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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) 356-549 FAX /
1. Name Fils�� / a %7 ?-oraic--Q(' &I-I:A f2. Mailing Address C- L Ar T- 4 " - , v t' 6224/
3. Telephone: Home 3 I q-L 2/- q q 3 Other: 'F ( Q- g) 9' 23 10
4. Prior experience in transportation of passengers: /06frt-)e-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? .)
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? WO
Type of Offense Where When
7. Have you been convicted of any traffic offenses in the last five years?
/60
Type of offense Where When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 1�C.
Type of offense Where When
9. Haveyou 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)
clerWtaxidrivbadg 03/2013
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
q \ 3 I'' ',. 1 7'2-q 0 . 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) t\
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Signature of Applican Date• ,.- I 'l
:t:t*.....***** ****** .... :t **:t*t*:t .. .....*:t t......."*:t**:t*.....**t.**********:t*.. .******�:t********** . . ....*:t*..*:t**t..",t**:t
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by T r-.v . reJ ce .3-6-c_1.--- >A, . On this L-t.L day of
A,
WENDY .MAY
o i Commission Number 72942b +'—
: -. m co emission Expires Notary -ublic in and r the State of Iowa ii
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*.******...******..***************.*.*****..**..*******..****************.*..********.*.*******.*.**********************************************
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).
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Sign re of Po f e 7 hi= 3r 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.
-724=c-- - i.L/ C - Xe-Le/', j - /Sr--/
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 5 1/2"
(height)and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record -
Website update
clerkltaxidrivbadgeapp2010.doc 0312013
elOWADOT ••
SMARTER I SIMPLER I CUSTOMER DRIVEN WWW IOWi9dot.go1!
Office of Driver Services
PO Box 9204 I Des Moines,IA 50306-9204
Phone:515-244-91241800-532-1121IFax:.515-239-1837
wwwiowadotgov
Certified Abstract of Driving Record
Inquiry Date: 3/6/2014 DL/ID#: 713A]7240(IA) Customer V: 6118960
Name: Jackson,Danielle Class: D ID Status: None
Address: 640 12TH AVE APT 1 Audit It: 7761070 DL Status: VAL
Issue Date: 02/04/2014 CDL Status: None
City/State: CORALVILLE,IA Expiration 08/03/2018 CDL Cert Status: None
522411772 Date:
Endorsements: 3 CDL Med Status: None
Mailing Address: 640 12TH AVE APT 1 Restrictions: NONE Restriction None
Date of Birth: 8/3/1979 Supplement:
Mailing City/State: CORALVILLE,IA Sex: F
522411772
History Information
CLEAR DRIVING RECORD
Name:Jackson,Danielle DL/ID:713AJ7240
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:
®�"e**(YICIFU°`e
..... ..yri, 3/6/2014
Mi IOWA o, ,,�
W D.o.T.;as c� 5t7f
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11% EOffice
of Driver
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Iowa Services
Name:Jackson,Danielle DL/ID: 713AJ7240
Mar. 10. 20144 1 :44PMM Div of Criminal Investigation ) No. 4722 P. 1/1
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, • Criminal History Record Check �� 0, �'_
•l . . A A Request Form ,\ H S
•
•
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DCI Account Number: L/Ct •L'
(leapplloable)
Tot Iowa Division of Criminal Investigation From: City of Iowa Cify
Support Operations Duman)lift Floor City Clerk's Office
21S F.71h Street 410 F.Washington Streot
Des Moines,Iowa 50319 .
(515)725-6066 Iowa City, IA 62240
(515)725-6060 Fax '
Phone: 319.3356-5041
Pax: 319356-5497 •
•
I am requesting an Iowa Criminal History Record Check on: '
LsE Name(rnondatay)tit
\First)Vame(mondaioy)lI NXlddle Name(recommended)
Lai., .
Date of Birth(mandatory) _ Gender(mandatory) ,�� Social Security Number(recommended)
_8.9 - z - i "(niq ❑Male ,XJFemale 3 2/0— 48- 7823e---
)
WaiverInforinafon:Without a signed waiver from the subject of the request,a complete criminal history record may not
be releasable)per Code of Iowa,Chnptor 692,2.Por complete criminal history record information,as allowed by law,always
obtain a waiver signature from the subject of the request.
WafverRelease;Ihereby give permission lb ea o requesting official to conduct an bola criminal history wool check with the DIvhflen of Criminal
investigation(1)C1). Any criminal history data ea airing m that Is mainlai d the DC ey eleascd as allowed by law,
Waiver Signature: Ae e1 w O • l
Iowa Criminal History Record Check Results (Daus only)
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As of 3`10-I , a search of the provided name and date of birth revealed: r t
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No Iowa Criminal history Record found with DCI -.1-7-)r', _v ;.n-11
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❑ Iowa Criminal History Record attached, DCI# ......f::---- Na =''
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initials '— _
Received Time Mar, 6. 2014 11 : 59AM No. 4486