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Home My WebLink About13-0041. Name 0/ 2. Mailing Address d C 3. Telephone: Home 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? AA) 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? a) 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? / Type of offense Where When v 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 0 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) No DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF—REV�V_J 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) derM.id,wbadg 09/2012 Authorization Number /3 - L -f- 1 l 1 (Office Use Only) �►+. milliltmr�Il 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- Friday.) Iowa Cit Iowa 52240-1826 -/�- 1/3 <[3 T9) 3S6-50 (319) 356-5497 FAX 1. Name 0/ 2. Mailing Address d C 3. Telephone: Home 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? AA) 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? a) 0 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? / Type of offense Where When v 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? 0 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) No DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF—REV�V_J 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) derM.id,wbadg 09/2012 I h re y rtify at I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number X a 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 of Applicant / Date STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by _Ma✓ l 4k/...z_ On this 7 day of 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). nature of Police Chief or designee / T i5 Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERICS OFFICE. Authorized taxi driver names are placed on the city website at iicgov.org. Signature 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 '7 -ice Date dwkrtamchivbadgeapp2010.&c 09/2012 IJan. 4. 2013 2:03PM Div, of Criminal Investigation NNo.0923 P.P. 2 �` `�a • 1 •� i r rb � I rIr � ' • � ''�� H' "�F CriminaMstory Recoscd Check TO: IOWA b10219h Or Cr(minal YnVestfgat(Oh Supp oyt Operlrtlons RaXOaa, Y'1 poor 218�7"'S{XeoC baxlblofna$Iowq 03X9 (5X-9) 725-6666 (615) 726-6086 Va j: mfind,lo IIQ ' -7to 0 ri'ndvef lnfarmaflolr: Wtihautgsl 5p>'61ea9abTe, ger Cade olrerypr Cliff) oblafnAwafversl nafurell mtho•au I�aivexlrele�e•lh�aaygNe permisslarc Ynyolllgaffon(DOD. dor 1pCXApcounClTum6er;ods F OfO pffCADfe) VOW CITY OE' TOW . GUY CSTZ Cum'sOlaxOR 410 'K'WARHLT GT014 SMgB TOl7A C7�g TOLfA 52240 Y'hon6Y 919-456�504i Aga," Numb ❑ualo A915male 1 Si 10 C tYom Ikasuhjeas of the Yeghestr a ep1n�(p!o pllta(np1 hlafory YeoOrd nYay rio t Por cotnpfete criminal hisdoty reeo5'(� jnrpXlllfltl011! a99IlOWBa 1)� 1flV/r ACPINyB nhoyeYeque9lAgaf(frio(!o rand.cf src Cosya cdm(na/ filslo�yveeordc6erkWd4Ne Dflfalan gYCrhnlnol YnlolhnUsmstatafned6j��hobOlmay,6orolc mdavallowedEylely. As of 1 1 aseazoh o thoprowfrfed Warne and data of bntb.•ieveared! N'oXowaci•1,�naIHis�ory�eoords�oundvv7thbCY Q To GSllnlnalkTisfiO Recordotiaohed,bCY# bCXiiit�als,_�/ ieceived�TimeSD'ec 21. 2012 1:-39PM No. 8379 roel rO o(ly� Iowa Department of Transportation Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines, IA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 10/25/2012 Name: Hulme, Mary Annis Address: 1603 CROSBY LN City/State: IOWA CITY, IA 522405815 Mailing Address: 1603 CROSBY LN Mailing City/State: IOWA CITY, IA 522405815 Convictions Certified Abstract of Driving Record DL/ID #: 428XX5051 (IA) Customer #: 4718071 Class: D ID Status: None Audit#: 5719978 DL Status: VAL Issue Date: 01/03/2012 CDL Status: None Expiration Date: 10/07/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Restrictions: NONE Restriction None Date of Birth: 10/7/1960 Supplement: Sex: F History Information Citation Date Conviction Date ACD Explanation County IUR 05/26/2012 06/21/2012 M14 Fall to Obey Traffic Sign/Signal 52 IA Name: Hulme, Mary Annls DL/ID: 428XX5051 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: p�G' :ip 4 y 10/25/2012 10. ab i 0. ic:_J� y''a Driver Services of D. RNER l Office of Iowa Department of Transportation Name: Hulme, Mary Annis DL/ID: 428XX5051