HomeMy WebLinkAbout13-059r
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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
Authorization Number
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
i '� -57q
(Office Use Only)
First /� M' le
1. Name f (� 0 J(Q P Last t (� T auo' . '
2. Mailing Address
3. Telephone: Home '��� �S ' �g Other
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Where When
0 <�4_`V , fly 1 J41 e
6. Have you beer�onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years?
Type of offense _ Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? � 3u
Tvpe 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) The re-
port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli-
cation.
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
den drwadg 09/2012
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
. 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 Pub ") l
Signature of App' ant 1 Date '� I
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STATE OF IOWA )
COUNTY OF JOHNSON )
and sworn to before me by r'"3 4I6wnfL On this _ day of
ani �
SONDRAE FORT
immission Number 159791
My commission Bores Notary Public in and for the State of Iowa
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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).
Signa re of Pf Chief or designee
4_/?
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 _ 74_1� . �Li�"I/
Signdtufe of City Clerk or designee
Taxi cab businesses are required to provide Driver Identification cards.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
3 -g-13
Date
de .ianwad¢ W2010mc 09/2012
Mar, 1. 2013 8:51AM Div of Criminal Investigation No, 4981 P. 1/11
Pe6,25. 2013 9:25AM City Clerk - City of Iowa City No.3265 ' P. 2
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Mar, 1. 2013 8:51AM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00517224
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DATE PRINTED -
2013/03/01
DCI:00517224
NAME: GILPIN,PAM
GILPIN,PAMELA SUE
DOB SEX RAC HGT WGT EYE HAIR SKN POE
19671203 F W 506 130 BRO ELM FAR IA
ADDITIONAL IDENTIFIERS
CCH RECORD ***
01 ARRESTED 19960211
AGENCY: IA0560000 LEE CO SO
CHARGE NO- 02 IA STATUTE IA706-1
,
ASSAULT
TRK#: 013605402
• COURT A16POSITI0N
AGENCY: IA056015J LEE CO DIST COURT
COUNT NO- 02 IA STATUTE IA700-2(2)
ASSAULT NO INTENT OF INJURY
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 013605402
SENTENCE
DISP EFF DAT
JAIL 30D
19960514
• FINE $250
19960514
COURT COSTS
19960514
PROBATION lY
19960514
CREDIT W/TIME SERVED
19960514
NO CONTACT ORDER
19960514
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 DCS.
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 OF CRIMINAL INVESTIGATION
1
No.4981 P. 2/11
Mar. 1. 2013 8;51 AM
Feb. 25. 2013 9 26A
S
I
Div
of Criminal Investigation
No.4981
P. 3/11
City
Clerk - City of lovra City
No.3265
P. 3
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Page 1 of 2
Iowa Department of Transportation
Office of Driver Services (Toll Free) 800-532-1121
PO Box 9204, Des Moines, IA 5030G-9204 515-244-9124
FAK 515-239-1837
Certified Abstract of Driving Record
Inquiry Date:
2/22/2013
DL/ID #:
830YY1331(]A)
Customer #:
212457
Name:
Alawneh, Pamela Sue
Class:
D
ID Status:
None
Address:
1453 DICKENSON LN
Audit #:
6527012
DL status:
VAL
Issue Date:
12/07/2012
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
12/03/2017
CDL Cert
None
522409163
Date:
Status:
Endorsements: 3
CDL Med
None
Status:
Mailing Address:
1453 DICKENSON LN
Restrictions:
NONE
Restriction
None
Date of Hirth:
12/3/1967
Supplement:
Mailing City/State: IOWA CIN, IA
Sex:
F
522409163
History Information
Convictions
Citation Date Conviction Date ACD ExplanationCounty JUR
01/24/2011 ,02/17/2011 S93 ,Speed i52 IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date
08/22/2009_
01/24/2011
Sanctions
Type Effective End _ ACD
Suspended 310/14/2008 '10/14/2008 _D51
Name: Alawneh, Pamela Sue DL/ID: 830YY1331
Case Number JUR
522060 TIA
of Child
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:
`oQOfJllClf p;A1, 4
tr t IOWA N 8' 2/22/2013
2/22/2013