHY#i-fff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C On this 9 day of Sm„iLa,�, N410 Notary Public in and for the State of Iowa 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 of Police Chief or designee 9/9-iz Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Signa re of City CWk or designee Date Taxi cab businesses are required to provide Driver Identification cards. *t***4*H#Rf**#Hf#######H##*#i****f H#H4#4#f41ff4#H#####4###*****#*kf*****HfiHRiitf*fH*Hfkf4lfHHH11ff4f f#####HH*i#ii*4ifHlfff#4H4 Office Use Only Approved application DCI report State certified driving record Website update d« dnwadge�2010d 09/2012 IOWA - /// —lU A a 'y IA MM JkATKINS, HMINKE ROLANN fy 031 ST AVE / IA 52206'-' .377WW86388/21/2012EXR08/29/20?7D End 3 '.Sex,,F�+. Res Diction +Hgl S5i.0 6 Eyes BRO DOSOS/29/195i P6NOR:v DD 562336241SC1247F290817R MEDq ,Dy.y Iowa Department of Transportation i I r, , Office of Drier Services (Toll Free) 800-532-1121 PO Box 9204, Des Manes, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/21/2012 DL/ID #: 377WW8638 (IA) Customer #: 422150 Name: Schminke, Carol Ann Class: D ID Status: None Address: 7180 31st Ave Audit #: 1567244 DL Status: VAL Issue Date: 10/10/2007 CDL Status: None City/State: Atkins, IA 52206 Expiration 08/29/2012 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 7180 31st Ave Restrictions: NONE Restriction None Date of Birth: 8/29/1951 Supplement: Mailing City/State: Atkins, IA 52206 Sex: F History Information CLEAR DRIVING RECORD Name: Schminke, Carol Ann DL/ID: 377WW8638 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 8/21/2012 IOWA'', f ). 0. .kNIF SR=' Office of Driver Services Iowa Department of Transportation Name: Schminke, Carol Ann DL/ID: 377WW8638 ..� Gr Pd9l4 ,4STATE OF IOWA 'j►,.�IOWAf FyP Criminal History1 1 Che Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 215 E. 7ei Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax T am remtestina an Tnwn Criminal Ristnry Rernrd Check nn - DCI Account Number: 9861-F (if applicable) From: City Clerk's Office City of Cedar Rapids 101 First Street SE Cedar Rapids, IA 52401 Phone: 319-286-5060 Fax: 319-286-5130 Last Name (mandatory) First Name (mandatory) Middle Name (mandatory) 5�.11 th im ke Am In Date of Birth (mandatory) Gender (mandatory) Social Security Number (mandatory) � I Qcl l51 []Male 19fernale Ll 9 Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request. Waiver ReieaSe: I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Criminal Investigation (DCI). Any criminal history data concerning me that is maintained by the DCI may be released as allowed by law. Waiver Signature: .- (d4M 4 , l! - • Date alai, 6:;l - Iowa Criminal History Record Check Results As of I a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI DCI initials DCI -77 (08/25/10) (DCI use only) .11 _ . '10 Single Contact License &Background Check Results Criminal Histor Background Check Last Name Maiden Name First Name DOB SSN Selection Criteria Schminke Carol 1951 -August -29 484668496 Results Not found in Database Background Check Complete As Of 8/21/2012 2:24:54 PM NOTE: The first and last names, date of birth, and SSN displayed in the abuse registry and criminal history results are just as they were entered on the screen. Billing Account 9861-F Cash Deposit Currently at $449.00 Generate PDF Search Again https://www.iowaonae.state.ia.us/SING/SINGSQLProcess.aspx 8/21/2012