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Home My WebLink About13-281 Authorization Number l 3-a1 I r 1 (Office Use Only) I APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Strcct between 8 a.m.to 3 p.m., Monday-Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX FirstMiddl Last 1. Name 'r A. I I TeZiel 2. Mailing Address x 3. Telephone: Home .jl — 02.24 Other: 4. Prior experience in transportation of passengers: TO.ki drryrv.6 4hhS S'- pec r kaft�,( e 10.11 S'lfs1e UJ) i vxi 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? qO 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? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? \* c, Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? No 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) \o 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerkltaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number Y1 I 7 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) 4 Signature of Applicant 9/1A.:4 . Z �y Date /2' /7" i 3 STATE OF IOWA ) COUNTY OF JOHNSON ) •Su cribed an sworn to before me by 11 rPt ber/c, b an . On this ) day of LecerY� r1 7LD/`3 1 // !/ :77-1A4,0 T<mission K.TUTTLE ee_ ([ i`'_ i /a (-4-6e ? ' al r_o mission Number 22181 otary Public in and for the State of Iowa Arly ion mo1a a Cx .:IT 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). ,%/ a -/ -L? Signatur of Polio! 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. -72 j••,-e-t ")--G---' `-'el • c--/ j./1------ ic9.--1 ''i-13 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 5 1/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 Dec. 16. 203121P Div rInvestigation o. P. 1/7 e . I , I3 ',4iyUteri( —uItyl lonty No. 8301 • Afl.il'et IOWA OF IO A gicrA ol.II f t r Criminal History 'ectird Check • 4..,dIowIatmI 1 i11equestForm fr �i• • • DCI Account Number; 4 bb a"r— (uapphcablc) To: Iowa Division of Criminal lnvestigalion From: CITY OE IOWA GUY Support Op011110nMEureau,1"Floor CLTY Cal1IC'S OFFICE . 215 E.71h Street 410 E WASI1INGT0N STREET Des Moines,Iowa 50319 (515)125-6066 . _ (515)725.6080 Fax Rhone; 319-3565041 ram 319-356-5497 I am requesting an Iowa Criminal I3istoryRecord Check on: Last Name(mandatory) First Name(mandatory) Middle Name(recommended) rqQ � Date ofBirth y(mandalory) Gender(mandatory) SocialSecurity (ru � Numberommcnae4) a- ��- `CRIA ®Male IFemale H\3- t I- 9te(4.1 Waiver_Information:Without a sighed Waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 022.For complete criminal history record information,as allowed bylaw,always obtain a waiver signature tYoru theaubleet of the regaest. Wei bier Release:thereby give perroleslon for to aboYo ttqucsting omcial to conduct an Iowa criminal hlarotyrecord check with the Division of Criminal 7nvesilaaiton Pa). Any criminal history data coneemin;me Ihat19 maintained by lb ober may beidolised as allows by lsw, . Waiver Signature; /.amu ' I - . , l + r n Iowa Criminal History Record Check Results (arose only) As of `-LA U 1 L3 , a search of the provided name and date of birth revealed: • No Iowa Criminal History Record found with DCI El Iowa Criminal History Record attached,DCI II • DCT initials Received Times Dec. 11.n2013 4:40PM No. 7962 .i. Iowa Department of Transportation OlfceofDriver Semicess (Toll Free)800-5532-1121 . 41 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/26/2013 DL/ID#: 769YY1730 (IA) Customer#: 4126236 Name: Drone, Kimberly Jewel Class: D ID Status: None Address: 812 FAIRCHILD ST Audit#: 7111701 DL Status: VAL Issue Date: 07/09/2013 -CDL Status: None City/State: IOWA CITY,IA Expiration 01/29/2016 CDL Cert None 522452832 Date: Status: Endorsements: 3 CDL Med None • Status: Mailing Address: PO BOX 3084 Restrictions: NONE Restriction None Date of Birth: 1/29/1984 Supplement: Mailing City/State: IOWA CITY, IA Sex: F 522443084 History Information CLEAR DRIVING RECORD Name: Drane,Kimberly Jewel DL/ID: 769YY1730 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: it. N-.1417A9/26/2013 Seca ,I IOWAa DO.T.; 4k• Ofce of Driver Services �IY� Iowa Department of Transportation Name: Drane, Kimberly Jewel DL/ID: 769YY1730