HomeMy WebLinkAbout13-090 I
Authorization Number 13 - 9D
�
r„ 1 (Office Use Only)
�.0
,—,,,,.� III�®rte
:: ,
CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER
(Police Department review must be made
410 East Washington Street between 8 a.m. to 3 p.m., Monday'`1Ffiday.)
Iowa Cit Iowa 52240-1826
`, 319) 356-504 .
(319) 356-5497 FAX
b
Fi t l Middle Last,
1. NameJ e 0 t ec L '� U.. Alaq
2. Mailing Address .0 . _OX •
• I q r -A........._ _ Ill 4 _ _dis..a. 9
3. Telephone: Home 3k. , (43 - 14 p-19 Other:
4. Prior experience in transportation of passengers: e)(3C-C- --r t Oa?j
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? nQ f\e,
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? '(Z O
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years? s� �1 t ( e,\S-.)
T .e of offe e Wherehen
...0-•46 & -a .-C:i .,- ( iA, . . 7;:, c3z)E3
1111
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? OC)
Type of offense Where When
9. Have ou 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)
derMaxidrivbadg 03/201,,
I hereby certify that I h_ave issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
�oR`(`
le`�595 . I understand that if I falsely answer any questions in this application, Mat 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, lowa,,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 /L. '.,+i�.Er .it.# Date lI'_ b
STATE OF IOWA )
COUNTY OF JOHNSON )
I
S scribed a d sworn to before me by CAA I i ce � ` Z� . this ) -
day of
j'Ai s KELLIE K.TUTTLE
o c commission Number 221819 Notary Public in and for the State of Iowa
My comm .,,,Aroc
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).
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
CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
// 4 I -el-' 4 ri - ��l � .'1
-. / - '3
Signature of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
.***.*..****************************************************************************************************************************************
Office Use Only
Approved application
DCI report
State certified driving record
Website update
cI rk/taxidrivbadgeapp2010.doc 03/2013
Y Apr. 16. 2013 10:49AM Div of Criminal Investigation No. 0381 P. 1/1
Apr. 10, 2013 1 :0411M City Clerk - City of Iowa City No. Sitss P. t
•
1114ig' ���IUl�St�.X Stb)f� BQ O�Id Q.'118a $� o vp;vc ,.z,,a Q
' DelAccount'Nlltnbor: �•o 0 .—e
, . ' (ItepjllaabbeJ
Tor Yolvil DIMfon orcrAainalYpvestigatcon wow car. o' inwA crt%
SUN artope{e[(on9Egroatt,]'t:Flcor an" CLERK'S onX014
E
218E,714STreet 41(1 R_ Wagr17070111STREET
baalt'Xphtes,rowa 50319
(,91s}723.6066 • IOWA CTTY TOWA 52240
(515)724-60Bo17
' .CS
khonay T 319-35R-5041
ft9Xi 319-i56-S6. 7
ram ret ttosttn 1. art ToWa Criminal iisro 'ocord Cheofi on;
Last grate mmtdsTdt9 • Th'aauto nand�s(-o. Middloltaxte recamnend'tdJ .
INGl I'i •
' Y
PLO inirt1i Anatae(aty) Condor 00'.46, a odd geo1 W N\imher taeammee ,
02' v25 / Q 4,9 afire • o.' ale . 17 ZJ`T "e/6 -3( ezp
?Tlllver'1nfor/trad4Yl;Varied*sfinedWitiYok,rtom,thosOdeatottheyagttes&0toropietecHhi(nAT1((s(oryrecardtuuynoC
• ha roleggAble,rev Cade ezTo'cv ,chapter'oni)10?cohreloWorlrnfaaIketoryro coy/Tnfoxma4(oft,aSBI16Wed by/his affrays
• obhafrt 4 T Atve]'dl:na(urohom fXa.ub oet:oritt•r•' ,bat'
iblYerietimis fthetewgoperifi(se(aa',tlhbabovemq s(fogolirthai(acondorkinTow4odm(anffihtoZ'f6aafdoheatcW riolonugionQ(cdmYna!
• . bwosl(getton pop.Myththlhf6(olydeldban•'• (rlgmolhatitmafnol d65thenota;yborakAsodasattowadhy(nw,1
falverSYgrlm' • r '1.,[ _a-4.111k �� �.,1�'i
rum Cx1minal Iffinthnr1 ecora Chock Reg dig , i (A0m doly)
j,.s of 1-k41`to 1 l) ,asearoh of tho provld'ea nlntte pita deco ot''6Q'threvealed: •• .--
a,�
Fi go ZMu Witting!IT:istoryltecord fhUndwitk ;DC� ••s•:
W Iowa admiral Snvforylteoord attached,DCX#
JCZii tick lt-- 1 ry .
Received Time-Aor, 10. -2013- 1 :03PM--No, 9882
Iowa Department of Transportation
ni, Office of Driver Services (Toll Free)800-532-1121
515-244-9124
PO Box 92(14,Des Maanes,IA 503E3ti 92i)4 FAX:515-239-1837
Certified Abstract of Driving Record
Inquiry Date: Freeni 4/9/2013 DL/ID#: 769YY9585 (IA) Customer#: 2509699
Name: Freeman-Zuniga,Jenifer Class: C ID Status: None
Lynn
DL Status: VAL
Address: 701 BAY RIDGE DR AuIssue : 05/18 2 CDL Status: None
Issue Date: 05/18/2010
CDL Cert Status: None
City/State: IOWA CITY, IA 522465885 Expirationrsm Dnts: 02/2E/2014 CDL Med Status: None
Endorsements: NONE
Mailing Address: PO BOX 2689 Restrictions: Corrective Lenses Supplement:Restriction None
Date of Birth: 2/25/1979
Mailing City/State: IOWA CITY,IA 522442689 Sex: F
History Information
Convictions
CitationDate52
Explanation _ y County ,IUR
Conviction Date
10/28/2008 12/09/2008 ACD p
:592 Speed!
IA
Name: Freeman-Zunlga,Jenifer Lynn DL/ID:769YY9585
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 es,that
custodian
office,and that I have been authorized by the Director of the t
the Io aDepartm na
Department of Transportation to so cert fy.l record currently In the custody of
said
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:
>pQ. G i' 4/9/2013
Mi IOWA %-.$ 47
°S.1..D. O. T..
of Driver S
',r1 j�,,OBIVER�J owaeDepartment ofices Transportation
Name: Freeman-Zunlga,Jenifer Lynn DL/ID:769YY9585 .