HomeMy WebLinkAbout12-284• I r t
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CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number la, — .�Bq
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday – Friday.)
3. Telephone: Home 3\R_ 3V3- as\'k Other:
4. Prior experience in transportation of passengers:
o r�
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? \Ao
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? �Ao
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N�
Tvoe 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,M widJwbadg 09/2012
I hely certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
I �0�1 �i l7 30 . 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 _Ln." Date 3 ;41
STATE OF IOWA )
COUNTY OF JOHNSON )
bscribed and sworn to before me by (_0-&_- r0. v�� On this )25+t\— day of
Public in and for the State of Iowa
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).
Signaty a of Po liq6 7
ief or designee
is ilia
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.
Signatuire of City Clerk or designee c
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Date
derNlarJdriMadgeappWl0d 09/2012
12/,Dec_12_ 20.12._853AM Div of Criminal Investigation
�Iawlirv�y
• V'AYY.-�'Y-V i��Y-.'1-A'
Criminal History'' Record Check .
Request Form
To: Iowa Divlslob oredm(oaTlhvempdoe
Support Operatlons Bureau, 14 Floor
215 X 7° Street '
Pea Molner,loww 50319
(515) 725.6066
(515) 7256080 Far
4 DCI IOWo.7942 P'—.1)3
DC1AmountNumber. N3g3'F+~
- �^ i(rtwoNo)
From.• Manns 10.X1
,Pdoael ,� 314 338-
Faq
0
Imt Name lewd,
first Name tmn4mri Middle Name (Awm
Rt"
1J`f0.v�1
1
Date of Hirth JmAT4iWW
Gender (ewouo Social SwuritY Number =toweled)
M I ack I kT14
O1H11e Female qi 7, ✓-A%-1IA IN
Wotrerinforlllafion. Wlthoets sipped waiver from tele eub)xt of the request, a complete cr7mlo l history record may get
be role WDlq per Coda of Iowa, Cheptor 6922. For complete erlmloal history record laforma0ou, as allowed by law. always
obteta a rrrly rl etun (romtbe aab ett oltherequest,
Waiver Adeare:Ihembye erwmimioofar:hedwa,eQYa,rtlonkulbennA¢+rdTnN�rJmmdNemrymeeNrlckwhldvDtvLlmefCom(nl
'"Wi ed ryft D(3=yhe Rlmed adleredby low.
(nvNt(pduh(DCa. Anr onmhul timry deo7M71
Walver8tgnature:
Iowa Criminal History Record Check Results p mcedy)
As of a search of the provided name and date of birth revealed:
No Iowa Criminal History Record found with DCI
rel
lowa Criminal History Record ettaohcd, DCi
DCI -77(08/25/10)
r
Received Time Dec. 4. 2012 1:57PM No. 7409
Iowa Department of Transportation
Office of Driver Services (Toll Free) WO -532-1921
PO Box 9204, Des Moines, lA 50313"2114 515-244-9124
FAX: 515-239-1637
Certified Abstract of Driving Record
Inquiry Date:
12/4/2012
Name:
Drane, Kimberly Jewel
Address:
906 E BURLINGTON ST
CDL Status:
APT 4
City/State:
IOWA CITY, IA
Status:
522403202
DL/ID #: 769YY1730(IA)
Class: D
Audit #: 6515237
Issue Date: 12/04/2012
Expiration 01/29/2016
Date:
Endorsements: 3
Mailing Address: 906 E BURLINGTON ST Restrictions: NONE
APT 4 Date of Birth: 1/29/1984
Mailing City/State: IOWA CITY, IA Sex: F
522403202
History Information
CLEAR DRIVING RECORD
Name: Drane, Kimberly Jewel DL/ID: 769YY1730
Customer #:
4126236
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Cert
None
Status:
CDL Med
None
Status:
Restriction
None
Supplement:
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:
Name: Drane, Kimberly Jewel DL/ID: 769YY1730
12/4/2012
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Officces
of Driver eoflTransportation
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owaaDepartment
Name: Drane, Kimberly Jewel DL/ID: 769YY1730