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HomeMy WebLinkAbout12-287III AMR= F.ZZ.1 • rM =Ocgq CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name 1 I.e ro t -A 2. Mailing Address 3. 4. Authorization Number 42 "AFI (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? AA0 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? IVI? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? SPS Type of offense Where When ^ 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? A1,0 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) derMY Idrivbadg 09/2012 , I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nuSnber 9z 7 AA ,17 %/3 . 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 Date12—�� 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). '�y� ' Si ature f Police Chief or designee 1.2 - i 2 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. a>� Signa f City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update a - l2 - Date !eR midnvb dgeapp2010.doc 09/2012 9 Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, JA 50306-9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/7/2012 DL/ID #: 987AA7713 (IA) Customer #: 823608 Name: Teslik, Dorothy Jane Class: D ID Status: None Address: 228 3RD ST SE Audit #: 3143961 DL Status: VAL Issue Date: 03/24/2009 CDL Status: None City/State: SWISHER, IA Expiration 04/02/2014 CDL Cert None 523389641 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: PO BOX 175 Restrictions: Corrective Lenses Restriction None Date of Birth: 4/2/1942 Supplement: Mailing City/State: SWISHER, IA Sex: F 523380175 History Information Convictions ciiatior Oat. Cenvi:rticn Date ACD Explanation County Jul: 03/29/2009 04/03/2009 S92 Speed 52 IA Name: Teslik, Dorothy Jane DL/ID: 987AA7713 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: Teslik, Dorothy Jane DL/ID: 987AA7713 I IOWA'12/7/2012 ¢° D. 0. T. 7f '••••"S Office Driver Services of "\RRIVER,_s Iowa Department of Transportation Name: Teslik, Dorothy Jane DL/ID: 987AA7713 I 2012-11c. e4,UY01i?t AIKvvRT SnullLh�iLKynal Investig3'iyti621094 >> , lam 1 No.6704 P. 2/2 515 Icy 608Q N e/2 STATE OF IOWA, p��. m f;•. CrFminal Hfstory Reroria Chdck Request Foyd � ytiy, r t lo; Iowa Dlvlrion of Criminal Invesfdgation Support Operations Hurenu, I" Floor 2.15..2. 7'a Street Des Molnes, Iowa 50719 (515) 725.6066 (SI 5) 725-6olfo Fal lest Record �Do DCIAccouncNumberr: trite fj 1-`�lti �ppllcah or{) From: alai a�fhu,r•�' Il. � � -T Phone; a Jat'n 'f- r �/ �^ 7 � I ❑h4ale Female + % �s '7�� �'��6� TT'aiver IltjnrdltaFiOn::Vl fhout a signed svalver tram the suhJect of the request, a camplete erhalnal history record may not be releasable, per Code Of IOWA, Chapter 692,2, For coini2lete criminal history record Information, as allowed by lase, afwnya obtain a waiver slnnatit rn horn en. -„w;..,..,.n._ .._�..... WrtlVer ReiCQSe: 1Inrcby give pennlltleil ror the tbovo requellinl; oHlolal to eandual ep foul e(Itnlaai 111610r),rceord clack *1111 the Diviaoa of c imiini bwe111gntleo(1)CO3 Any criminnl hhloty, dela cun-nming me last if matnmincd by 1116 DCI maybe released as allowed bylaly. Wa1verS1g1laM'04 C F -As of I a/Y //;2, a search of the provided name rnd date of birth revealed: No Iowa Criminal Mistoly Record fowid with DCI 1 s © Iowa Criminal History Record attached, DCI 4 DCC initials 4 DCI -77 (08/25/10) Received Time Nov. 21. 2012 1:57PN No -5071 (Dcr u1c only) I