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Home My WebLink About12-291CITY OF IOWA CITY 410 East Washington Street Iowa -City, 4ewa 52240-1826 ed'r4) 3 5 6_ (,t, d )242* (319) 356-5497 FAX . First 1. Name Authorization Number 19 " ;qi (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 2. MailingAddressuIa59 %Annan Dr A-pf 314 7•C• lky 3. Telephone: Home I T 9 abet 45-(a9 Other: 4. Prior experience in transportation of passengers: T J CQ\K *ON U )AU r Of Cab lb c9eEa OtA0, 21'VE been Ar iy i rnq 564e l�j far ao �Apo(-S. 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense W Where L;1.h r; 6. Have you been convicted of operating a motor vehicle while under the years? n) o Type of Offense Where When of alcohol or drugs in the last five When 7. Have you been convicted of any traffic offenses in the last five years? al o Tvpe of offense Where When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N(7 Tvpe 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 ST T-FFtTIFI n 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) deft) drwbadg 09/2012 I hereby certify/t�ha4t I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number %%2 ZZ H 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) ll Signature of Applicant Date O� STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by P1,e4 rn r Gi On this ?-C) 00"� day of 1 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 ture of PoficErCh& 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. Signature of 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 D to deh .Wrivb.d,. 2010.doc 09/2012 Page 1 of 2 Iowa Department of Transportation Office of Driver Services (Tull Free) WO.532-1121 PO Box 9204; Des Moines, IA 5939&9204 515-244-9124 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/19/2012 DL/ID #: 782ZZ9129 (IA) Customer #: 5058595 Name: Willard, Virginia Louise Class: D ID Status: EXP Address: 1259 SHANNON DR Audit #: 5084230 OL Status: VAL UNIT 324 Issue Date: 03/15/2011 CDL Status: None City/State: IOWA CITY, IA Expiration 09/09/2015 CDL Cert None Revoked 522464162 Date: UA Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1259 SHANNON DR Restrictions: NONE Restriction None UNIT 324 Date of Birth: 9/9/1976 Supplement: Mailing City/State: IOWA CITY, IA Sex: F 522464162 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 0400 02//25 111/27/2006 n33 -Drug/Drug Related C nvicJon 57 I tNO Iowa Department of Transportation Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended.04/13/2004 D53'Non-Paymentof Iowa Fine rIA SIA Revoked ,j10/20/2006 10/22/2008 04/19/2009 A33 :Drug/Drug Related Conviction UA IIA I Name: Willard, Virginia Louise DL/ID: 782ZZ9129 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: "•.!P%4y� 12/19/2012 IOWA *y CV40V 0. T::e I ..... g�'_= Office of Driver Services tNO Iowa Department of Transportation 12/19/2012 Dec.27. 2012 2:02PM VC L, 17. LVIL L•J Ii IYI Div of Criminal Investigation oily UIerx - L,Ity of 1otya L. i ty a v - - SII,&.1LA 01C YOCVA --- (i xA rfaaraaM,gtoryRecord wheels Request Yo1rm Too Iowa MV1110n of Crlm11talinwatlrgarfoh Support 09oeatfotys pgreulr,11,1?toor, 2ZS F..114 Sircot 1),99 Mytne9j.10WA 50419 (919) 729.6066 (615) 925-6080 NOX L_ ,A C_O Tte Yoiea4gfiie, per Coda 01610r WIVIfer.ReCepser YnYOSlfgelfon(pCJ). Aq 19,61�1(A Noo. �8 [8 P. z/2 x1C1Acoo)WNumber. O,;x- P arnppgoab e) cxxx adz's oraxC.>, 410 F TfAS$ING OD7 �TR _ ^TOWA CITY T0&7A RMM_ Maim 919-156-501 �aXl 91,4-.95F-.5497 L.o0 iSr_ �fzyxAze ' Ienlare �,Oa3�5(��Da5� 1WaiYeribrtthesnblectofthe Yapma)acompfoteON(Y)AIMforyrecordmaytint 692AIrorcotn iatacrimtnAThistot7ro0Ora III NSmAttotr�01aaawoAbyln%W,af{vays tDrlhoabove nqursllnzorncia([v owa Cximbal Imstory ReOOK4 Check RegnitgCheck Regnit� . _I__wci Asoi \�-7 � aseaYclzo#fheprovidednameandttafeo$biYtha'avoeled: •i-;:� " ,-. Nolbwaalminai14stayRecord foundwlrh))CT �' �otNsL`rimina113'isfoxylZ000xdatfached,7]Cr� �a2��o� � �1- `N" Zeceive� Time" Dec. 19, 2012 2:31PM No.8182 Dec.27. 