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Home My WebLink About14-139 Authorization Number / -J--i39 1 (Office Use 4:7;:ginoir-4112t4 imp zap icianiiir 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 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name d-hle(n At\rt L_of1 Cif 2. Mailing Address 0;4- (,x%11' s ptr°n M('ad'c:� �)! t v e / 3. Telephone: Home 1 Other: Ci'i i (31`I) C9 al - 4. 1 -4. Prior experience in transportation of passengers: No-i e 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? No Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? NO Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? �c Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 14c Type of offense Where When 9. Hay you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) t..)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) clerk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number c ke a-7 G3 . 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) QQ�,,_� Signature of Applicant 1 Vrx ... Date 0 ' / - 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 ) J ./-4//7 Subscribed and sworn to before me by el //�"7!? '4' . On this ' day of t— - ://2/17lfJ Notary PDblic in and for the State of Iowa 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-re ..ents 4f t•e City of Iowa City (Title 5, Chapter 2, City Code). Iii► L � 1// 1 Sig -tu - of Potteg ief 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. 2) "2"t 42�. I. 7/- �Signa re 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 derk/taxidrivbadgeapp2014.doc 03/2014 ' Jun. 10. 2014 4:30PMI Div of Criminal Investigation No, 2130 P. 6/6 QUI!. V• LVIR L. VJIII VI ty OK Uri ICIIty UI Le (' UIIY IVU. 4re4 1. L • • • . 7r a STATIR OF IOWA x�f ft . . � p' 'PJ JAL-0144;i�� x ` Criminal History 1RecoS Cheek �; ;,.,, l 11 l t a '.;act::;}' ,. 5 DCIAccomrtNumber: Le0 0 2, - F • (Irepplloable) 'pot YowaiDivlslonofCrimIuutDIV eafigalion From: City of Iowa City ' Support Operations Bureau,i nFloor City Clerk's Office ' 215.E,71hStreetdie E..Washington Street Des Moines,Iowa 50519 (515)725-6066 Iowa City, IA 52240 (515)IZ5-6050 Fax . Phone; 319,356-5041 Fax: 319356-5491 • I am raquosting an Iowa Criminal IIistorykecord cheek on; .Last Nature(maudetol}) Mint Name(mondetory) Middle Name(rewmmended) • Date of Birth(mandatory) Gender(mandatory) Serial Security Number(recommended) 61I°S illif • ❑Male Wemale L{72 — ed- 7z17 l{iL1dveriri/brmatlou!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 etgnafut'e from the subject of the request, • ➢YajpeP Release:raercbyalve permission frrthoabovorequ sting oalciol to conduct an town criminal history reeerdchecic with the Division of Criminal Investigation(DCI). Any criminal history dala conccnangmQUz eet_hat tsmetntefned by the DCI maybe released as allowed bylaw. Waiver Signature; i. / 7t <� I'C// . ivisdi . • owa (Criminal Il1otorsr Record (Cheek Reguit . (DCiuseCAW As of U I ID V a searoh of the provided name and date of birth revealed: .• • Vi' No Iowa CriminalIiistoryRecord found with DCI ii'••i' ,1 ' .i. • .!c.; Cil a;7:: El Iowa Criminal Tistoty keoord attached,DCI# c..) , c.. J.— • • na nrr;riit/via Received Time Jun. 6. 9014 2:04PM No. 1 .. I ' Iowa Department of Transportation II Office of Driver Services (Toll Free)800-532-4121 PO Box 9204.Des Mother. IA 50308 9204 515-244-9124 FAX:515.239.1837 Certified Abstract of Driving Record Inquiry Date: 7/9/2014 DL/ID#: 296AE2763(IA) Customer#: 3016467 Name: Loney,Cathleen Class: D ID Status: None Ann Address: 2432 WHISPERING Audit#: 8137616 DL Status: VAL MEADOW DR Issue Date: 06/05/2014 CDL Status: None City/State: OWACI051 IA Expiration Date: 01/08/2022 CDL Cert Status: None 5224Endorsements: 3 CDL Med Status: None Mailing Address: 2432 WHISPERING Restrictions: Corrective Lenses Restriction None MEADOW DR Supplement: Date of Birth: 1/8/1971 Mailing IOWA CITY, IA Sex: F City/State: 522406805 History Information CLEAR DRIVING RECORD Name: Loney,Cathleen Ann DL/ID:296AE2763 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: tlfltCLf 'ii Mi7/9/2014 sIOWA• % t 'p •D. O. T. :�roiregon eicepezik 're i ...... • . c h...jr.>. Office of Driver Services Iowa Department of Transporation Name: Loney,Cathleen Ann DL/ID:296AE2763