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Home My WebLink About14-077 Authorization Number /I/1— Alt / 7 _ 1 (Office Use Only) APPLICATION FOR TAXI 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 Mjddle Last 1. Name ' Ke 2. Mailing Address '7/ 3. Telephone: Home 3(7 "7".-/ ' 7 S 3 ,1 Other: 4. Prior experience in transportation of passengers: ( Cov fi 5k 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When SPS (--62(-"A 1,1 a o �Z 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? IU o l ' Gto 0 U ' Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? No 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) (moi c) 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 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number X77 Lobo e L 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 �d.�( �„� ,,,,�� Date 3/a7 (/ STATE OF IOWA ) COUNTY OF JOHNSON ) l.t Subscribed and sworn to before me by o\ P hnS (-)""'"'",\\C„ J . On this day of Nota4y_P lic in and for the State of Iowa -z I (I`, 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). t) 7//1--/ / Signatur of •.licePp(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. l� • /� /vv L?/(2.7,0/1 / Signatu -of City Clerk or designeeate 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 _ clerMaxidrivbadgeapp2010.doc 03/2013 a(f 6 iA rnrv,io vvadot.go) SMARTER I SIMPLER I CUSTOMER DRIVEN d ,. ... � Office of Driver PO Box 9204 I Des Moines, IA 50: Phone:515-244-9124 1 800-532-1121 I Fax:515-: Certified Abstract of Driving Record Inquiry Date: 3/21/2014 DL/ID #: 377WW8638 (IA) Customer#: 422150 Name: Schminke, Carol Ann Class: D ID Status: None Address: 7180 31ST AVE Audit it: 6233624 DL Status: VAL Issue Date: 08/21/2012 CDL Status: None City/State: ATKINS, IA 522069776 Expiration 08/29/2017 CDL Cert Status: None Date: Endorsements: 3 CDL Med Status: None Mailing Address: 7180 31ST AVE Restrictions: Corrective Lenses Restriction None Date of Birth: 8/29/1951 Supplement: Mailing City/State: ATKINS, IA 522069776 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County 08/20/2012 08/24/2012 592 Speed (10 mph &under in 35-55 mph zone) Washington Name: Schminke, Carol Ann DL/ID: 377WW8638 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do here 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 offic currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportal certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa thi: _ IEHICIf pip\ O�''.......�/G�i�/ 3/21/2014 s' IOWA 'e4 ej4rI'cly: F f II11��f�O....'S4Q��' ice of Driver Servi IowaTransportation Name: Schminke, Carol Ann DL/ID: 377WW8638 OF '' cqSTATE OF IOWA ~ y~ - k _ of` isot IOWA ; 1 Criminal History Record Check a• orrotTim-v� Request Form r4cRlMINatas• vox DCI Account Number:__9861-F (if applicable) To: Iowa Division of Criminal Investigation From: .City Clerk's Office Support Operations Bureau,1°t Floor 215 E.7th Street City of Cedar Rapids 101 First Street SE Des Moines,Iowa 50319 Cedar Rapids,IA 52401 (515)725-6066 (515)725-6080 Fax Phone: 319-286-5060 Fax: 888-966-0171 I am requesting an Iowa Criminal History Record Check on: Last;:Name.(mand ry)_tI _ _First_Name anaa>ory) - Middle tmanaatory) = — Gender�manaatory) = =T -Social_Security Number.mandatom *r - Female Waiver Information:�Without a signed war rfrom,the sublecU f the request,a,�omplete criminal history record may not -be releasable,per Code oaf Iowa,Chap 6922 For complete criminal h tory recon formation,as allowed by la_w always obtain a waiver signature from th s b�ecfof aWaiver Release I hereby grvepermission for theabove requestwg cffictal to conduct an Iowa cnminal history record check with the Division of Cnmmal =—�� —f =7nvestrgahon(DCTj Any cnmrnal history datii concerning me thaf rs maintamedby_the DCI—nay be released as allowed by-law=_T _ - Waiver Signaare� � tu � Iowa Criminal History Record Check Results (DCI use only) As of , a search of the provided name and date of birth revealed: ❑ No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI# DCI initials DCI-77(08/25/10) PLEASE MAKE ADDITIONAL COPIES AS NEEDED. a,ING Page 1 of 1 Single Contact License & Background Check Results Criminal History Background Check Last Name Other Last First Name DOB SSN Name Selection Schminke Brunssen Carol 1951-August-29 484668496 Criteria Results Not found in Database Background Check Complete As Of 3/21/2014 3:21:02 PM NOTE: The first and last names, date of birth, and SSN displayed in the abuse registry and criminal history results are just as they were entered on the screen, Billing Account 9861-F Cash Deposit Currently at$1364.00 Generate PDF ISearch Again I w � https://www.iowaonline.state.ia.us/SING/SINGSQLProcess.aspx 3/21/2014