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Home My WebLink About14-087 • Authorization Number / 9 - 8� 1 (Office Use Only) 't"mit CU1gi 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. Name1,(0S, F- 1 k) \(' 1101-f. 1 c A 2. Mailing Address all bbl 'f( r I i Yic M S- (—mem- I pA r h'3 Qi'1-1 3. Telephone: Home,S(03 (o-7(0 Other. 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Y-(S Type of offense Where When r Sty deRckv Ac'c`CL- Qo' W.u, ve_ 10` anvg 6. Have youeen convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? N.,=> Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? V, Type of offense Where When rats-` 6 51 zo 10 vvoVA\=t x-N ) 10Izoo 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? uZ) 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) 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) cre../tak dr.vhai 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `.1 2'Z_ 3$ g — . 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 %, • ! fa 'r�14 Date /-1, 1 �-�j 1 L-I 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. «* *.**.*.*...... .k****..,.}.*********..****.*.*.**********************************x.*******, ***, .,t .******* ************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by L,;1„CQS rlpj . /}�.c_45dv. . On this q tk day of A c1 ) ?-vlU �""`7 WENDY S MAYFR Notary Public in andndr the tat of Io�ada Commission Number 729428 •ow r 7 Commission Expires ******, *************************..*************************************************************************** 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). ,teii. L y ,1e97/S gnature Po. e 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. � �X��?�� /4W) /7- / — � � Sfgnat of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5'/z" (height)and prominently displayed to all passengers. **************************************************************************************.********************************************************* Office Use Only Approved application DCI report State certified driving record Website update Gerk/laxidrivbadgeapp2014.doc 03/2014 Apr, 4, 2014 9: 22AM Div of Criminal Investigation No• 6648 P. 1/1 Apr. 1. 2014 12: 13YM City Clerk - City of Iowa City No. 11-561 P. 2 STATE OF IOWA Jon y 'r ~ Criminal History Record Check to" „-•'�y�; Request Form s • DCI Account Number: 4t F (ifappllcsble) To: Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau,l"Floor City Cleric's Office 219 B.7ih Street 410 B.'Washington Street be.s Moines,)Awa 5031$ (515)725-6066 Iowa City, IA 52240 (515)725.6080 Fax • phone: 319356.5041 • Fart 319356-5497 ' ram repeating an Iowa Criminal Nieto Record Check on: Last Name (mandatory) FjrstName(mandatory) Middle Name(recommended) kue x\ I-. tndsc9 N1choI-e Date of Birth(mandatory) Gender;(mendalory) Social Security Number(recommeided) (5 \COI cies Malomale W78' i1' 5(030 Waiver Ifrforfflalioll;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 cgmnleto criminal history record Information, as allowed by law,always obtain a waiver signature from the subiect of the request, Waiver Release:Thereby gin permission for the above requesting official to conduct an Iowa criminal hh ioiy record cheek With iho DMrion oferintlnal Investigation(DCI). Any criminal history data concceemingmothat ismalnialnedbyIlio Del may borelcercdorellolvodbylaw. Waiver Signafure; g ,(/Lr4.#.t}• G� -Cl Iowa Criminal History Record Check Results, _'AWEurf only) - As of IM \ k\1 , a search of the provided name and date of birch revealed: r'• C' "' a J) i brit ,f;r`r1 _;i_ri No Iowa Criminal History Record found with DCI : i ' =r ;.i •• D ,7 r _ • ® Iowa Criminal History Record attached,DCI it DCIinitialsA . _ • • T�rr-77 roaf9AJ10\ Received lime Aor. 1, '2014 12: 11PM No, 6423 IP , -3 VtMlV Iowadotrgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-91241800-532-1121 I Fax:515-239-1837 ww tiewadot.gov Certified Abstract of Driving Record Inquiry Date: 3/27/2014 DL/ID#: 845ZZ3882(IA) Customer#: 4196095 Name: Hudson,Lindsey Nichole Class: C ID Status: None Address: 707 BAY RIDGE DR Audit#: 6859351 DL Status: VAL Issue Date: 04/12/2013 CDL Status: None City/State: IOWA CITY,IA 522465885 Expiration Date: 05/01/2017 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 707 BAY RIDGE DR Restrictions: NONE Restriction None Date of Birth: 5/1/1989 Supplement: Mailing City/State: IOWA CITY,IA 522465885 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County JUR ...W _ .... a ,...._ _.._ .... ... 05/01/2010 05/20/2010 S93 -Speed .W Johnson . _ IIA 7 710/05/2010 111/23/2010 IFOfi Violation of Motorcycle or Moped Requirements Johnson IA E Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident DateCase Number MIR05/01/2010 ... . . ....._ 570190: ._........ ... . .. ._ . `dA Name:Hudson,Lindsey Nlchole DL/ID:845Z13882 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: wyy d (Ctf Iltl O@ ...........".efa 3/27/2014 fr' i IOWA ?a: io9 r atesowek iv rtil . _ Ilf... .. Driver S rvices ht Iowa Department of Transportation Name:Hudson,Lindsey Nichols DL/ID:845ZZ3882