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Home My WebLink About13-267 Authorization Number ) 3 -,„- L0-./.. 1 (Office Use Only) —fes. _4 iVIII -Ulm �� CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday–Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX Fist " Middle Last _(_ �/� 1. Name a. �(_ki i _ f✓ I t7che c 1 V o ! 2. Mailing Address 2_3 i/ 2 S • hUbU 11-e S+ Al : I 3. Telephone: Home 3 I 1 S `-I . (6 �Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have youe�r(.cpnvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? t�k (J Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last fiyears? yve a Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? v d 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) ISG 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) clerWlaxidrivbadg 03/2013 w ` I hereby certify that I have Issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 78 of t4 836 0 . 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 r-1 - Date ( I (2A 1 ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by \/ct e.r; 4— . . ( 'y f.tJc vt . On this a 1 - day of /.,�-,kf4.1“- of )o11 dvii1i14... wENDY S.MAYER k� rnmmiecun Nutnher 120428 Notary Publiand for the State f 1�6 owa • M Commission Expires 1-4—) til ************************************************************************************************************************************************ 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). iiii------------ 1/-,7//3 signature of Police Chief 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. � � ‹. 7 -Z12--- 1) -,3 1-13 Signa--71/( 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 clerkttaxidrivbadgeapp2010.doc 03/2013 111111 Iowa Department of Transportation Office of Drier Services (Toll Free)800.532-1121 PO Sox 9204,Des Moines,IA 50305-9204 515-244-9124 FAX 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 11/21/2013 DL/ID#: 587AH8380 (IA) Customer#: 5522817 Name: Gyetvan,Valerie Class: D ID Status: None Elizabeth Address: 23 1/2 S DUBUQUE Audit#: 7547104 DL Status: VAL ST APT 1 Issue Date: 11/21/2013 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 05/18/2017 CDL Cert Status: None 522403954 Endorsements: 3 CDL Med Status: None Mailing Address: 23 1/2 S DUBUQUE Restrictions: Corrective Lenses Restriction None ST APT 1 Supplement: Date of Birth: 5/18/1989 Mailing IOWA CITY, IA Sex: F City/State: 522403954 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/25/2012 08/06/2012 592 Speed (10 mph& Johnson IA under in 35-55 mph zone) Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/01/2011 650271 IA Name:Gyetvan,Valerie Elizabeth DL/ID: 587AH8380 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 �iF tf 41 4 IOWA 1I/21/2013 czt 111 ys;D. 0. T...14,1 ',;c'ft% •••1#5 r , % 0111111_47F Office of Driver Services Iowa Department of Transporation Name: Gyetvan,Valerie Elizabeth DL/ID: 587AH8380 OF PUg.c State of Iowa NS,...c4.OF,Ok ' tirsDivision of Criminal Investigation w� q 215E7`�'St -. Ie -„w IOWA Des Moines IA 50319 ' .:u, :. Ph.515-725-6066 Fax 515-725-6080 z �°�.�'°� ' g o� Ah 9o-`070N 0-y�Q Iowa Criminal History Record Check ��qrM'"A,�� Walk-In Request Your name \\fa IPS( lc Gue Address 2 3 1/ 2 S bu 6j v-e St .'gyp{'- it City/State/Zip U, O,_ (' �-t 4 I `---ZZ O Fill in all shaded areas. Phone# l 9 t 1-1- (D 'l‘1')PD Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) G,le- s\ian V - Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) 0 c / \b i 19 ❑Male akemale S'2"9 . LI , 9 I c Waiver Sign ure Firma(if the request is on y urself,please sign. If the request is on someone else,write N/A.) ci1/40i2optik r‹,......-/ N.......- Results DCI USE ONLY As of /7— n .a —/3 , a name and date of birth check revealed: ❑No record found Record attached, DCI # 7c5 /a.,?(f/ DCI initials44() f -, Receipt Number of requests x $15.00 per last name=Total amount$ Method of payment: Ocash ❑money order ❑check# ❑MasterCard or Visa Cardholder's name Last 4 digits of MC or Visa DCI initials Credit Card Number# Exp. Date IOWA CRIMINAL HISTORY DCI 00834626 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2013/11/20 DCI:00834626 NAME: GYETVAN,VALERIE ELIZABETH DOB SEX RAC HGT WGT EYE HAIR SKN POB 19890518 F W 503 110 HAZ BRO FAR IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED 20080509 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA124.401(3) -2 POSSESSION CONTROLLED SUBSTANCE, MARIJUANA TRK#: 1A0044D01 CHARGE NO- 02 IA STATUTE IA715A.6 (2) -C UNAUTH. USE OF CREDIT CARD < $1,000 TRK#: 1A0044D02 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A.6(2) -C UNAUTH. USE OF CREDIT CARD < $1,000 COURT CASE ID: 06521 AGCR083214 CHARGE CLASS: NON CONVICTION TRK#: 1A0044D01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20081017 PROBATION 1Y 20081017 SELF SUPERVISED PROBATION. PROBATION EXTENDED 1Y 20091023 PROBATION EXT TO 10/17/10 DISCHARGED FROM 20100316 DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 AGCR083214 CHARGE CLASS: NON CONVICTION TRK#: 1A0044D02 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20081017 PROBATION 1Y 20081017 SELF SUPERVISED PROBATION PROBATION EXTENDED 1Y 20091223 PROBATION EXT TO 10/17/10 DISCHARGED FROM 20100316 DEFERRED JUDGEMENT COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE IA714.2 (5) DCI 00834626 ' PAGE 2 OF 2 THEFT 5TH DEGREE - 1978 COURT CASE ID: 06521 AGCR083214 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0044D03 SENTENCE DISP EFF DAT TIME SERVED 1D 20081017 JAIL 1D 20081017 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 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION