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Home My WebLink About13-121 Authorization Number /3 I 1 (Office Use Only) APPLICATION FOR TAXI DRIVER CITY Y OF IOWA CITY (Police Department review must be made 410 East Washington street between 8 a.m.to 3 p.m., Monday—Friday.) ofwa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name I sA 1-\)N6 2. Mailing Address -(; E C "4 �J1 (,J [ �� t .L{�G 1 ,Q ;52:714, 3. Telephone: Home 3(q- 76, / Other: 4. Prior experience in transportation of passengers: Nea Ur l/.1 Gt .t.`— FAA . 1 L LS (:)-41-1 Er- f'E'PLS t< D5 Do S CC4_Art 7,) 0 Lill .& 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A/0 d 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? tib;i _ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? J1L.5' v -rue AT(AeN� LYLo,_3(AA Type of offense Where When tia I ,�a� �c �,�, � t{LA �- cis. L6Lial 6c) 2-( 9 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? �&.IC) 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) .&P 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) clercflaxidrivbadg 03/2013 I hereby certify that I have rued to me by the Iowa Department of Transportation a valid Chauffeur's license number (ole Lim `7)37 . 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 Applic. t 4), _ Air/ Date /3 ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) SuloObed and( . o before me by L-1�s-A- 41, S . On this 3 1' day of l 1�1-c U/ • LTA Ike.A KELLIE K.TUTTLE Notary Public in and for the State of Iowa Guinndssion urnoerZ1.1tf1y My Co' ssio Ex res J_YW ********************************************* * *** * *************************************************************************************** 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). gnatur 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. Signature of City Clerk or design 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 derkftaxidrivbadgeapp2010.doc 03/2013 May, 20. 2013 3: 34PM ,Div of Criminal Investigation iNo. 4107 iP. 11 nln,. iv. 'LV IJ � c,�nn • oily �icln mile' ui ivva ti;21 i l r 1i 1 , • • • 4 l LL 1 • r Ild leq 1 l 'Ave ly n'lae.• 1 • ,4-.V tt ISn�'lC+ r.y1l/'IO'1� ,yyp1` ', ,"�.:„rr i;') . ip�1 1 ,' ... ,/'Y�p uvpl (� pn® ��e�,Jy,LV'n•�Yyf.l� 'py 'nan l .,. 4(6,4: ylll'T'j�l1Y r C4 ui zal. l fistoxyry-r4 eWeor Cheek i.P1C �•Cf��y t�i 1 '! 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K , kYtolio1 are-3s6--s 4i • _ t1AX! 47R�.15(,-4447 I Ane requostAAg eaIoyiA Crtmi natllisroryRecord Check on; • • , Last Matte tnndnoid ' S+ retName rndnddfd N1iddleN'ame ecaml1s 6ld) all L ($fl ANA) • • Dago 0103.11'tlt(mwhiory) GmierOnandaloly) SGof4I&eCTi%ttyN11)n�Cr(rceammcndo41 C) 2. 194 16 1 171vrais • wan. ato ,3Q b-- b l/3 ✓(1dvef'1iglfa)DIaifaYl;Wlfhontasigdd$'cmfr r rotnlhesubfeoEotthovoano t;n Can* thrilAlh(sfa l word)naynot . — )atasa6IEeitodaThiCfin1a,VerrcmptatacrMadlilsca r ASln)5 ntiewottyla , ---- • Warn A watvorslghaturehom Ow attract 01'th vool(6si: , _ Ttt'erRefepys;IferctygYepItnIsffdabob noverequesUngottoitocouiuota1raWAor iriatAltlowrecolde eckwithfisDYatonofC,mial • . lcsdg (onP°D•AnvcrimfnsllJctory•, ,.nordfignehattme(nmrn • !hob cmeyyor ,44ssrllowcdVim • WaiVdig1f1�A• i A _ I • • Air r�_I N c.., 't Iowa,Criimhip;WateryktCbra t •eekResaitg , • mawoonto Mo ` 1ra seat Ofthe•provictedname and.date afbirthreveglad; : - Jr.• No Time Crimiria1)rtisrayRecord tbvud with JD CI ® ram aloairal MolyRecord attached,Dail .Raraivod Time May. 1h. 9014 19,46PMkRn_ 479Q arcIowa Department of Transportation . . Office of Driver Services (Toll Free)80D-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/16/2013 DL/ID#: 366UU9035 (IA) Customer#: 1367565 Name: Hayes, Lisa Ann Class: D ID Status: None Address: 405 E 4TH ST Audit#: 6918285 DL Status: VAL Issue Date: 05/03/2013 CDL Status: None City/State: WEST LIBERTY, IA Expiration 02/06/2015 CDL Cert None 527751414 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 405 E 4TH ST Restrictions: NONE Restriction None Date of Birth: 2/6/1951 Supplement: Mailing City/State: WEST LIBERTY,IA Sex: F 527761414 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/09/201104/17/2011 ;B64 No Insurance Card 70 IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident DateCase Number 7UR 12/11/2009_. .__._ .......... ;542613 ->., .....__. .. _.. _ IA Name: Hayes, Lisa Ann DL/ID: 366UU9035 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: i;:.11Clf Oj`.. 5/16/2013 ;¢:' IOWA :*'3, ',e: D. 0.T. '. c rr1i��x Anita Iowa eDepartme Department Services