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Home My WebLink About14-055 Authorization Number 1q-ST I _ 1 (Office Use Only) Mel gal ZIT 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 Middle `` Last 1. Name �� 1'11 e , / 2. Mailing Address 1 14 'j DIC '6g-sil t_LL .�— I .A-uv,-kA C'-b-i , . (\ c-2 z- 3. 3. Telephone: Home :319 R/• /fat. Other: AJ9, 6-9-7,/d till, 4. Prier experience in transportation of passengers: /O-/" 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? 11 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 1\-C C4)/1440.0 c7;)(7)I I 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? il--C� . 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) 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 3c 1 -331 . . 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) 2 / Signature of Applic: t .' ' 3/ Date '6'1 Lf STATE OF IOWA COUNTY OF JOHNSON ) ' 4bscribeat and sworn orn to before me byck A Ir'L t��lE�� . On this L day of "ELLIE K.TUTTLE /4, / A sic Number 221N�ary Public in and for the State of Iowa 0r. SSI t ItOs ************************************************************************************************************************************************ 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). r d 6-14/ Signa re of Pol'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. / *9. ` /, Sign. ure of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2"(width) and 5 '/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010 doc 03/2013 fri Iowa Department of Transportation Office of Driver Services (Ton Free)8110-'i77-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX Certified Abstract of Driving Record Inquiry Date: 2/5/2014 DL/ID E: 8307Y1331(IA) Customer E: 212457 Name: Alawneh,Pamela Sue Class: D ID Status: None Address: 1453 DICKENSON LN Audit A: 6527012 DL Status: VAL Issue Date: 12/07/2012 CDL Status: None City/State: IOWA CITY,IA 522409163 Expiration Date: 12/03/2017 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1453 DICKENSON LN Restrictions: NONE Restriction None Date of Birth: 12/3/1967 Supplement: Mailing City/State: IOWA CITY,IA 522409163 Sex: F History Information Convictions Citation Date Conviction Date ACD Explanation County ]UR • 01/24/2011 [02/17/2011 593 'Speed ;Johnson IA Accidents-Accident involvement indicated does NOT mean the Individual was at fault or given a citation. Accident Date Case Number ]UR 08/22/2009 1522060 ;IA 01/24/2011 ,614926 IA 07/30/2013 '750711 iIA Name:Alawneh,Pamela Sue DL/ID:830YY1331 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: .4. `4 i 2/5/2014 t: IOWAçj �Ci .4t..... mwceof DrivDepartment of Services Name:Alawneh,Pamela Sue DL/ID:83DYY1331 Feb. 21. 20144 2: 20PM Div of Criminal Investigation No. 3536 P. 3/5 , <U, IU. L., 11J.,,, d� vlly UI ;In Lilly UI ,Lina Ul ly I1v. T,e) I. • . ` ', ., STATE OF 11017A r , . Iy . J 4 O ' CrrhamlF< sto>y Recoil Cheek I4pppp Form • (47::::::111:d..11:1,31:: ,` DCIA000untNulnbor .1iOoa-F (If applicable) To; ,Xowa Division of Criminal Investigation Y'rome City of Iowa City Support Operations Bureau,1"1Floor City Clolt's Office 213 X.7'h Street 410 T.Washington Street • Des Moines))(owls 80319 (5I5)725.6066 Iowa City, TA 52.240 (515)923-6090 'Cu • Phone: 319-356-5041 • Fax: 319-356-5497 I am requesting an Iowa.Criminal histol Record Cheok on, Laet Name(mandatory) _ First Name(manda(oly) Middle Name(rerAmnteeded) G I1►Yn - k<ceelhle lPaitn ,2 ( oi Su e Date offirth(mandatory) Gender(raaadetary) Social SeeurltyNumber(recommended) Ila r (PT ❑1Vdale caleittale ,393 '3-di cg - Waiverlnfonticatatt: Without a signed wafrerfrom the subject of the request,a complete criminal history slecord may not bo releasable;per Code a[Iowa,Chapter 692.2.Vor compiete criminal history record information,as allowed bylaw,always _abtain.a.wntvo,_slgnaturarrom-the subject of.the_request • Waiver Release:Thereby glvopermiss .