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Home My WebLink About18-045 4 ,, , 1 IDENTIFICATION NO. /cej—(`)Li 5 l i (Office Use Only) i=:4.....1.— ®d1 .11 . 111 Vist Ala It "1/4-1114—Amino lir ael.Y . APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX Firs),S,, Coddl p� Lash `_ 1. Name(REQUIRED) /nary l Middle /r C et 1-1--h 2. Address(REQUIRED) I Z� a3 kb !1'I/en ye ` #A- Com 11/ i le I A s- MY 3. Contact Information (REQUIRED) Email: mo1.Cc»life �j mat I. Co iii Cell Phone: 3/f'34/- //'Z0 (All written commurlieation sent via email) 4a. Driver's License expiration date (REQUIRED) it rn46.4- a3/ aOa3 b.Taxicab Business Name(REQUIRED) idecte1 (1-4.'1-/ r - 5. Prior experience in transportation of pass ngers:v/_a 11L. i e22c 41I"�16( ce&) S7_a r 1---111:`°-"r, a eJ '11/\°e (/ - , 1-'44"14,--"4 4— 6. Have you been arrested//charged with any misdemeanors and/or felonies in this State or elsewhere? 7(0—. Type of offense Where When What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/charged with any traffic offenses in the last five years? �,--, Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7fr8. Has your drivers license or chauffeurs 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) ✓lo 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 r � APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certifythat I have issued to me by the Iowa De art nt of Trans ortati n a valid Driver's license number d a ti U 'Ts issued on f/Q 7 L,i piring on /� 3 /.moi�.3. I understand that if I falsely answer any questions in thit application, that this appficati n may 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 authorization to be a taxicab driver 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) 7t= Signature of Applicant ' ' '"'�j ,e- 77‘2-f-1-1-'2"5/-�/� �� Date vvv STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by . _ on this 7 day of 1 "Z-e5t$ WENDY S.MAYER Commission Number 7228 Notary Public in .1d for the State o •wa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City(Title 5, Chapter 2, City Code). Expiration date of D ' -i's ' ense 11-z, 3-Z 3 1.7 Sign. •r- of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature of City Clerk or designee Date ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update ClerldTAXIDRIVBADGEAPPL92014amended.DOC 07/2016 Apr. Ib. LUld 1 :411'M Uiv of Criminal Investigation No. U938 Y. 1/1 Frpn:CI TY of Iowa City Clerk Off loe 310 3666607 04112/2018 19:96 N470 P.002/002 I ',••;7 I,.`. �,,` off� STATJi OF IOWA �y, u Le? Idy,n t1 ` . Criminal History Record Check �. Request )Form ^ :- • DCI Account Number I-fan Z (irapplieoble) To: Iowa Division of Criminal Investigation Prom City of Iowa City Support Operations Bureau,V'Floor City Clerk's Office 215 E.7 Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725.6000 Fax • Phone! 319-356-5041 Fax: 319-3565497 Iain requesting an Iowa Criminal Aistory Record Check on: Last Name (mandatary) First Name(mandalory) Middle Name(recommended) McCat Ravt.j C'alei� Date of Birth(manancgi Genderr((naandatary) Social Security Number(recommended) 1 I - Z3 - 115.E :Male .Female 47z- Ii - ?13 / Waiver Information: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.Per complete criminal history record information,as allowed by law,always obinln a waiver signature from the subject of the request. Waiver Release;1 hereby give permission for the above requesting osicial lo conduct en have criminal history record cheek with tim Division of Criminal Investlgaiian(DCI). Any criminal history doll cencemingme that is maintained by the Delray be released or allowed by law. Waiver Signature; 7ctr e• ' `" lf� 44/1418. Iowa Criminal History Record Check Results (DCluse only) As of I'" 1(0'1? a search of the provided name and date of birth revealed: kr No Iowa Criminal History Record found with DCI • n) . • ❑ Iowa Criminal History Record a shed,DCI# DCI initial N.1 • DCI-77(08/25/10) Received Time An. 17. 9018 19:56PM No. 7228 • c410 wA DOT Driver & Identification Servicel. P.O. Box 9204, Des Moines IA 50306-9204 Certified Abstract of Driving Record • .n Inquiry Date: 3/29/2018 DL/ID#: 040009959 (IA) CDL Permit Class: None Customer#: 3192702 Class: C CDL Permit Issue None Date: Name: Mccarthy, Mary Colette Audit#: 2295368 CDL Permit None Expiration Date: Address: 1200 23RD AVE APT 2 Issue Date: 11/07/2017 CDL Permit None Endorsements: Expiration Date: 11/23/2023 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522413144 Endorsements: NONE ID Status: None Mailing 1200 23RD AVE APT 2 Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA 522413144 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 11/23/1953 CDL Cert Status: None Sex: F CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Mccarthy, Mary Colette DL/ID: 040009959 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Driver&Identification 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: tetra OG IggN We<" ^/001,0110111.1% oy 3/29/2018 0 o i o��GA(OeC, S' Driver&Identification Services Iowa Department of Transportation Name: Mccarthy, Mary Colette DL/ID: 040009959 (IA)