The URL can be used to link to this page

Home My WebLink About12-289CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX First 1. Name 2. Mailing 3. Telephone: Home 4. Prior experience in S, Authorization Number ra - a 89 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle _O/ 51 n Other: of passengers: /lit /_ _ i - %I i c'LS ` -7 A --I _ 7 n� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? C-dQ� Type of offens Where, When 1�cc, 5L't4-(A 3-10-2no r�)1 ,I ,t- ,cam n .t , _ Q_Q- -2^^(�) 6. Have you been convicted of operating a motor vehicle while years?4L Type of Offense Whe ni t � t 1 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where influence of alcohol or drugs in the last five When When 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? UQ� Type of offense When Zo 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) d kAaxidrwbadg 09/2012 I eby certi thatqI have / issued to me by the Iowa Department of Transportation a valid Chauffeur's license number /—i?i t X / r) W) . 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 aJLes of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Puj*Gy---7 /J / i Signature of Applic Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �� ha Pn��g\\��h�c�� C On this day of �w.b.,, a,012� Notary blic in and for the State f 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). Signatur of Poli ief or designee 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. S+gnnnareo Cty erc r'designee — 'Dates Taxi cab businesses re required to provide Driver Identification cards. #4+#########++###*#*#*****#*####*h#*###***##4*##*##**##*******#**44**+#*t#+t+##44#4#*4+##44+#+######4###4##*+##*#+##*#*******#***#**#**#44*++4++ Office Use Only Approved application DCI report State certified driving record Website update d.Md ,dnwad 2010.d. 09/2012 State of Iowa Division of Criminal Investigation 215 E 7u` St Des Moines IA 50319 Ph. 515-725-6066 Fax 515-725-6080 Iowa Criminal History Record Check Walk -In Request .n 9 Your name V1,0, Middle Name Segundo Nombre (recommended) Address Ci /State/Zi t J Phone# 3 t q Reauestine an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apeiiido (mandatory) First Name Primer Nombre (mandatory) Middle Name Segundo Nombre (recommended) T+4ALK5n-J�iGk!5 6 1C q1WA, +0C V-, V\ - Date of Birth Fecha Nacimiento (mandatary) Gender Genero (mandatory) Social SecurityNumber (recommended) — z L - 1 � ID S�` ❑Female LlMale V 3 ` D p _ 8 ,� 6 Waiver Signature Firma (If req st i yourself, pleas sign. If the request' n someone else, write N/A.) As of ( a - 1 y " I a a name and date of birth check revealed: ❑No record found *Record attached, DCl # G 3 9 y 8 DCl initials Receipt Number of requests x $15.00 per last name = Total amount $ Method of payment: ❑cash ❑money order ❑check# Cardholder's name DCI initials DCI USE ONLY t -j C-) ❑MasterCard or Visa Last 4 digits of MC or Visa Credit Card Number # Exp. Date. tv IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00639848 NAME: HICKS,REGINA ANN THALKEN,REGINA ANN THALKEN-HICKS,REGINA ANN DOB SEX RAC HGT WGT 19651026 F W 507 160 DCI 00639848 PAGE 1 OF 2 DATE PRINTED - 2012/12/14 EYE HAIR SKN POB BRO BRO FAR CA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC L CHK TAT ABDOM TAT L WRS TAT R HIP TAT R SHLD CCH RECORD *** O1 ARRESTED 20010310 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE/SCHEDULE I TRK#: 100180901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCR058209 CHARGE CLASS: NON CONVICTION TRK#: 100180901 SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION lY COMMUNITY SERVICE 20H DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED 20090908 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE TRK#: IA007OB0I COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCR088327 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA007OBOI DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION DISP EFF DAT 20010817 20010817 20010817 20021022 SENTENCE JAIL 2D FINE $1250 DCI 00639848 PAGE 2 OF 2 DISP EFF DAT 20091202 20091202 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF 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 IDENTIFICATION THIS RECORD IS BASE INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COV SUBJECT OF YOUR INQUIRY. DIVIS N OF CRIMINAL INVESTIGATION C • ARTS Page 1 of 2 Iowa Department of -Tran I sportation Office O Box Driver Mals (TatFreB)515.244-1121 P6 Box 9284; Oen Manan, IA 503€iFr92a4 '515-244-914 FAX: 515-2394837 Certified Abstract of Driving Record Inquiry Date: 12/13/2012 DL/ID #: 431XX9040 (IA) Name: Thalken-Hicks, Regina Class: D Effective Ann ACD Explanation Address: 621 S DODGE ST AFT 8 Audit #: 6486622 Issue Date: 11/21/2012 City/State: IOWA CITY, IA Expiration 10/26/2017 522405401 Date: Endorsements: 3 Mailing Address: 621 S DODGE ST APT 8 Restrictions: Corrective Lenses Date of Birth: 10/26/1965 Mailing City/State: IOWA CITY, IA Sex: F 522405401 History Information Convictions Date Conviction Date . ACD 09/08/2009 712/02/2009 While Intoxicated Operating While Intoxicated Test Refusal/Test Failure violations Occurrence 09/08/2009 ACD Test Customer #: 622326 ID Status: VAL OL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Restriction None Supplement: IUR Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Sanctions hoe Effective End ACD Explanation Occurrence IUR SUR Suspended 107/20/2010 109/09/2011 iD53 ;Non -Payment of Iowa Fine Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 Pursuant to Iowa Code §321A0, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportatlon; 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. http://172.29.254.55/drivers/reports/customerhistory/C.ertifieddrivingrecord.aspx 12/13/2012