HomeMy WebLinkAbout14-221 Authorization Number ``t
t 1 (Office Use Only)
APPLICATION FOR TAXI/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
x'(319) 356-SOTtr — ,►�3jr;
(319) 356-5497 FAX
First • / Middle Last
1. Name (REQUIRED) t509.3
2. Mailing Address (REQUIRED) Qi 3 S.�Jt� -DT' } 1.40, JC �1 1 p 4:-)30-1(p
3. Contact Information (REQUIRED) Email:p,rIP.c1/pl. 1(-4 dkriltibt C)rn Cell Phone:'y- q50 - 68623—
4. Prior experience in transportation of passengers:&1 U i YlC SCin(ItA biA5 0 i LA u-l
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IW
Type of offense Where When
6. Have you kteen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? IU
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?(J'fCS
Type of offense Where When
CA.)‘\l; T111GI4- C Yl Coyl Nw .>, 2($ 2 l2 e- I0
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? i\-
)C)
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 rrarne(s)
C% F_ :T 4. _.i
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEPREVIEW
You must apply for an individual Department of Criminal Investigation Report(form available upon-request).
• •
r>.)(OVER FOR REQUIRED SIGNATURE AND NOTARY) c,3
09/2014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
71 , TO 31 1 1 . 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 ..0 a_L X 1)5' ✓J Date j(_; - =' J--1
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.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by ')/1/1_;en e. L . 1(3, S . On this L ,r-A day of
0r A- Jot
c 9A/ ,,,,1ti, V s N4AviR Notary Public in a for the State of wa
Commission Numoer 729428
My Commission Expires
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 ure of ':l e Chief 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.
---7)1A-C---e
Gd2c � - ' -414 _,', /e' -"\c---- 12
Signatue-of City Clerk or designee Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width) and 51/2"
(height) and prominently displayed to all passengers.
,................*.......................*......*.,,,,. ..............*........................*****...**.......*......**..**..*.***....*.*.....
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIerWTAXIDRIVBADGEAPPL92014amended.DOC 09/2014
Iowa Department of Transportation
4 Woe of Driver Services (Toll Free)890.532-1121
PO B0%9204,Des Mimes,IA 503015-0204 515-244-9124
FAX:.515 239 1831
Certified Abstract of Driving Record
Inquiry Date: 9/25/2014 DL/ID#: 773NN3111 (IA) Customer#: 3138468
Name: Bogs, Danielle Lee Class: C ID Status: None
Address: 2128 S RIVERSIDE Audit#: 7933585 DL Status: VAL
DR TRLR 40
Issue Date: 03/29/2014 CDL Status: ELG
City/State: IOWA CITY, IA Expiration Date: 02/04/2022 CDL Cert Status: None
522465832
Endorsements: NONE CDL Med Status: None
Mailing Address: 2128 S RIVERSIDE Restrictions: NONE Restriction None
DR TRLR 40 Supplement:
Date of Birth: 2/4/1974
Mailing IOWA CITY,IA Sex: F
City/State: 522465832
CDL Downgrades
Type Effective End ACD Issuing JUR
Downgrade 05/06/2014 IA
History Information
Convictions
Citation Date Conviction Date ACD Explanation County JUR
12/04/2010 01/31/2011 D72 Fail to Have Vehicle Washington IA
Under Control
Accidents - Accident involvement indicated does NOT mean the individual Was at
fault or given a citation. c, ,,,y1
.•}—1 —I _
Accident Date Case Number JUR C)—‹ i :
—I C 7 C,.
12/04/2010 607740 IA .<1:n—
<r n
--a-.:7; N -'
GO
Name: Bogs, Danielle Lee DL/ID: 773NN3111 �-
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:
[Ci[ ;4 k, 9/25/2014
IOWA ••101
.D. . T. i
elermetileVial0
t�h▪ DJ flJ - Office of Driver Services
▪ toss
Iowa Department of Transporation
Name: Bogs,Danielle Lee DL/ID:773NN3111
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i i Oct. 3. 2014 10: 39AM Div of Criminal Investigation INo. 1946 P. 1,
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gTA'Tt T OF IOWA,;A, �0,„
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r_r. (C1rnl�m�Arra�� History peco Check ,i ;;;.' ,':..