• • .•obororequestingofficialtoconductanIowacriminalhilleryrecerdcheekwiththeDivisianofCrinlinal Investlgation(OCl). Any eriminnlIthlo Qua concerning n Illaiinnainids , f aDCI may barcicascdasallovcdbylaw. Waiver Sign' ire: ItAlst fr....—all i / t 14- - Iowa II Criminal Motor!R c4.4Cllaeok Result . (DC.I sse onlyi As of 'IA\r1l , asearch ofthe pro'vided?lamoand date ofbirth revealed: :=r`:. . II n:c.: 0 NolowaCriminalllistoxyRecordfoundwithDel ):=: ray �� - c- Iowa Criminal History Record 7 attached,DCI# L 5\ V r'_• N DCIinitials C e) 5cA . V( 6 \ 11\`AlcAvo1 a Received TimerFeb., 18,;;2014— 3:43PNrNo. 9797 Feb. 21. 2014; 2: 20PM,( Div of Criminal Investigation No. 3536 P. 4/5 ..v , s iv. toTU '4 J• , 1n „ vn vy vi . n viL3 vi ,vu v„v qv. 1J0/ Ii J STATE OF'IOWA ' meal Cr nntAall IEfSSoryRecoidCheek 1-t NCiittV • Request Perm44;9::j::':.:0;;;;;;,::fr-rf `ra , t` " a sofilic. DOIA000untNumberi 4t -r (Ifappiiorhb) To: Iowa Division of Criminal Investigation Ttrom, City of Iowa City Support Operations Bureau,1"Pio or City Clerk's Office 215E.ih street 410 E,Washington Street Des Against,Iowa 50319 (515)725-6066 • Iowa City, IA 52140 (515)72S-6050 rax Phone; 319-356-5041 Fax: 319-356-5497 • I amrequesting an ToWa Criminal History Record Check on: . Last Nano(mandatory) First Name(mandatory) Middle Name(recommended) Dato of Birth(mandmory) _ Gender(mandatory) Social Seeuri&Number(recommended) / Z , 3 , 107-, (]Male AIs enlale rt3 3 I -*-2, . 0S-73-- Wiiverinforimit n:Without a signed waiver from ildsubject 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 bylaw,always —_obfain.a waiv.er_signafureSrom.dwsubjeet.ofdhe request. . .. — Waiver Release:Ihctcby give pctmisston ,. .• flew reenesiingofTcfait, Hutt enIowa criminal fdstoryrecord check with the Mitten ofCiiminal invesitganon(DC7), Ay criminal history dal on�mingm.that ismointai,m i . - Tmoybc rckaycd as allowed by kw irl'ai'verSS'gnafu,r• , /��J I 1 A ol,•-&. 1-/l • Iowa!Criminal ..4y ori l[8cco m� ch 1[8��adit (Ochre only) As of 2\71\ lt-) , a search of the pro'videdname and date of birth revealed: �` L-- . ( , 1 �i ,rri C:• c:0 i ® No Iowa Criminal history Record found with DCI -2;-, Cr) Jk Iowa Criminal History Record attaolaed DCI# CA-1 iZq Sr.: '.F: 'r • r.�. N j : j� vI— _... DCI initials ___ rnt 05 1\,f 1 n— titch te, Feceived Time—Feb. 18. -2014— 3:43PM—No, 9797 r'nr net/n n In c„n. Feb. 21. 2014 2:20PM Div of Criminal Investigation No. 3536 P. 5/5 IOWA CRIMYNAL HISTORY DCI 00517224 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- OCY:00517224 2014/02/21 NAME: GILPIN,PAM GILPIN,PAMELA SUE DOB SEX RAC. HGT WGT EYE HAIR SKN POB 19671203 F W 506 130 BRO BIN FAR IA ADDITIONAL IDENTIFIERS CCH RECORD •*t 01 ARRESTED 19960211 AGENCY: IA0560000 LEE CO SO CHARGE NO- 02 IA STATUTE IA700-1 ASSAULT TRIO: 013605402 COURT DISPOSITION AGENCY: IA056015J LEE CO DIST COURT COUNT NO- 02 IA STATUTE IA708-2(2) ASSAULT NO INTENT OF INJURY CHARGE CLASS: MISDEMEANOR CONVICTION TRR#: 013605402 SENTENCE DISP EFF DAT JAIL 300 19960514 FINE $250 19960514 COURT COSTS 19960514 PROBATION lY 19960514 CREDIT W/TIME SERVED 19960514 NO CONTACT ORDER 19960514 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISTON 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 IDENTIFICATXON THIS RECORD IS BASED ON INFORMATXON FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION �VIy-\l\y[n�.�-� rti7