The URL can be used to link to this page

Home My WebLink About13-100 r r Authorization Number ) -1W (Office Use Only) -Alt antigulgy 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 First Middle Last U 1. Name SAr- 45"6."C�n ?�� 2. Mailing Address to t t h {f-,) ( c. 1()t , ]� 5--22/-/L) 3. Telephone: Home Other: -Jtct- Q? .'/ i/ 4. Prior experience in transportation of passengers: 7. )/7..e_ 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ././d Type of offense Where When 6. Have yo een convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 2 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �U Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ✓✓C, 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) derksaxidrivbadg 03/2013 I herebycertify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number. Li 3 AA 315O‘. . 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) XSignature of Applicant � i�` f�l 7 Date S-3- 1'3 STATE OF IOWA ) COUNTY OF JOHNSON ) uts. sw ri•ed andsworn o before me by S I U ---)) le of lni./ S . On this r day of r IT19 KELLIE K.TUTTLE i c K tic_Commission Number 221819 Notary Public in and for the State of Iowa rr U. Ce nCpir •iwA i ****************************************************** ***************************************************************************************** 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). ✓o,,',i C JFss V L.'cr..r ignature 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. 71 i--(..- K �� 3 -- i3 Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width)and 5'/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update c.e-V;2,1 Ladgeapc2oio dc 03/2013 4, Iowa Department of Transportation Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,lA 50306-9204 515244-9124 FAX 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 4/22/2013 DL/ID#: 435AA5159(IA) Customer#: 4732710 Name: Dennis, Mary Ellen Class: C ID Status: None Address: 2619 INDIGO CT Audit#: 5807185 DL Status: VAL Issue Date: 02/17/2012 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 02/16/2017 CDL Cert Status: None 522406810 Endorsements: NONE CDL Med Status: None Mailing Address: 2619 INDIGO CT Restrictions: NONE Restriction None Supplement: Date of Birth: 2/16/1989 Mailing IOWA CITY,IA Sex: F City/State: 522406810 History Information CLEAR DRIVING RECORD Name: Dennis,Mary Ellen DL/ID:435AA5159 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: pp 1,,n�ilci��f�t�`�i, 4/22/2013 II'S:1.D. a T./4 Caeideti rthh+NQOiV rJ Office of Driver Services Iowa Department of Transporation Name: Dennis, Mary Ellen DL/ID:435AA5159 Ayr. 30. 2013 2: 50PM Div of Criminal Investigation No. 1684 P. 2 Apr. 23. 2013 12: 16PM t City Clerk - City of Iowa City t No. 3409 P. 5 t . ( , • • e 1I , r • ✓ eo(ii % l ` rSt ,FgSTATL OE XOWA ,,,4;04,113444, .1 i ^J • N , y , ? ) • I' ' b 04i ii,v / . CW�Y((;llYlab1o7 1.eUrd CflQ � iue; , ot'ilf<4.(1. 1Yi+ ' , I DeXAceounCNumberi 4(-o0a-1 ' • otopptiaabio) tos town)1IV1*(otcofCrhnitalAlivest(g'nfoh ; *any ern of Tota ant e support operatrau3Bunny,le'Bloat an crawcy0 oMCB 2XSLn,91hstrebt - 410 Re YJAR01(0101sT STREET DmItifalnea,Towa 60319 ' (,9X9)129.6066 • TOWS. CITY TOA 52240 C516)124-5080 Naze e X}ItavI R79-R56-5,041 ' IYaXI '74 95fi 5497 Tom regttostt1ng aaIoWA CriminalflisCoQ 13dcord Clinic on: • e , • Last Maxie(mMda(ory) ' Tjrst Imes anda(oly , MiddloNaute((ecommeadpa) ' Bate ofTh)tb, mwtdprory) C onfer andalary) SaoinZSte oUtI NlInttex(rcoaromcltdea 0-- 1G - IGc62 nyfa a • gram' . 33 -$2- 65Y6 Waivetto,fartilallam Without Asfiaed aiyovfromthasu6Jeetoffdoyoquasi;atompleleotflu(nAlh(sforytc•ordmaynob ha ralegsghte,per code otTowp, chapter 692,a.)orsignnlatprlm(nai.1itstory recant fnformAtfoh,alalT4Wo 7py11YP,(twaye — -e tafn . mon!otattroironrCk mhfatottpt4411, t: ,� - Waver Sekayerlhcrcayeve permisJfort air tkopho\oppm ngoafpial to codling anmaorhdaal dtvelyceca(4oileckwth rhoDMalon of Criminal • rgresdgagpa(q01).41yolniT6lh(atogt dal adn7em(ngm6ihntiama(ntafnedhythob0lmpybotoleased ay al(owcd hy(a1Y. WrllverSYgtature; ,j/ _ - • • ditn i Iowa Criminfil)ttstotyReo_Ara Cho*Reaulis , ' oDOlatao4 As of L1-30-13 . . .. ,,a sena'of au)provided name and date of bi th.levesied: ; . V gotbwaCriminal Nistotyltecordfound withDer t.. El TOM Crlurina1BL toyyRoCord attached,DCC# - P._, • . -. • fClinitiols .