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Home My WebLink About14-149 Authorization Number / y --`'-I G • - 1 (Office Use Only) ECG grbdp. , r II japiliag ftq tie Ell 11:441r APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa City, Iowa 52240-1326 (319) 356-5040 (319) 356-5497 FAX First Middle 4.ast 1. Name k Ckv-1 2. Mailing Address 1 Cpl 3 S'p 't cc Ct_ 3. Telephone: Home 0 Other: 31 q-325-LI 11 b 4. Prior experience in transportation of passengers: V3Nri J inti q 1i rn o , v' E)(rr LSS 1 i rndS irk NI Or LbeJets d 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When NAVY__ W a G 0 /2,06-1 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 3c Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NC, Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? \\)p 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) 0 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) clerI taxidrivbadg 03/2014 I hereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I -7)3 Yy '- 7 Ut j . 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 -, 6),„' Date (57/B /2,01 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 }3 LLQ ; I 1.,....0.1 . On this Si - day of o alA�,• IAIF�r1Y S MAYFR Notary Public in an for the State of wa� a i Commission Number 729428 MCOm i; i n Expires ...*******.*,.,tln�`-=— *,,, ++w.ra«************************************************************************************************* 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). W _ � 1 /i! Signature .” "dice Chief or designee 9 Date YOU A_RENOT 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. v 1 Signatur of City Clerk or designee \Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 '/2" (width)and 5'/2" (height)and prominently displayed to all passengers. ************************************.*********************************************************************************************************** Office Use Only Approved application DCI report State certified driving record Website update clerk/laxidrivbadgeapp2014.doc 03/2014 Page 1 of 2 , r ' enefi la i " 111:, 1 1, ,"S' D . , : . T 3 ' ';. SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOW , . , �Ot t�OV Office at DriverServices PC)Box 9204 i Des Moines,IA 50306-9204 Phone:515-244-91241800-532-11211 Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 7/30/2014 DL/ID It: 713YY4765 (IA) Customer It: 5001261 Name: Blrney, Bethany Jane Class: D ID Status: EXP Address: 1613 SPRUCE CT Audit it: 8306361 DL Status: VAL Issue Date: 07/30/2014 CDL Status: None City/State: IOWA CITY,IA Expiration 09/26/2018 CDL Cert None 522406029 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1613 SPRUCE CT Restrictions: Corrective Lenses Restriction None Date of Birth: 9/26/1986 Supplement: Mailing City/State: IOWA CITY,IA Sex: F 522406029 History Information Convictions Citation Date Conviction Date ACD Explanation County _ JUR 09/05/2007 12/12/2007 A20 jDeferred Judgment OWI ;Johnson :IA —I Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR 09/05/2007 'A98 SOW'Test Failure 'IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 109/16/2007 03/13/2008 A98 ;OWI Test Failure iIA IA i Name: Birney, Bethany Jane DL/ID:713YY4765 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: w o qnq _pE1VClf n..4.. 7/30/2014 0z4Jul:23, 2014r 2:37PM Div of Criminal Investigation ' ' _,. DOI 'IC%cNo. 5414 P. 1/2 L . ... .. . . (-1C4C 6 . ' • • ' STATE OF IOWA • ., . • ;; �, Criminal History Record Check • _, _.`r Request Form . DC1 Account Number: 43$3 - • Mania applicable) TN2owa PlvWon of Criminal 7avestlgatlon From: rr va'rnia TAXI Sopport Operstloai Bureau,1"Floor . ,5� O 216 E.?StreetIktG tws r • ' • Des Melees,lows 50119 ' 5 -- ..--------144-6„ , A - ... (516)T1� Fan Hume; . 319) 338a9y' Fast. . (3(9) 55-1-S?19 l am requesting an Iowa Criminal Wino Record Check oni • •• Last Name(madrtety) Fleet Name(nova torr) Middle Name(terommensx0 ?)vr Zv Cie aASa c Date of Birth(oatCy) GendorJmwduory) Social Security Number(moomnrawd) • pa/2C/ 19-8 G - " able ENFemale 1 B- 17-71 20 - Waiver I'rform ailon:Wallow t signed waletr from tba object of the roquost,IL complete ertmlaal history record may not be releatable,per Code ortown,Chapter 692.7.Par foulelete ettmtn■l history record Information,as allowed by law,always • obtain a waiverolanalore from the subject of the mount, Waiver Release:)heavbgiro pa,awwbfor Ow amtoiningomowtoconduct u Tow*criminal hMotymold deck w.htheM.hloeofGemini] . )nvrepdon(MCA. Anycnmidal Meaty dam teeeaning an INi El mehaWad b/the Dcl m ftem ams a.liowod by law. . . -..-.._ ---____— sig ----6;A.ra - Waiver aahuet- ._ ...__._...____.:_.._.__ Iowa Criminal History Record Check Results (OCr me only) As of 7fr 3//y ,a search of the provided name and date of birth revealed:. ;_ • t ., ❑ No Iowa Criminal History Record found with DCI I t • ;: — - Iowa Criminal History Record attached,DC1# €I"J 4 LI -.3 •) II • c:'r DCI initials ' DCI-77(0825/14) Received Time Jul. 17. 2014 1 :03PM No. 4661 Jul. 23. 2014 2:37PM Div of Criminal Investigation • No. 5414 P. 2/2 IOWA CRIMINAL HISTORY PCI 00813492 NON CONVICTION PAGE 1 OF 1 DATE PRINTED- 2014/07/23 DCI,00813442 NAME: BIRNEY,BETHANY JANE DOB •SEX RAC HGT WGT EYE HAIR SKN POB 19060926 F W 506 125 GRN BRO FAR IA • • • ADDITIONAI. IDENTIFIERS PHOTO AVAXLAELE: Y SC RP ARM CCH RECORD +++ 01 ARRESTED 20070905 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) • OPER VER WH INT (OWI) / 1ST OFFENSE TRK#: 1A002A201 COURT DISPOSITION • AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 1ST OFFENSE COURT CASE ID: 06521 0WCR080728 CHARGE CLASS: NON CONVICTION TRKQ: 1A002A201 SUBSTANCE ABUSE EVALUATION SENTENCE OISP EPP DAT DEFERRED JUDGEMENT 1Y 20071212 PROBATION 1Y 20071212 DISCHARGED FROM 20001113 DEFERRED JUDGEMENT 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 IbENTXFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. btVSSION OP CRIMINAL INVESTIGATION 'VAl'/^'' 1