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Home My WebLink About14-067 Authorization Number / L) — Lp7 - 1 (Office Use Only) /fes.®a1 tIII ANNI BO 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 Fi st Middle 1. Name N. > �YG 2. Mailing Address 3-2-� i_ac� NAY-- 1 S 03 Ot (c.)i I 3. Telephone: Home (I 2* -3 33 - 6 a g- Other: 4. Prior experience in transportation —FA_of passengers: I n c e ' U C 15;r. c!)S S` rs t; .i S ,rte-k" 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? 1'2- Type of offense Where When P o S at" fry r c J \J \\ \3 2-c3CA �\A\O x )- C�,6. kiNqu-N n • �� wit(\ VN 2 0 ::,2 20o& 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /\)6, Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? U' Type of offense Where When / ' r -2/Sl 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) 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) derkttaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number --? —_.Z—t 4-1 . 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 wth all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) 3/Signature of Applicant ,�r 4_, i------- Date )y/i q 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 ) Subscribed and swr to before me by P\4-AN 1 '1,-) . (C- rap Q_( . On this 1 4-0.k. day of .Pa'4`t WENDY S.MAYER Notary Public hand for the State Iowa 4 7 Commission Number 729428 • My Commission1Expires **********W***F*** fest �rltx xnxx Y******************************************************************************************************** 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). Sig ature of Police Chief or designee 1/7/// 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. i ,r e _) k 3// 7//5./ Signatare 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 clerk/taxidrivbadgeapp2014.doc 03/2014 Page 1 of 2 C4arAooTvuvw�nr.iowadat.go SMARTER I SIMPLER I CUSTOMER DRIVEN .. Office of Driver' PO Box 9204 I Des Moines,IA 50; Phone:515-244-91241800-532-1121 1 Fax:515-; wM.iaw Certified Abstract of Driving Record Inquiry Date: 3/12/2014 DL/ID #: 781ZZ7885 (IA) Customer#: 1045217 Name: Graper,Ashley Nicole Class: D ID Status: None Address: 3338 BLACK HAWK AVE Audit#: 7335939 DL Status: VAL NW LOT 505 Issue Date: 09/12/2013 CDL Status: None City/State: OXFORD,IA 523229204 Expiration 10/02/2018 CDL Cert Status: None Date: Endorsements: 3 CDL Med Status: None Mailing Address: 3338 BLACK HAWK AVE Restrictions: NONE Restriction None NW LOT 505Date of Birth: 10/2/1982 Supplement: Mailing City/State: OXFORD,IA 523229204 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County 08/28/2009 _/06/2009 592 !Speed (10 mph Ea under in 35-55 mph zone) Johnson 10/30/2009 12/08/2009 1s92 .(Speed 'Washington 06/06/2010 08/17/2010 _ IS92 ]Speed (10 mph&under in35-55 mph zone) Johnson 12/05/2011 03/09/2012 S92 !Speed Accidents -Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/06/2010 ;547131 IA Sanctions Type Effective End ACD Explanation Occurrence 3URvW Suspended X08/25/2010 '01/05/2011 D38 ;Fall to Post Security for an Accident-Owner Only SIA Name: Graper,Ashley Nicole DL/ID: 781ZZ7885 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 offtc 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 this 3/12/2014 0..ar. 14. 2014 2: 27PM CDiv of Criminal Investigation 0.0: 2059 p•P. 1/3 • rii,orN STATE OF IOWA .-•,941. -%r •1 .5), Criminal History Record Check :s =' .L.� ;.Ai v Request Form • 5r' r. if i D CI Account Number: Yong (ifapp rabic) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,tSloor City Clerk's Office 215 E.71h Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA. 52240 (515)725-6000 Fax Phone: 319-356-5041 ax: 319-356-5497 I am requesting an Iowa Criminal Bistoty Record Check on: • • L Name (mandatory) L Fist ante(mandetory) Middle Name(tccommcnded) Date of Bithh121 (mandooroiy) Gender(mdat anory) •_ Social Security Number(recommended) .l() blc Maleemalo 0 --5-2,---5-2,— Nil � 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 cornploto criminal history record Information,as allowed by law, always obtain a waiver signs tura trorn the subject of the request. Waiver Release:I hereby glue permission for the e6ove regi wring oftlolal to conduct an Iowa criminal history rccer4 check with IhoDlvislon ofcrintnal Invesligalion(DCI). Any Mining history damn wnceminglne Ilia,melntnfled byihoACl ha termeda a allowed by law. Waiver Signature: :7%i k_9!_ ._ .... . •i-, (�/tw6,e�_ Iowa Criminal Histojy Record Check Results (D CI in only) As of 3'1 4-1 q , a search of the provided name and date of birth revealed: L> 0 No Iowa Criminal History Record found with DCI . >c ° • :Ts ca;h—rr o ,�,��-yy I�1.. Iowa Criminal HistoryHistoryRecord attached,DCI# 10508 t 3 c� = x .. �. N DCX initials &w Rote ivat: Tima_Mer 11 •41(11A 4• 1APM Ain 4141 Mar. 14. 2014 2:27PM Div of Criminal Investigation No. 2059 P. 2/3 IOWA CRIMINAL HISTORY DCI 00650813 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/03/14 DCX:00650813 NAME; GRAPER.ASHLEY NICOLE DOB SEX RAC HGT WGT EYE HAIR SRN POB 19821002 F W 505 170 GRN BRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT BACK TAT T. FOOT TAT L GELD TAT R ANKL TAT UL ARM CCH RECORD •4* 01 ARRESTED 20010012 AGENCY: • IA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESSION/MARIJUANA TRK#: 055399601 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA124-401-5 POSSESSION MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 055399601 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20011009 COURT COSTS 20011009 PROBATION lY 20011009 JAIL 7D 20020117 FINE $250 20020117 COURT COSTS 20020117 RESTITUTION SERVICE 20020117 REVOKED 20020117 02 ARRESTED 20020305 AGENCY; IA0920100 WASHINGTON PD CHARGE NO- 01 IA STATUTE IA123-46 PUBLIC INTOXICATION TRK#: 055423901 COURT DISPOSITION AGENCY: IA092015J WASHINGTON CO DIST COURT COUNT NO- 01 IA STATUTE IA123.46 CONSUMPTION / INTOXICATION COURT CASE ID: 08921 SMSM036477 CHARGE CLASS: MISDEMEANOR CONVICTION TRKµ: 055423901 SENTENCE DISP EFF DAT JAIL SD 20020320 CREDIT W/TIME SERVED 20020320 Mar. 14. 2014 2: 27PM Div of Criminal Investigation No, 2059 P. 3/3 DCI 00650813 PAGE 2 OF 2 03 ARRESTED 20000620 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA726.6(7) ENDANGERMENT/NO INJURY TRK!}: 1A004FT01 COURT DX:WO:ITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA726.6(7) CHILD ENDANGERMENT/NO INJURY COURT CASE ID: 06521 AGCR083748 CHARGE CLASS: NON CONVICTION TRIQ$: 1A004FT01 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20081024 PROBATION 1Y 20001024 DISCHARGED FROM 20090819 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD• MAINTAINED BY THE IOWA DIVISION OF CRIMINAL 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 EASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION V •