HomeMy WebLinkAbout13-215 Authorization Number f J c2) 6
K _ 1 (Office Use Only)
ISI 0111
APPLICATION FOR TAXI DRIVER
CITY OF IOWA CITY (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
(} C MCi � ddle
1. Name tLis)C.k n
2. Mailing Address cYc f _1.y1 c t O C k
3. Telephone: Home 31(1 q 3O—a �.3 Other: 311 61 1 3 6 - j7
4. Prior experience in transportation of passengers: fYone
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or el-
Type of offense Where '�_�-�+ �* Fir'
c
116 - 1 AWAMPA...
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? NN7
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? IU(3
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense Where When
on Pc(ynu,'_.r-f vc' C,f )OO/i3/0>ola - of/o(/oi/
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
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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)
clerk/taxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license r�,umber .
159-W Co Li J . 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 Applican vi-ut e9- — Date 9//$/0)6 1,3
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by .4.u_nkd)c., •-.1-0-,._..1 e,,...c �c...r&S. On this Pa tL-t day of
Notary Public in a for the State of Iowa
crCo�nr MMMM
****** ** F- - � �* �******************************************************************************************************
•
•
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).
AS� 9-j�-/?
Signature f Police ' - . designee Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorizedtaxi driver names are placed on the city website at icgov.org.
Sign ,,ure 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
•
derMaxidrivbadgeapp201 G.doc 03/2013
11111 O
Iowa Department of Transportation
Dnverces (Toll Free)800-532-1121
NC83 PO Box 9204.Des Moines, IA 50306 9204 515-244-9124
IIIP FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 9/9/2013 DL/ID #: 959AA6945 (IA) Customer#: 1236155
Name: Edwards,Amanda Class: D ID Status: None
Joy
Address: 2619 INDIGO CT Audit#: 7319496 DL Status: VAL
Issue Date: 09/06/2013 CDL Status: None
City/State: IOWA CITY, IA Expiration Date: 07/07/2018 CDL Cert Status: None
522406810
Endorsements: 3 CDL Med Status: None
Mailing Address: 2619 INDIGO CT Restrictions: Corrective Lenses Restriction None
Supplement:
Date of Birth: 7/7/1982
Mailing IOWA CITY, IA Sex: F
City/State: 522406810
History Information
Sanctions
Type Effective End ACD Explanation Occurrence IUR
]UR
Suspended 10/13/2010 01/06/2011 D53 Non-Payment of IA IA
Iowa Fine
Name: Edwards,Amanda Joy DL/ID:959AA6945
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:
''Pii 9/9/2013
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fir: IOWA
at
it D. O. T., I =ed.*. Oegiesptza jie
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� -r Office of Driver Services
Iowa Department of Transporation
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Received Time Sep. 12. 2013 21 38P No. 7274 41/44._
Sep. 17. 2013 4: 21PM Div of Criminal Investigation No. 8023 P. 7/11
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IOWA CRIMINAL HISTORY DCI 00809205
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED-
2013/09/17
nrT.onang?OS
NAME: EDWARDS,AMANDA JOY
DOB SEX RAC HGT WGT EYE HAIR SKN POB
19820707 F W 505 185 BRO ORO FAR IL
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
TAT UR ARM
CCH RECORD ***
01 ARRESTED 20070726
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA715A.6(A)
- UNAUTR. USE OF CREDIT CARDS - 1987
TRK#: 1A001YQ01
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA714.2 (5)
THEFT STH DEGREE - 1978
COURT CASE ID: 06521 PECR077773
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 1A001YQ01
RESTITUTION
SENTENCE • DISP EFF DAT
JAIL 2D 20071107
•
02 ARRESTED 20070827
AGENCY: IA0520200 IOWA CITY PD
CHARGE NO- 01 IA STATUTE IA708.2A(2) (B)
DOMESTIC ABUSE ASSAULT WITHOUT INTENT CAUSING INJURY
TRK#: lA0027aol
COURT DISPOSITION
AGENCY: IAOS2015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA708.2A(2) (A)
DOMESTIC ABUSE ASSAULT
COURT CASE ID: 06521 SRCR080604
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 1A0027001
RESTITUTION
SENTENCE DISP EFF DAT
JAIL 2D 20071107
FINE $100 . 20071107
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFTION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW
ENFORCET AGENCIES BY THE DCI.
IN THE ABSENCE OV FINGERPRINTS FOR POSITIVE IDENTIFICATXON 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