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Home My WebLink About13-023�I r 7. `IIl11ticccccorz`s CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name -.First rt u Authorization Number I 2 1 (Office Use Only) APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) 2. Mailing Address 160-5 S�o,-y�c� Sh- 3. Telephone: Home 4. Prior experience in transportation of passengers: kS drt vt Last Other: 3V`t -16�!> 85(2 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 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? Y\-Ap Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? When Tvpe of offense Where When 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 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) TD,c> , 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) der4taxidnr dq 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number SS b t zt: . I understand that if I falsely answer any questions in this application, that this application may a 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) I Signature of Applicant Date 1ff***1*4##4**ittflfYfl4*14flfHfffiffffYl#fYfflfffl3#Yfififffftffl111f1141!*i4fIH41#ft*f**fiflf#*4****#itfi***lttfFf141ff1ff44kf*fifffitff11f1f STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by Ir c4 On this day of / 3 in and for the State of Iowa *****R#**#*R#*******R*R#RR#*****#*##R*#***R#RR##**#****#R*##RR************#****R**R*#*R3*****#*##33#*#*#***#R#####3**#***##3#*k#33*##*##***#**** 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). Sign ture of Police Chi r 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. SignaWe of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Date ##***###}###+*}+#}#f}##+##}+#*#}#}#4}###+**#**#+##+####*#}R#####}*+#####+3f#H**f*#1f##*3113#fY3R#Mff*4111141#lfffffffflMlff#ff}11111#}#fff+ff Office Use Only Approved application DCI report State certified driving record Website update den ia vbadeea 2010. 09/2012 /' Iowa Department of Transportation �/ Office of Driver Services (Toil Free) OIM-532-9929 PO Box 9204, Des Mmes, 1A 503Q6 9221744 595-244-1837 FAX: 515-239-1837 Inquiry Date: Name: Address: City/State: 1/4/2013 Yeggy, Tricia Ann 1603 SPRUCE ST IOWA CITY, IA 522406048 Mailing Address: 1603 SPRUCE ST Mailing City/State: IOWA CITY, IA 522406048 Convictions Certified Abstract of Driving Record DL/ID #: 556YY1218 (IA) Customer #: 2287973 Class: D ID Status: None Audit #: 5791317 DL Status: VAL Issue Date: 02/10/2012 CDL Status: None Expiration 09/15/2017 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 9/15/1971 Supplement: Sex: F History Information Citation Date Conviction Date ACD _ Explanation County;, _ JUR 06/16/2006 08/07/2006 S93 .Speed MN 01/27/2007 05/01/2007 S92 ,Speed 52 IA Name: Yeggy, Tricia Ann DL/ID: 556YY1218 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: Name: Yeggy, Tricla Ann DL/ID: 556YY1218 ;.......: sV�9i, 1/4/2013 IOWA D. 0. T.::� 9" Ste= D81VE8= Office of Driver Services Iowa Department of Transportation f..4 D9 9CJ STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 R 7t° Street Des Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Fax T am remtestinu an Towa (Yrninal HistdrvRecord Cbeck nn: DCI Account Number. 9861-F (if applicable) From: • City Clerk's Office City of Cedar Rapids 101 First Street SE Cedar Rapids, IA.52401 Phone: 319-256-5060 Fax:. 319-286-5130 Last Name (mandatory). First Name (mandatory) A i/d�dI6 Name (manaaimry) .;�;�'I � . _ �' V,l 0..10. 1ti�':, '.n' ' . '. •.. ?'rt Date of Birth (mandatory) Gender (mandatory) Social Securi Number (mandidory) ' S. ❑Male Female Waiver luformation: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa Chapter 692.2. For comolete criminal history record information, as allowed bylaw, always obtain a waiver k store from the subject of the request Waiver Release: I hemby give pem fission for the above requesting ostial to conduct =Iowa criminal history record check with the Division of Criminal hrvesfigation (DCI). Any criminal history data concemiag me that is maintained by the DCI may be released as allowed by law. Waiver Signatures v Date Iowa Criminal History Record Check Results in As of a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI DCI -77 (08!25/10) DCI initials (DCl use only) _ ,/SING Page 1 of 1 Single Contact License & Background Check Results Criminal Historr Background Check Last Name Other Last Name First Name DOB SSN Selection Criteria Yeggy Beach Tricia 1971 -September -15 468085880 Results Not found in Database ttacKgrouna Check Complete As Of 1/22/2013 3:26:22 PM NOTE; The first and last names, date of birth, and SSN displayed in the abuse registry and criminal history results are just as they were entered on the screen, Billing Account 9861-F Cash Deposit Currently at $1614.00 Generate PDF https://www.iowaonline.stat&.ia.us/SING/SINGSQLProcess.aspx 1/22/20,13 IOWA SA U IA — 0+YEGGY ' TRICIA ANP 1603 SPRUCE 5T IOWA CIT! .A oi. vo 218 ,reqs 02/1012012/1=012 Ana 09(1512017 I S' Fe3 C-5.-06- Sc 5. R a G� 3II NOr,E �-�OO6V91i5li971; _ `�s'v' �r �1 ao ]St913R�VTI40iF15B91]F