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Home My WebLink About14-002 Authorization Number /C4 - c:71 j _ i (Office Use Only) I 1001 gailir CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (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 f First iddle Last 1. Name ��() r',.' AH frt. / 2. Mailing Address Mr d A (11.- dvv �'� +7 ft zd y. 3. Telephone: Home 3 i 9 - -y I'J1 �, Other: 4. Prior experience in transportation of passengers: /K '-JJ 4-a. ; O ; I- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? ii(_, 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? )J Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? yt. Type of offense Where When y /' w.riJ 3.0/ I.( (1 6.. it ;--/--y 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N u _ 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) `,T; DEPARTMENT 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 nu fiber . 1-1.1 cXX c-,5 ) . 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) /d (mo/n�,, '' / ` Signature of Applicant i I _ , , Date / 1 "/ L/ STATE OF IOWA ) COUNTY OF JOHNSON ) • Subscribed and sworn tq before me by [111 u rvi pt_ H ) -&e . On this -Tat day of j�,v�‘,A;;,_-- � !/l1[ d .�°'"‘s WENDY S.MAYER Notary Public Id and for the State Iowa z 4.'..i. CVimiusaiv�r Nuli�be 729420 • '.q • M" ommis n Expires low ( ) LQ • 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). i /►: 7-ill f. Signatur f Police of 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. -241.e. z� - 1--1 -P-1 Signature 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 • cIork/taxidrivbadgeapp2010.doc 03/2013 Jan. 7. 2014 12: 58PM Div of Criminal Investigation No. 9966 P. 2/2 Dec. 31. 2013 1 :49PM City Clerk - City of Iowa City No. 4242 P, 2 `>ra STATE OF IOWA `r`!'IU �-i1": Criminal History Record Check ' • ° 'P.,loon ! `'° %, ReIiiiiquest Form "`` DCIAccountMather: LAM7__-\-- (ifeppiicablc) • To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,lit Floor City Cleric's Office 216E.7'h Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725-6090 Fax Phone; 319-356.5041 Pat. 319-3564497 • lain requesting an Iowa Criminal History_Record Check on; Last Name (mandlcry) First Name(maudatoiy) Middle Name(recommended) IA)M`b Mary /4 Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) / 0 -7 - 6, O Male .Female i/Vj/ -g o -c),?1,1) r Waiiverin/orntadon:Without a signed waiver from thesltblect of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.Por complete criminal history record informs as allowed by law,always obtain a waiver signature from the subject of the request }$valvarRelease;thereby give permission for she above requcssingoflicial to conduct an town criminal hislotyrceord oheckeith iho Division of Criminal tnvestlgallen(DC1), My criminal lib lory data conccming me that is maintained by she a lin . be released as allowed bylaw, Waiver Signature; //i ie �� _ _ s '-.),{� Iowa Criminal History Record Check Results pcf ase enly) As of \hl\c--\1 , a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI El Iowa Criminal History Record attached,DCI# • ` DCX initials lib Received TirheiDec. 31. 19014 1 :48PM No. 9571 • Page 1 of 1 Iowa Department of Transportation 4,ir Office of Driver Services (Toil Free)800-532-1121 PO Box 9204,Des Manes, IA 50306-9204 515-244-9124 RIIIP FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/4/2014 DL/ID #: 428XX5051 (IA) Customer#: 4718071 Name: Hulme, Mary Annis Class: D ID Status: None Address: 3013 STANFORD AVE Audit#: 5719978 DL Status: VAL Issue Date: 01/03/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 10/07/2015 CDL Cert None 522454929 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 3013 STANFORD AVE Restrictions: NONE Restriction None Date of Birth: 10/7/1960 Supplement: Mailing City/State: IOWA CITY, IA Sex: F 522454929 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 05/26/2012 06/21/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 02/07/2013 04/08/2013 592 Speed Johnson IA Name: Hulme, Mary Annis DL/ID: 428XX5051 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: ,�.� ..sk 1/4/2014 Mt( ? J; may: czeal.p,s7 aweezreviLA ',i Ike' I �d Office of Driver Services �`+‘ Iowa Department of Transportation Name: Hulme, Mary Annis DL/ID:428XX5051 1/4/2014