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HomeMy WebLinkAbout14-170 r Authorization Number (y 1 -1 D I _ 1 (Office Use Only) iipLiiirgairtilit t.*1 -rt.a4_ CITY OF IOWA CITY APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday-Friday.) Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX jFirst \ 1 MiddleLast 4.ex_ 1. Name I ZL3�bC� 'f`f TVI ry �le_ On1 I S 2. Mailing Address 71 ? P rnu S '2-0 L.0(4 S9 S- 3. Telephone: HerneCe/. 3 Iq- 4,a) q l5S ther: 1 �R. l /� � (Qt� 4. Prior experience in transpo ion of passengers: S+L In� 1)1 4 A�.JSIness 046,e d r<' vir S-\-a �` k r w o+efkii--1/Gv� L'� CF-r da r . Lc, 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense _ Where When 54k, -.,�,_ it^e4 Cr .o c.o. to A Pow Con + . Co ?Q 1)- 5 - t q(o 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? f10 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? tA D Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V 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 REVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerWtaxidrivbadg 03/2014 r . I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number �XAz 1 fit/ /1 0 31 3 cl . 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 S 1 /ry iq 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 an sworn to before me by . V I _t., On this 1et k_ day of .\.n A (-9- t.`>t A WENDY s MAY ER No ary Public i land for the State o(Iowa ;r: Cpff1MMV° Itofl xptres My Comm ss • .,4 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). � C Signa .re of Pf ic:'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. //(!�'u�iv f�ll�iL� ?-/ `y — / Signattare of City Clerk or designee Date 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 clerk/taxidrivbadgeapp2014.doc 03/2014 O --0 of PUVA State of Iowa �,P1'`E oF�otw;;` B Division of Criminal Investigation cy • + " y.` Wm Nr �� 215E 7 St °. i IOWA Des Moines IA 50319 - c * n ,„Fl"" ,'r, Ph.515-725-6066 Fax 515-725-6080 004 '" '� ; '"" ' d .off �I iy !owe * H.+4 10. OAON 0.. Iowa Criminal History Record Check ;/MINPLL +- ` tI Walk-In Request Your name ill 2 ak TUl11_ On l 1 VL� Address 71 ._ r ot> StCity/State/Zip ,,,„_Aig: ct.,, 4y` ,n Saat 45- Fill in all shaded areas. Phone# 31q- Cea 1 - QISS Requesting an Iowa criminal history record check on: Last Name Apellido(mandatory) First Name Primer Nombre(mandatory) Middle Name Segundo Nombre(recommended) \11\ , 1 s-k-ec ei -zakel-n Lay l Date of Birth Fecha Nacimiento(mandatory) Gender Genero(mandatory) Social Security Number(recommended) 9 ` (5^ lg7y ❑Male Female 5S - 23 —07393 Waiver Signature Firma(If the request iston yourself,please sign. If the request is on someone else,write N/A.) (cyl / Results DCI USE ONLY As of `e-1pp 3-14 , a name and date of birth check revealed: - ❑No record found - RRecord attached, DCI# 55`7 bf-) r. DCI initials Receipt 1 Number of requests { �#, $15.00 per last name=Total amount$ 10-- , Method of payment: cash ❑money order ❑check# ❑MasterCard or Visa Cardholder's name �' )) Last 4 digits of MC or Visa DCI initials Ylr " Credit Card Number# Exp. Date IOWA CRIMINAL HISTORY DCI 00514269 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- 2014/08/18 DCI:00514269 NAME: MILSTER,ELIZABETH GAYLE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19740915 F W 502 175 BLU BRO MO ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ANKL TAT L HIP TAT NECK TAT R ANKL CCH RECORD *** 01 ARRESTED 19951222 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401-3 FOSS SCH I-MARIJUANA TRK#: 018652401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-3 FOSS SCHEDULE I MARIJ TRK#: 018652401 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960415 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA665-4-2 • CONTEMPT OF COURT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 018652402 SENTENCE DISP EFF DAT FINE $100 19961105 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 SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot g©v Office of Driver Services PO Box 9204(Des Moines,EA 50306-9204 Phone:515-244-9124(800-532-11211 Fax:515-239-1837 www.towadetgev Certified Abstract of Driving Record Inquiry Date: 8/19/2014 DL/ID#: 242AD3839 (IA) Customer#: 5401729 Name: Master, Elizabeth Gayle Class: D ID Status: VAL Address: 713 BROWN ST Audit#: 8323092 DL Status: VAL Issue Date: 08/05/2014 CDL Status: None City/State: IOWA CIN, IA 522455901 Expiration Date: 09/15/2022 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 713 BROWN ST Restrictions: NONE Restriction _ None Date of Birth: 9/15/1974 Supplement: Mailing City/State: IOWA CITY, IA 522455901 Sex: F History Information Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended ;06/29/2011 :03/13/2014 :053 'Non-Payment of Iowa Fine IA IA w, Name: Mister, Elizabeth Gayle DL/ID: 242AD3839 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: *fWvgyy Clf<pi 8/19/2014 41 IOWA y'' yc:D• . O. T.its /,,Ii ''rn Dina%`/ Iowa Office Departmr Sert vices Transportation Name: Mllster, Elizabeth Gayle DL/ID: 242AD3839