��AA!! 1yI Iy1�](��r j11r`�'l y',I1I�I1 v:; ),.;_ •
`' ' V,r -' Req zes V J4 oletwa !�),,%,:
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(ffapplfoaulo)
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To Iowa b(%Ision ofCliminalInvestfgetion ){'rom. City of IOWA City fr 1 _
Support Opor'A(tons Burorep,1"ly'loo' city Clerk's Office, . r n c ' -1,---,219 E .ire 13treet 410).Washington Sti�9e_.i -�1
beiMoines,Iowa 50319 (�-•< I .
• OLS)726-6066 Iowa Cltyr TA 2220 --tom' __
(915 )/29.6080 Fax TO ' LOlb 'AY 'OR —n'_` "j
'IS REB : Ar-Al l`Ifone: 319.3564041 =
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PL ASE RE • a N TH • .ORM Foxe 319-356449 y _ ,
I am 1erpesting an Iowa CLlrninal.1ilslofyl000rd Chcok on;
Last Name (II,andalory) YrvE;Id'alEnQ cmend.(ov) , - Kiddie Njtiitle(reeohm rtded! _ .
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Data of'frah (mendbleTy • • 'Gehdcr IU IIGaro gocfal Security irthex(recommended) - . - -
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r.Ce .o 141 , , ❑maze elrr0ie . .� 7Q- c/OVJ/Yo -
p'i ver'%/(foyn!lou:Without a s(gned waive fi•otn the subject of the request,n oolnpIota crlminol hlt(ol'y recorItMay not
bel-eleacablor Or Code of Iowa,Chapter 692,2.For complete criminal Ida toll'record.itiforr>7a11on,as allowed by lava,a1Waye•
obtain a waiveralgmetlure iron the slrlilecl of th 0 raQgest. . .
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ft/verft/1)er RereaMihardbytivc penn13.91anfor thrsaborcrrquestipgofficfslre eande'ctErr Iowa orirolnelhhloryI'mad oliaokWitli IhoblvlrionofCtlrefliai
low ligetlon(p CO. My
Waive?Sigfaallire;l ./ ./ ' L ...ea .o. .___(4/44,4—j_, /..Ato_.A , _
l[ovva Criminal f&&&ory Record Check Res lis (opture.ot6)• .
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As of 10 -D-I-I a a search of the provided name and date of birth revealed; !.b Ir I ' =
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a,� : .
0 No Tows,Criminal History,Raoord found with DCI ' ' .."'I
0 Iowa.Criminal S tstay Re.ord aifaohed,DCX fr` -
)CX initials OW
Received Time, Oct 2 �'�2014 V 2: 1QPM1���11•/+ o 1173 --
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Oct. 3. 2014 10:40AM Div of Criminal Investigation No. 1946 P. 3
Terry E. Branstad """��, , Department of Public Safety
Governor Va'
Kim Reynolds Larry L. Noble
Lt. Governor ` '�•-'° �� Commissioner
October 3, 2014
To Whom It May Concern:
The Iowa Division of Criminal Investigation believes the attached record is the same individual as the
subject of your request.
if you feel that these results are in error, you may provide fingerprints for positive identification.
Please contact our office at 515-725-6066, between the hours of 8 a.m. and 4:30 p.m., Monday
through Friday with any questions or concerns.
