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Home My WebLink About13-104 Authorization Number .> _ - ' G (Office Use Only) Nil®111 ..rte` 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.) lowava 52240-.1826 9) 356-5040_ J SAS (319) 356-5497 FAX First Midg! Last � }� 1. Name !�� l A v C\�✓l I 2. Mailing Address 3 2- £ 3 I ` t) r vi l �'- ( � 3. Telephone: Home ,S /7 _ q-3 ?,-3( Other: �( 4. Prior experience in transportation of passengers: l yeh✓ 1— Z1 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? yeS Tye of offense Where When fes,, I, . 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1\.L' Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? yf T e of offenseWhere When :0 A.t„ii �L� (�� I cE'L (42 / AVY 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? L\0 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) 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) derk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number '- - c LI, Z z- L Z ( 61 . 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) J Signature of Applicant Date S• l- STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cflibed and sworn to before me by /\-� !i(�i ( ' �Z- . On this /C'1 \-- day of { V kri..(. 12. 1 �/ J :i KELLIE K.TUTTLE //e (.6r Cc. ...' �" y Commission Number 221819 Notary Public in and for the State of Iowa 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). .7 ,4,-- S _/C- ./. 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. "..,44.4.---- /• `�' 5- 7a -/3 Sig nature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (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 clerldtaxidrivbadgeapp2010.doc 03/2013 Iowa Department of Transportation ..;� Office of Driver Services (Toll Free)830-532-1121 PO Box 9204,Des Moines,IA 50308-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 5/7/2013 DL/ID#: 796ZZ6219 (IA) Customer#: 1745715 Name: Kuntz, Nancy Ruth Class: D ID Status: None Address: 320 2ND ST APT 231 Audit#: 6374845 DL Status: VAL Issue Date: 10/10/2012 CDL Status: None City/State: CORALVILLE, IA Expiration 06/17/2015 CDL Cert None 522412649 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 320 2ND ST APT 231 Restrictions: Corrective Lenses, Left Restriction None and Right Outside Supplement: Mirrors Date of Birth: 6/17/1969 Mailing City/State: CORALVILLE, IA Sex: F 522412649 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/05/2012 09/05/2012 861 ,Vlolation of Accident Requirements 52 IA Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 08/05/2012 697101 IA Name: Kuntz, Nancy Ruth DL/ID: 796ZZ6219 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: 'viicEe 11 > 00• .�G/d+�s 5/7/2013 ( $?M laegOexa YtOffice of Driver�OF OBI � owaDepartme Department Services 5/7/2013 • Page 2 of 2 Name: Kuntz, Nancy Ruth DL/ID: 796226219 c/tel Nn 10 1WOMay. 9. 20131 2: S1PM Div of Criminal Investigation No. 2999 P. 1/4 YIa;. U. LVID ILi Y7riti r,l ly blala - blly UI I r, l et . )4) I r. 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FY/11WSigna lurer,_ —� 4.1111111, ILS Iowa Crimiktal JWatorrReo(ixd Check Resat& , . room onil, Aa of1" 111� • y a aentob o;Ftllopr'avid'ed name pied data ofri>1'ihaavoaled: ' . E1 No Ibwet cilmlwagisfoxy. teeordfolfnd-with Dct Orrowa CiminaI illetozyRe ord attaohed,DCX8 . ),,q • • n.. Received Time May. 6. 2013 12:0111 oaj19 May. 9. 2013 2: 51PM Div of Criminal Investigation No. 2999 P. 2/4 IOWA CRIMINAL HISTORY DCI 00501902 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED- 2013/05/09 DCI:00501902 NAME: KUNT2,NANCY RUTH DOB SEX RAC HOT WOT EYE HAIR SKN POB 19690619 F W 509 285 HA2 BLN FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y GLASSES SC BREAST SC CHEST SC R FT CCH RECORD *** 01 ARRESTED 19950613 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A-2 FORGERY-MULTI CTS TRK##: 017950601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA715A-2 FORGERY TRK#: 017950601 RESTITUTION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19951221 PROBATION 3Y 19951221 02 ARRESTED 19960212 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA714-1(5) THEFT-4TH TRK#: 019614701 COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE IA714-1 THEFT 5TH CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 019614701 SENTENCE DISP EFF DAT PLEAD GUILTY PAY SURCHARGE 19961005 FINE $50 19961005 COURT COSTS 19961005 03 ARRESTED 19981230 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA719-1 INTERFERENCE W/ OFFICAL ACTS TRK##; 045063302 COURT DISPOSITION May. 9. 2013 2: 51PM Div of Criminal Investigation No. 2999 P. 3/4 • DCI 00501902 PAGE 2 OF 3 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA719-1 INTER W/OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 045063302 SENTENCE PINE $2S0 COURT COSTS 04 ARRESTED 20070102 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A. 6(2) -C UNAUTH. USE OF CREDIT CARD < $1,000 2 COUNTS TRK#; 1A000KJ01 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 AGCR078268 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A000KJ01 RESTITUTION SENTENCE DISP EFF DAT FINE $625 20070402 05 ARRESTED 20100809 AGENCY: IA0520200 IOWA CITY Pb CHARGE NO- 01 IA STATUTE IA708.7(2) HARASSMENT / 1ST DEG. - 1989 TRK#: 1A009YFO1 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA708.7 (3) HARASSMENT / 2ND DEO. - 1989 COURT CASE ID: 06521 AGCR087724 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A009YFO1 SENTENCE DISP EFF OAT FINE $315 20101210 06 ARRESTED 20100009 A AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA708.3A(4) ASSAULT ON PEACE OFFICERS AND OTHERS TRK#: 1A009YGO1 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT May. 9. 2013 2: 52PM Div of Criminal Investigation No. 2999 P. 4/4 DCI 00501902 PAGE 3 OF 3 COUNT NO- 01 IA STATUTE IA708.3A(4) ASSAULT ON PEACE OFFICERS & OTHERS COURT CASE ID: 06521 SRCR087738 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 1A009YG01 RESTITUTION SENTENCE DISP EFP DAT TIME SERVED 16D 20110119 JAIL 16D 20110119 FINE $315 20110119 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 OP CRIMINAL INVESTIGATION r--27