HomeMy WebLinkAbout12-290� . -4
CITY OF IOWA CITY
410 East Washington Street
,Iowa City, Iowa 52240-1826
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
/a - ag0
(Office Use Only)
First 1e,)im Middle 11Last Q1�Un
1. Name 1 K
2. Mailing Address o
3. Telephone: Home Other. - - -Li
4. Prior experience in transportation of passengers: Z u inrKPc1 Por 1= L(alt'r e3erV 1 CAS
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? k1r)
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?-NC\&Y'
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? in-�
When
Type of offense Where When
Fay 1 fe Fi le
5;iz9a.. _AA POOg
8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? *®. 1Jo
o.
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 rGtaTtF1FD
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)
deo- idnwadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nuniber
`J`J`JXKl�llal) .�E �i 60. 01'SnPl 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 )
iSt2bscribed a sworn to before me by eSi L O(56Y1 On this ����- day of
ll
KELLIE K. TUTTLE
MV
i
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).
Sign ur�icgnee
�/ ;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.
Skina)ure of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
der =id vbadgeap 2010.tl 09/2012
Iowa. Department of Tran.aportation
Office of Oliver Services (Toll Free) OM -632-1121
PO Box.9204, Des Manes, 1A 5Q30"2(14 515-244-9124
FAX. -515-239-1837
Inquiry Date: 11/7/2012
Name: Olson, Jeslca Holll
Address: 4591 SAND RD SE
City/State: IOWA CITY, IA 522409396
Mailing Address: 1901 1/2 BROADWAY ST
APT 8
Mailing City/State: IOWA CITY, IA 52240
Convictions
Certified Abstract of Driving, Record
DL/ID #: 555XX1960(IA)
Class: C
Audit #: 4346803
Issue Date: 05/13/2010
Expiration Date: 04/08/2013
Endorsements: NONE
Restrictions: NONE
Date of Birth: 4/8/1985
Sex: F
History Information
Customer #:
3041918
ID Status:
EXP
OL Status:
VAL
CDL Status:
None
CDL Cert Status:
None
CDL Med Status:
None
Restriction
None
Supplement:
07/20/2007
Citation Date
Conviction Date
ACD
Explanation
County JUR
06/02/2007
08/30/2007
S93
i5
SIL
06/02/2007
;08/30/20_0_7
M34
-peed
;Following Too Close
SIL
07/20/2007
_
j08/21/2007
B20
_. ._......._ .._..._
Priving While Suspended, Denied, Cancelled, Revoked
_ _' ....�
.._.... .... ... ..
52 -IA
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence JUR JUR
Suspended
.03/20/2008
'06/17/2008'
_.
!W01
............
.Habitual Violator
r _............... ..._,.. ..............
,IL SIA
......... ....._.._
Suspended
.._..
,11/09/2009
...p.. ....._....
.12/04/2009
-.........
IB63
....... .. ...._..._
Fall to Refile SR22
........... ............ .. .. .. ...........
.IA IIA
Name: Olson, Jesica Holll DL/ID: SSSXX1960
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
'Name: Olson, Jesica Holli DL/ID: SSSXX1960
11/7/261Y
IOWA
D.O.T.' ;
Office of Driver Services
FDRIVER S
'q�a��
Iowa Department of Transportation
'Name: Olson, Jesica Holli DL/ID: SSSXX1960
Dec.12.
2012
2:37PM
Div
of Criminal Investigation
De c. 5.
2012
9:03AM
City
Clerk - City of loeia City
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