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Home My WebLink About18-059 IDENTIFICATION NO. /ea -- 0 $ r (Office Use Only) 4=mop= g:rait 21. ul A4 ilk Oa 11111114T1 APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) CITY OF IOWA CITY 4 1 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX —T--'^a / vc ^1 -14,ct� First Mid le Last V 1 � 1. Name(REQUIRED) ree ' i(t Ca \ v 2. Address (REQUIRED) t 5 OC-k �,4,-e_ir 3. Contact Information(REQUIRED) Email: ''"r1 « uC t`�} �ti "� Phone: 3teli 33(-6( ( I written communication sent via email) 4a. Driver's License expiration date (REQUIRED)j1 1- — 2. ) I b. Taxicab Business Name (REQUIRED) `f p ' 1(j 1 Cab 1 U � C t 5. Prior experience in transportation of passengers: N �.�1a"„ C.b ` \NG)v LIC. ✓ 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When TC `��h.�a 1 C,_ C I -- ton 1 Y • i What happened to the charge? (Circle one) —M) Convicted Dismissed (Deferred ) Suspended Plead Guilt'- Cit 7. Have you been arrested/charged with any traffic offenses in the last five years? f6 / `J r ,, ,r' Type of offense Where When �O - -- / 5-- What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ` I Z I X CIO y issued on 1,- 5-zee expiring on -1 - . I understand that if I falsely answer any questions in this application, that this application 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, _ d I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisi.n of Ti e 5 er 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant /A _ Date L -1 l- Zv ( STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by f{� �� s3 - t K,L,_,�1•-i on this j i day of J ►,e Zot P' . WENDY S.MAYERu e o 141vCO 7]W2$ Notary Publi.p and for the S':tof Iowa • My CorsVmipikExpires **************************************************************************************rt******* ***A A AA A A*************** 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 I •� : license io---Z G - zyZ Signat - of Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB Wp►t'�ITY Fa NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.Air fir- rn i _ Signature of City Clerk ordtiesignee . D$ •• CT Office Use Only Approved application DCI report State certified driving record Website update OeAJTAXIDRIVBADGEAPPL92018amended.DOC 04/2018 - ' ' - 0:55AM Div o' Crlmilal Invest Iga' pan ¢A)p3t9338s s. • • ^11002 06'VJILV Il! ,/,.i0 1Mew/rkw .w STATE OF IOWA. �..� C : Criminal history Record Check , •• ' Request Form a t ea DCI Account Number. 9967-F . (ifpplicaela) — To: Iowa Division or Criminal Investigation Prom: Yellow Cab of Iowa City Support Operations Bureau.1"Moor P.O.Box 428 215 F.7"Street Des Moines,Iowa 50319 Iowa City,IA. 52244 (515)725-6066 . (515)725-6080 Fax (319)338-9777 Phone: Paz: (319)339-7302 I am requesting en Iowa Criminal Ristoryjteoord Check on: Last Name LMunde:o!y) •First Name(mandatory) Middle Name(reeomeneitded) 744 L1 "' 14LC S ; ti"1t"G-tvQ A- Ki k) Date of Birth (mandatory) Gender(mildewy) Social-Security Number ocoroorg.a6ko, 10 '""111rkciL [Nate94?emale ICJ — l "" Ul.ote-4 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.For complete ethnical history.record information,as allowed by law,always obtain a weir tgriature from the subject atilt retreat._ - • Waiver Release:I bacby sive permtaioe tot Ilia regva1efM tofficial to-. • • as We orhnbtal blowy mord ehedc with the()Milos orCi ua) laveatl=itioa(DCI), My criminal htetery dela pan "'+ is mol nod by I y be Mewed a,chewed by Iiw. Waiver Signature' . 