2012 2:02PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00628661 NAME: GINNY SLATCHER, VIRGINIA SLATCHER,VIRGINIA LOUISE WILLARD,VIRGINIA LOISE WILLARD,VIRGINIA LOUISE WILLARD,VIRINIA LOUISE DOh SEX RAC HGT 19760904 F N 506 19760909 ADDITIONAL IDENTIFIERS TAT L SHLD TAT UL ARM DCI 00620661 PAGE I OF 4 DATE PRINTED - 2012/12/27 NGT EYE HAIR SKN POB 140 BRO BRO MED MA CCH RECORD www 01 ARRESTED 20000029 AGENCY: IA0530100 ANAMOSA PD CHARGE NO- 01 IA STATUTE IA321J-2 owl TRK#: 039745101 CHARGE NO- 02 IA STATUTE IA726-6-1A CHILD ENDANGERMENT TRK#: 039745102 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 03974$101 SENTENCE ' PLEAD GUILTY SUSPENDED JAIL 30D FINE . $1000 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 02 - IA STATUTE IA726-6(3) CHILD ENDANGERMENT CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 039745102 SENTENCE PLEAD GUILTY SUSPENDED JAIL 120D FINE $500 02 ARRESTED 20010311 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA'108-2A-4 ASSAULT ON PEACE OFFICER DISP EFF DAT 20010216 20010216 20010216 DISP EPF DAT 20010216 20010216 20010216 No. 9875 P. 2 Dec,27, 2012 2:02PM Div of Criminal Investigation No.9875 P. 3 TRK#: 501054601 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA719.1 (ALMS) INTERFERENCE WITH OFFICIAL ACTS CHARGE CLASS: MTSDEMEANOR CONVICTION TRK#: 501054601 SENTENCE PLEAD GUILTY FINE $250 COURT COSTS COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 02 IA STATUTE IA123-46 PUBLIC INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 501054602 SENTENCE PLEAD GUILTY FINE $50 03 ARRESTED 20010321 AGENCY: IA053000D JONES CO SO CHARGE NO- 01 IA STATUTE XA321J.2(A) OWI TRK#: 057360901 CHARGE NO- 02 IA STATUTE IA726,6(3) CHILE ENDANGERMENT/ NO INJURY TRK#: 057360902 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06531 OWCR002662 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 057360901 SENTENCE SUSPENDED JAIL 30D JAIL 301) FINE $500 PROBATION 2Y COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 02 IA STATUTE IA726.6(3) CHILD ENDANGERMENT/NO INJURY - 1985 COURT CASE ID: 06531 OWCR002662 CHARGE CLASS; MISDEMEANOR CONVICTION DCT 00628661 PAGE 2 OF 4 DISP EFF DAT 20010816 20010816 20010616 DISP EPP DAT 20010816 20010816 DISP EFF DAT 20010817 20010817 20010817 20010817 Dec,27. 2012 2:02PM Div of Criminal Investigation No.9875 P. 4 DCI 00628661 PAGE 3 OF 4 TRK#: 057360902 SENTENCE DISP EFF DAT SUSPENDED JAIL 120D 20010817 JAIL 120D 20010817 PROBATION 2Y 20010817 04 ARRESTED 20020604 AGENCY: IA0310100 DUBUQUE PD CHARGE NO- 01 IA STATUTE IA123.46 CONSUMPTION/ INTOXICATION TRK#: 300310101 COURT DISPOSITION AGENCY: IA031015J DUBUQUE CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1970 COURT CASE ID: 01311 SMCR052165 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 300310101 SENTENCE DISP EFF DAT JAIL 1D 20020013 FINE 20020813 COURT DISPOSITION AGENCY; IA031015J DUBUQUE CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION - 1970 COURT CASE ID: 01311 SMCROS2165 CHARGE CLASS: MISDEMEANOR CONVICTION TRKO: 300310102 SENTENCE DISP EFF DAT JAIL 1D 20020813 OS ARRESTED 20060718 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: 503674401 ' COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06571 SRCR060186 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 503674401 LICENSE REVOKED SENTENCE DISP EFF DAT Dec.27. 2012 2:02PM Div of Criminal Investigation DCI 00628661 PAGE 4 OF 4 TIME SERVED 2D 20061127 JAIL 2D 20061127 FINE $250 20061127 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 02 IA STATUTE IA716,8(1) TRESPASS - < 200 COURT CASE ID: 06571. SRCR060166 CHARGE CLASS: MISDEMEANOR CONVICTION TRIC#: 503674402 SENTENCE DISP EFF DAT TIME SERVED 2D 20061127 JAIL 2D 20061127 FINE $50 20061127 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, ,-ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS ON INFOR ON FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SU F YOUR INQUIRY. DIVISION OF C AL INVESTIGATION No. 9875 P. 5