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Home My WebLink About13-008. I r 1 —0 —did CITY OF IOWA CITY 410 East Washington Street low 52240-1826 319)356-504 1bt �r 356-5497 FAX 1. Name 2. Mailing Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday.) 1.)— le" (Office Use Only) 3. Telephone: Home 6 tEj 1,5 Other: 4. Prior experience in transportation of passengers: 1 t�2U f . 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? X'I 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? N[� Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? C t o's-, Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) denna.idnwad9 09/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nGmber 5�Y S�'i . 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) Signature ofApplican4Date / t #4111#*#i*#i**#*11ff1fHff 441t##11111#1#4#f4ff#IrlrYe##R#R#i*fei#*i##M1f f##f if*Hf i##*iiflffff1ff11fiffN11ff11ff11f1f1ffffff11f1f#f###1f##### **#f# STATE OF IOWA ) COUNTY OF JOHNSON ) Su scribed and sworn to before e by l ( ]�_ rte, On this day of I ,us KELLIE K.TUTTLE LL umb r 22191 otary Public in and for the State of Iowa 1, My Co m so 1 k#***ft*tt#}#kill!!}}}1!1!1}111}}t}tRRt#RRRR}NRRt#tt* YtR t**#**1t*}f#434fttH3##t*t*fiit44}f1f}t}t4}t*}ff}ft44}tf}1f}}}1f}41R*##*#**#t#*****#* 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). D c Sign ture of Police CVef 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. § y inM/ Signat f 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 deh.Aa dC .1geapp2010C /-i�4-i3 Date 09/2012 CA Iowa Department of Transportation Office of Driver Services (Toll Free) 8811-532-1121 FO Baas 9204, Des Moines, JA 5031)&9264 515-244-9124 FAX: 515-239-1837 Inquiry Date: 1/8/2013 Name: Kane, Kourtney Kaye Address: 1206 E COURT ST City/State: IOWA CITY, IA 52240 Mailing Address: 1206 E COURT ST Mailing City/State: IOWA CITY, IA 52240 Convictions Certified Abstract of Driving Record DL/ID #: 838YY9949(IA) Class: D Audit #: 6123883 Issue Date: 07/13/2012 Expiration Date: 07/13/2013 Endorsements: 3 Restrictions: NONE Date of Birth: 7/13/1984 Sex: F History Information Customer #: 3912615 ID Status: EXP DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 08/28/2006 09/14/2006 620 Driving While Suspended Denied Cancelled, Revoked 70 IA 02/09/2009 _ _ ,03/22/2009 S92 Speed_ _.. _... ... _ , ._ _ _ - - 70 IA 02/15/2009 y03/11/2009 M14 Fall to Obey Traffic Sign/Signal 52 IA 03/26/2010, ,04/28/2010 S92 Speed 52 SIA 01/31/2011 03/01/2011 864 'No Insurance Card 52 IA Sanctions Type Effective End ACD Explanation Occurrence ]UR ]UR Suspended 07/01/2009 ,02/17/2010 _ D53 Non -Payment of Iowa Fine ;IA IA Suspended 08/29/2009 02/17/2010 ,D53 Non -Payment of Iowa Fine IA IA Name: Kane, Kourtney Kaye DL/ID: 838YY9949 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: J.: • • • • • •.: �!% '4 1/8/2013 IOWA*' W \i Office of Driver Services Iowa Department of Transportation Name: Kane, Kourtney Kaye DL/ID: 838YY9949 Jan. _...14. 2013 11:01A Div of.,C.,r,i.minal Invve,stigaation ,,.y armnpsi'c Asx, ,a� - ----- --,S71`,A,rfN OMWA Request Form To; 101VAY1IVtstohorcilminalXavoolgntfou support operations)luro)lu, V'Voor 215E, llh Ureot baslvl�.(ncr,xolvA 50319 (e1a}7z�•6o�6 . (515) 739-6090 ;Hoyt Chook e- (n)M A[orv) 1No, 914lll`1 1P, 2/2 DClrl000unt9l)rnbar: moa' `T— peog,lfoearc}~ . Fromf -- Q-rW A -P TAMA T9• • CITY CzERK15 0):P=C13 s PhonO; yLq—��(-.Sn�1 law31 amara Gemara �r 63 �rrittrltori; Without a st�n6d WaNgr>tom thasubjaaC oPtho regaast) a comp)rte o1•frvlaAl htstory recorri mny uo C per We afYOWA, Chaptor6927,11orsonip ala'at9m(oalAIstoxyreeoWfnfotmntlon, ass)Yawed byInvr,AlWays i�(liya7'.iiera(LS'g;ihaceygtvepermrss(enRrlhoahovaronuulfaaolfrvlalto wndvaf�iYo�vaorrmfn.Yfirsmry�eco<dcfieckwhnu�eDwlonoPcrimi�dt YnYcstlgac(on(DcU.AnyorimtuetlAmtydaoieoncoml Mo1)nll�lnnfAlalnadbyihopOlmey6otorcaScdgsnf(oYcg6ytnW. As of --I N ` 13 - I RsenrCh. of thoprnvlded nuno And dato ofbixtf)lavealed; No lbwa foand wlthbCT Yowa CximinalHIstoxyRecord atteohed, D U # bex'Utials Received"Time$Jan. 8. 2013 1:42PM No, 8196 _ rno ?.M 391-S�4�� 1 U WA USA MONOMER..1 IA R UHTNITY KAYE DOUGLASS CT A CITY, IA 52246 a 838YY9949 7113/2012 rxv 0 sNt �3 NONE JF.yca ttA2 .., D0807/13/19 no esvae>.KHieolriwnw lI1 'O Iowa City DL Station Eastdale Mall 1700 S First Avenue Iowa City, IA 52240 Statement Receipt: 28783664 Customer Information Name: Kane, Kourtney Kaye Address: 1206 E COURT ST IOWA CITY, IA 52240 Phone: Fax: Email: Attached Customers Kane, Kourtney Kaye Transaction Office Information Date: 1/8/2013 12:54:41 PM Location: Iowa City DL Station Name Type Description Amount MISC Finance Transaction - Kane, Kourtney Kaye $5.50 Product Amount Sale of Records - Certified $5.50 Total Due: $5.50 Payments Payment Method Payor Payor # Number Amount Tendered Cash Kane, Kourtney Kaye 3912615 NA $10.00 Total Tendered: $10.00 Cash Back: ($4.50)