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Home My WebLink About14-204 Authorization Number / 0 9 A r 1 (Office Use Only) 4011 Vivirraka. •It Ong 11:41T 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 (319) 356-5040 e r)-71 l) /91tA1/ - '4-/ jE, y, ,0 (319) 356-5497 F' . first Middle Last 1. Name(REQUIRED) MI k.vY\e 4...'4- 14-ouodA & 2. Mailing Address(REQUIRED) / b t'p S S4 , CeiZ_ e‘C u t e 3. Contact Contact Information (REQUIRED) Email: - i,/Q,yLp,14 ,p I honed33/-' O ,7y 4. Prior experience in transportation of passengers: II -i A /41.41 , - , 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IVO Type of offense ( )� Where When 1 v Uri. 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Ivo Type of Offense Where When IV19- 7. Have you been convicted of any traffic offenses in the last five years? ci')_ a dQ r1, �[Y dak- Type of offense Where When // o y/2,/1 Na - Zivthit, 2.4 /21-a 1/ 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fiyears? ,�/ p / � v 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£me(s) 22) I Z -- 1J3it/ rl .�_ DEPARTMENT OF CRIMINAL INVESTIGATION(DCI)REPORT AND STATE f RTIF+ED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CFiREVIEW You must apply for an individual Department of Criminal Investigation Report(form available'upori reque (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 4- 1-3,-/414 '/ 5 ' . 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 J AL..," ilit,,eDate //// Z /c,! YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CI • NTIL 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 Al evt-t-t±-n, H . An‘►.lam i+Lut. P. On this / 1 Lk day of Q„ r J. VVENDY S.MAYER NoTary Pub it cc and for the St owl i, ,. Cunrrrnss u,Nurnter 729426 • .,y{ • My ComrNssion Expires J(341 "1-) --l lr0 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). Y 1/!1 1 Signature o �'iief or designee ate 9 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. ) - - ti.}/ i//,/i Signature of City Clerk or designee to Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update CIeriTAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Seo.18. 2014 . 3: 43PM Div of Criminal Investigation No. 9625 P. 7 <<vb. c.. LVI1 II . Irnw (Div VneIn k. nny ui LVW t.Ity N0. 2IOL P. t • (4-;• iw�;,,� • . STATE OF IOWA ?:7 � :� ~`i'` Criminal History ecordl Check �f - , .N•',u- tzI IaNJA t�1i; :.. er,1:1.1-�laS;ot.� /Y �t� „��i+. y ;f Request Forma , :. ;; _ rile► DCI Account Number: 'Iutia IF (ifapplieabto) , To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau, 1"Floor City Cleric's Office • 215 E.7u`Street 410 E.Washington Stveet • Des Moines,Iowa 50319 • (515)725.6066 Iowa City, IA 52240 (515)725-6004 Fax Phone: 319-356-5041 . ir'axt 319-356-5497 I am i'equcstingan Iowa Criminal History Record Check on: • Last Name(ningdstory) First Name(mandatory) Middle Name(recommended) • .Li" , t i...o — iff . ' r i Le.ivl&.e 6,__, - eo IN M' Date of Iirth(mondotory) Gender mandeiory) Social Security Number( recommended) • �/ C - �I e m z)-P ,.S 17 �o ❑Male la emaIe jq-(Q �Q a - +�'r y Waiver Infori Won: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 complete criminal history record Information,as allowed by law,always obtain a waiver signature t-ern the subject of the request, . . Waiver Release:Xfmcby 61vo permission for the above requesting offlolal to coact an To va cr"nine'big ory sword check wich(be,Divisiiir7o(Criminal Investigation(DCI). Any criminal history data concerning me that Is maintained by the n C ley.-r- -ased. . : ed by le.. ::;.:::(:-.1 <n • WaiverSYgnature / _, _• k..._ A. is V —41411V2i' — .. - 0- Vii,, Iowa Criminal istorr Record Check Results (D ,Sao,,; --' As of c/f5- / , e search of the provided name and date of birth revealed: . .• ` : • ® No Iowa Criminal History Record found with DCI , t • Iowa Criminal History Record attached,DCI# "3 0$7,3 S$ . . r:,) DCI initials 6' ieceived Timer-iAug. 79. 09014 11 : 15AM No. 8197 Sep, 8. 