4111 --11111111. — • 7 Iowa Criminal aidro Record Cheel`C Results • (DC7 We 00.34 f• N AS of lQ • "' , a search of the provided name and date of birth revealed: r e� 6 c.' • .D-=+ = 0 No Iowa Criminal History Record found with DCI ;, < 1. -Hc, — r m :2- e • e 53- Iowa Criminal history,Record attaohed,•DCI# (0 31 g�tg .,�, Q DCI initials_ dr, �� • .c :n . r DCI-77(08125!10) • - • Received Time Jun. 5. 2018 9: 09AM No. 9975 . J . 7. 2018 10:5 AV Div 0 Criminal No. 0140 P. 21 IOWA CRIMINAL HISTORY DCI 00639848 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2C18/06/07 DCI:0063984e NAME; HICKS,AEGINA ANN THALKEN, REGINA ANN THALKEN-HICF8,REGINA ANN :IUB SEX RAC HG'! WGT EYE HAIR SKN PUB 19651026 F W 50/ :60 BRC BRO PAR ('A ADDITIONAL IDENTIFIERS PHOTO AVAILABLE' Y SC L CHK TAT ABDOM TAT L WRS TAT R HIP TAT R SHLD CCH RECORD *'* 01 ARRESTED/TAKEN INTO CUSTODY 20010310 AGENCY: IA0520200 IOWA CITY PC CHARGE NO- 01 IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE/SCHEDULE I TRKR. 100180901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO 7IST COURT COUNT NO- 01 IA S'7ATUTE: IA124.401(5) POSSESSION OR A CONTROLLKD SUBSTANCE COURT CASS ID: 06521 SRCRO58209 CHARGE CLASS: NON CONVICTION TRKM: 100180901 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010817 PROBATION 1Y 20010817 COMMUNITY SERVICE 20H 20010817 DISCHARGED FROM 20021022 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20090908 AGENCY: IA0520000 JOHNSON CO 60 0 CHARGE NO- Cl IA STATUTE IA321J.2(A) -- c:v OPER VEX NH INT (OWI) / 1ST OYFEN:E r r} TRKM: 1A0070801I COURT DISPOSITION 7 0 AGENCY: iA052015J JOHNS JN CO DIST COURT COUNT NO- 01 IA STATUTE: IA3213.2(A) j rn 0 OPER VEH WH INT (OWI) / 19T OFFENSE '� •• COURT CASE ID! 06521 OWCR088327 rn CHARGE CLASS. MISDEMEANOR CONVICTION TRKM: 1A0070901 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT J,'_ ?. 2018 10:56AM Dtv of Crir2 nal irrtstitatoan ho. 0'.0 P. 3/3 DCI 00539648 PAGE 2 OF 2 JAIL 2D 20091202 FINE $1250 20091202 AN ARREST WITHOUT DISPOSITION ::8 NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRAAINAL 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 INQt:IRY. DIVISION OF CRIMINAL INVESTIGATION N CD ca —T1 >=I I C) __ r-- In & IOWADOT DC)ar SMARTER I SIMPLER I CUSTOMER DRIVEN UVWtiIV'IQWadotgOV Dom.&Idsntricatlon Undoes PO Box 92041 Des Mortes,IA 503069204 Phone 515-244-9124 1 Fax 315.239-4837 Certified Abstract of Driving Record Inquiry Date: 6/5/2018 DL/ID#: 431XX9040 (IA) Customer#: 622326 Name: Thalken-Hicks, Class: D ID Status: EXP Regina Ann Address: 1527 ROCHESTER Audit#: 2864263 DL Status: VAL AVE Issue Date: 06/05/2018 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 10/26/2025 CDL Cert Status: None 522453135 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1527 ROCHESTER Restrictions: Corrective Lenses Restriction None AVE Supplement: Date of Birth: 10/26/1965 Mailing IOWA CITY, IA Sex: F City/State: 522453135 History Information Convictions Citation Date Conviction Date ACD ;Explanation County JUR 09/08/2009 12/02/2009 A20 Operating While Johnson IA Intoxicated 10/28/2015 11/20/2015 S92 ,Speed Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation ,3UR County 09/08/2009 A98 OWI Test Failure IA Johnson N Sanctions c) co n c m Type Effective End ACD Explanation OccurrenEi ...D......4 JUR •••••• JUR in , _ 1- Revoked 09/19/2009 03/17/2010 A98 OWI Test Failure IA ,<rf;1 Igy r 0 x' Ch Name:Thalken-Hicks, Regina Ann DL/ID:431XX9040 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver&Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by 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: 41'}04 r OF 7,4 6/5/2018 44. ( ?) 4 G dOcyt- ,c4 Driver&Identification Services 7O�4L Doc, Iowa Department of Transporation Name:Thalken-Hicks, Regina Ann DL/ID:431XX9040 N Ca CDCD co C — r rri r m OX s O Oti