Thank you,
Iowa Division of Criminal Investigation
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DIVISION OF CRIMINAL INVESTIGATION•215 EAST 7TH STREET•DES MOINES,IOWA 50319-0041 •515-725-6010
Integrity, Fairness, Respect, Honesty, Courage, Compassion, Service
Oct. 3. 2014 10:40AM Div of Criminal Investigation No. 1946 P. 4
IOWA CRIMINAL HISTORY DCI 00459069
MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1
DCI: 00459060 DATE PRINTED- 20141003
NAME: COBLENTZ,DANIELLE LEA
COBLENTZ,DANIELLE LEE
DOB SEX RAC HOT WGT EYE HAIR SIGN POB
19740204 F W 505 150 }A2 SRO FAR IA
ADDITIONAL IDENTIFIERS
TAT R ARM
CCH RECORD **
01 ARRESTED 19930501
AGENCY: IA0520100 CORALVXLLE PD
CHARGE NO- 01 IA STATUTE IA714-1
THEFT 4TH DEGREE
TRK# 009601601
COURT DISPOSITION
AGENCY: IA052015J JOHNSON CO DIST COURT
COUNT NO- 01 IA STATUTE IA714.2(4)
THEFT 4TH DEGREE - 1978
TRIO: 009601601
SENTENCE DISP EFF DATE
DEFERRED JUDGEMENT 19930817
02 ARRESTED 19960105 c=
AGENCY; IA0520100 CORALVILLE PDCD
Q
CHARGE NO- 01 IA STATUTE IA124-401 (3) >
POSSESS SCHEDULE I/ MARIJUANA C7-<
TRK# 013266601 " r- rn
COURT EISPOSITION O'er )
7.:
AGENCY; IA052015J JOHNSON CO DIST COURT j` N �`J
COUNT NO- 01 IA STATUTE IA124-401-3 CO
POSSES SCHEDULE I/MARIJUANA
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 013266601
SENTENCE DISP EFF DATE
FINE $250 19960208
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 DCI.
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
3. 2014 10:40AM Div of Criminal Investigation No. 1946 P. 2
,Oct.•+,.• +, <• cvi�t t. r1110 (, ILy LIcra (..Iry ul toric L : ky No, )LU`f P. 4/4
.414.,.:-;.7k--.., STATE OF IOWA *_•�� _• ,N,
Vis, Crriminal History Record Check :L' ':`.�•,''
V; 4' TT".-*_fir Request Form • '.,, ' `
v.it,it'Air /jah
DCI Aecolmt N't mbor: '4r ?'-F
(ifBpplikablc)
To: Iowa Division of Criminal Investigation . From: City of Iowa City
Support Operations Bureau, 1't Floor City Clerk's Office
215 E,714 Street 910) .'Washington Street_
pea Moines,Iowa 50319
(515)725-6066 •Iowa City, IA 12240
(515)721.6080 Pau
Phone: 319-336-5041
Fax: 3194564497
•
I am re.nestin_ an Iowa Criminal histoi Record Check on:
La9t Name (mandato 1 first Name(mandatory) Middle Name recommended)
LWtiea. --e_ . i cwt.. i e..1, - .
Date of Birth (mandatory) Gender(mandatory) , Social SecurityNumber. racontnreadad)
el r —7 — LI DMale emale 1.1--1-14 —(4p i 1 C)
Waiver Information:Without a signed Waiver:Yom the subject of the request,a complete criminal history record may not
be releasable, per Code of Iowa,Chapter 692,2,1'or complete criminal history record Information,as allowed by law,aiwayg
obtain a waiver siZnature from the subject of the request. .
Waiver Release:I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division ofCrintinel
Investigedon(DCI), Any criminal history data concerning me that Is rnaluained by the PCI may be released as allowed by law. •
Watver Signature: l -i fit
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oVva �1{�mxlEaaZ lCasto�°y l�eco��d lei s ��s :
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As of 10 -31 LI , a Search of therovided name and date of birth revealed: ` t
P -t c� w ',.1:, t 7: •
Fri- t
0 No Iowa Criminal History Record found with DCI ...": • •T,rc
C.A.) -,
III Iowa Criminal History Record attached,DCI il 59 068
DCI initials SX/-'
•
Received Time Oct,- 2.•02014 2: 10PM No, 1173