2014 3 : 43PM Div of Criminal Investigation No. 9625 P. 8 IOWA CRIMINAL HISTORY DCI 00308358 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 3 DATE PRINTED- 2014/09/08 DCI:00308358 NAME: CUEVAS,ALEMETA DOWNS,ALEMETA DOWNS,ANITA HENRIETTA HENDJE,ALEMETA E HENDJE,ALEMETA HENRIETTA HOWARD,ALEMETA E HOWARD,ALEMETA HENRIETTA • HOWARD-HENDJE,ALEMETA E 00 ARD-HENDJE,ALEMETA HENRIETTA DOS SEX RAC HOT WGT EYE HAIR SKN POB 19560625 F B 509 210 BRO BLK MED IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y SC L WRIST SC R KNEE CCH RECORD *** 01 ARRESTED 19830414 AGENCY: IA0820200 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA708-2 ASSAULT W/BODILY INJURY 'IRK#: L24530501 COURT DISPOSITION AGENCY: IA082015.1 SCOTT CO DIST COURT COUNT NO- 01 ASSAULT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L24530501 SENTENCE DISP EFF DAT PLEAD GUILTY 19830823 FINE $100 19830823 02 ARRESTED 20040408 AGENCY: IA0020200 DAVENPORT PD • CHARGE NO- 01 IA STATUTE IA700.2 (3) r� ASSAULT W/DISPLAYTNO WEAPON TRK#: 902858301 r- C"") rn y3 COURT DISPOSITION -� -0 AGENCY: IA082015J SCOTT CO DIST COURT C')- COUNT NO- 01 IA STATUTE IA708.2 (5) 1-<1;" ASSAULT COURT CASE ID: 07821 AGCR267719 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 902858301 co SENTENCE DISP EFF DAT PINE 20040708 03 ARRESTED 20040908 AGENCY: IA0820200 DAVENPORT PD Sep, , 8. 2014 3:43PM Div of Criminal Investigation No. 9625 P. 9 DCI 00308358 PAGE 2 OF 3 CHARGE NO- 01 xA STATUTE IA714.2(3) THEFT 3RD TRKf): 903058701 COURT DISPOSITION AGENCY: 1A082015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE IA714.2(5) THEFT 5TH DEGREE - 1970 COURT CASE ID: 07621 AGCR271788 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 903058701 SENTENCE DISP EFF DAT FINE $50 20041014 04 ARRESTED 20080603 AGENCY: IAO 8202 00 DAVENPORT PD CHARGE NO- 01 IA STATUTE IA708.7(3) HARASSMENT / 2ND DEO. - 1989 TRK#: 9A0053D01 COURT DISPOSITION AGENCY: IA082015J SCOTT CO DIST COURT COUNT NO- 01 IA STATUTE IA708.7 (3) HARASSMENT / 2ND DEG. - 1989 COURT CASE ID: 07821 SRCR311883 CHARGE CLASS: NON CONVZCTTON TRK#: 9A0053B01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20061119 PROBATION 1Y 20081119 DISCHARGED FROM 20100224 DEFERRED JUDGEMENT 05 ARRESTER 20100322 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA714.2(3) Z5 _ THEFT 3RD DEGREE - 1978 C� f 6 -t3 TRK#: 1A00 6ZM01 _r- COURT DISPOSIT1ON -� g , 1 AGENCY: IA052015J JOHNSON CO DIST COURT fii COUNT NO- 01 IA STATUTE IA714.2 (5) C? .• � THEFT 5TH DEGREE - 1978 COURT CASE ID: 06521 AGCR090263 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A008ZM01 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 1D 20100908 JAIL 1D 20100908 Sep. 8. 2014 3:43PM Div of Criminal Investigation No. 9625 P. 10 DCI 00308358 PAGE 3 OF 3 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 /Al Q CD Zn 71 > 'v =MM. r rn 31° w ca 1 1'1°410 i SMARTER I SIMPLER I CUSTOMER DRIVEN ._ ----- Office of Driver Services PO Box 9204 i Des Moines.iA 50306-9204 Phone:515-244-9124 800-532-1121 I Fax:515-239-1837 www_iowadot_gov Certified Abstract of Driving Record Inquiry Date: 9/11/2014 DL/ID#: 937AA4655(IA) Customer#: 4162728 Name: Howard Hendje,Alemeta Class: D ID Status: None Henrietta Address: 209 HOLIDAY RD APT 111 Audit at: 5125763 DL Status: VAL Issue Date: 04/01/2011 CDL Status: None City/State: CORALVILLE,IA 522411132 Expiration Date: 06/25/2015 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 209 HOLIDAY RD APT 111 Restrictions: NONE Restriction None Date of Birth: 6/25/1956 Supplement: Mailing City/State: CORALVILLE,IA 522411132 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County 1UR 10/14/2011 11/08/2011 S92 Speed `Johnson IA 04/25/2012 05/11/2012 664 No Insurance Card 'Johnson IA Name:Howard Hendje,Alemeta Henrietta DL/ID:937AA4655 Pursuant to Iowa Code§321.10,1,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: f,%...l........4,,,l • *ot/ 9/11/2014 4 �IOWA -0' ;o: soy A. s.D. 0. T. 4 f+i,%1ADn % of Driver Office Sof ervices Iowa Department Transportation ", D>=4 --aa c-)--E --- r- Name:Howard Hendje,Alemeta Henrietta DL/ID:937AA4655 ""ic: t fit) r.;