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Home My WebLink About13-133 Authorization Number ' 3 — J J r (Office Use Only) 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 �1 First M)ddle ast 1. Name 41 f 2. Mailing Address Lk V.,carkA.e l_cm I1 pc C1)(-b,cj I _y,._}{- 3. Telephone: Home -93[- - .t(P Other: 319-(oy3-4S-110 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? illi) 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? /Oo Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 40 YE.S Type of offense Where When SQE ,r -1-C)tAxL._ a0 Ili 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? A/) 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) 1)C) 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) derWlaxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number! 1 Sae,‘ ,3(03, . 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 / :OW Cp- 1 q'13 pP �.a.� �.� .. :..i.,///1 Date / v ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) i � . SSc� � /J Subs ribed and sworn to before me by / / �� On this / �7G2 day of r.4 .6tP / 0/'� J i4 c ((t- / —/-7,.74// KELUE K.TUT�rLE �ota Public in and for the State of Iowa ^_ r"mm' 47Eçes My Cop�r ********************************************************* *********************************************************************************** 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). 4.4 -15-/a fin, Ke- Sign ure of ;. /e 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. 71 «s. z>✓ -K • �= o — c,2o — / 3 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/z" (width)and 51/2" (height) and prominently displayed to all passengers. *****,,,..*********...,**********************************************************************************************************....,****** Office Use Only Approved application DCI report State certified driving record Website update • clerkttaxidrivbadgeapp2010.doc 03/2013 fillilIowa Department of Transportation Office of Dover Services (Toll Free)800-532-1121 PO Box 9204,Des Moine,IA 50306-9204 515-2444124 %leFAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 6/11/2013 DL/ID#: 152863632 (IA) Customer#: 3458100 Name: Detert,Alyssa Anne Class: C ID Status: None Address: 4 BRADLEY LN Audit#: 4811438 DL Status: VAL Issue Date: 11/09/2010 CDL Status: None City/State: WEST BRANCH, IA Expiration 11/07/2015 CDL Cert None 523589401 Date: Status: Endorsements: NONE CDL Med None Status: Mailing Address: 4 BRADLEY LN Restrictions: NONE Restriction None Date of Birth: 11/7/1977 Supplement: Mailing City/State: WEST BRANCH,IA Sex: F 523589401 History Information Convictions Citation Date Conviction Date ACD Explanation County 3UR 02/05/2010 02/16/2010 592 Speed 52 IA 08/07/2012 08/29/2012 S92 :Speed (10 mph&under in 35-55 mph zone) i52 IA Name: Detert,Alyssa Anne DL/ID: 152683632 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: Cfe�ENI %pi ` ..........4,4 6/11/2013 ;c;z: ' w hlices lhx4.B csr owaeDepartme Dof Driver epartmentTransportation Name: Detert,Alyssa Anne DL/ID: 152883632 Jun liJu9. 14. 2013 ,1 :,21PMab 0Dj0..of Criminal Investigation 3193382708 No. 6193 P. 1 ,. i �� STATE OF IOWA ,11 e ' '?'co Criminal History Record Check 5 el • rF „ Request Form "4u—, ,` 1j. DO Account Number: 990—r ��," tif.pplicuble) Tug Inca 11iridion at Criminal Invesli((a(inn From: tIta...J L.Aa aat. :Iva C(Pj . Sunned Operaliuns Born it, 10 Floor 2151 i.71°sl reel P.O. (3oX 45.8 Deo Moincr,lows 50319 (51$)725-6066 T3...l. l'.:ty , ?A. 511.4V . (515)125.6080 pax phone: .31.4 338-•`117 7 Fax: t4 ?31-73'z I um regnustine an Iowa Criminal ifistory Recnrd Check on: Last Name nnnndawn) First Name(nnnduhuyl Middle Name(recommended) 1)e, - AIL\ Ang) Dale of 13irth u_ndalorrl Gender(nt ndaoy) Social Security Number(recommended) 1\ -151- 1411 ❑Male MFemale fosii If(liver Iajornuitio9: WID10111 A signed waiver AM the subject of tho request,n complete criminal ldsloty record may not be relen torbld,per('ode of Iowa,elm pier 692.2.Fur tom n)e(e criminal history record information,as allowed by law,nhvays obtain a waiver signatu re from the sublet(of the request. Waiver Meuse:I hcrehv gime pamiseinn jri: the ur,we requesting oll'i:mi la comfort nn loon criminal history record check with rhe Division of Crimiaol Imes um.uian ilk'1). 4"r eridamdMoor,.,lata c,umming me rho is muinllniinud Ivy the DCI may Lie Mom)os idioms'by Inv. Waiver Signature:_1 Gf % J Iowa Criminal History Record Check Results (DCI tad only) As of (42,�,,• ,a search of the provided acme and date of birth revealed: . • Tr No Iowa Criminal History Record found with DCI • ❑ town Criminal History Record attached, DO itro • DCI initials ____ • DCI-77 Will25/10) • Received Time Jun, 11. 2013 12:24PM No. 5791