The URL can be used to link to this page

Home My WebLink About18-0651 CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. ' g — c' (Office Use Only) APPLICATION FOR TAXICAB 1101 a REDICAB VEHICLE DRIVER (Police Department review musite made b a.m. to 3 p.m., Monday — Friday) Failure to complete the "reauirJ4fiA6jtan fMl00A in denial of the application 2. Address (REQUIRED) Z)� 3. Contact Information (REQUIRED) EmaiI:M0AIAfL I 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) f0WA CITY,'OWA First Middle aqoLrvtA IA e �A cL wke- (All written communicafion sent via email) Cell Phone: 5. Prior experience in transportation of passengers: �\ 1 0� 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? T Type of offense Where When 4-�\ uwo_ 12 13 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended G adsau' Other Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When spm IL �iJ ►g �7v�U What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? r\ Lc, 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) NAGE FUR NU I ARY) 04/2018 IN f APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORTANO—STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICA II fff�i LOEPf9CE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). 2018 JUL 13 AM 10: 44 CITY CL I herebycertrfy that I have issued to me by the Iowa Depa ment aW;1o}ta11< A`valid Driver's license number `ISL) AF Lo11 I issued on 2 I 1 2 C1 3expiring on Q -31 0S 1 LO I understand that f I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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 fr�Iont of a Notary Public) Signature of Applicant Date V ► ]III ++++++++rrrrr+rrrrr+r++++++++++arr+rrr++rr+r++++++r+r+rr++r++++++e+++++rr+rr++r++++++++++rr++r+rr++++++rrr+rr++++++++++r+rr+r++++++++rr++rrr++++ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by \!�� , on this 1-2— day of 3A1A Public in and fdr the State of Iowa I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration Dr er' iEense P3' D. .3 97 Sign a of Police Chief or designee 07-13-1A Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. �1 A ?�i3 fr of City Clerk or diesignee Date Office Use Only Approved application DCI report State certified driving record Website update Ge*frAXIDRNII DGEAPPL92018ammae WC 04/2018 Ju l.li. 2018 8:37AM Div of Criminal Investigation O/IVVILVIV 1 .4v.cavrl Cab (FAR)319338&Iiw6249 P. r,0031003 ;,. F i LED:.. STATE OF IOWA M ypp 4� Criminal HistoryZ�d��1 H'e. RequestPolrglY CLERK " !r To; lows Division of Crlmtua I "Investigation Support Oparations )3ureau, l'! 1?loor 215-9. 7" Street Dag Moines, Iowa 50319 (515) 725-6066 (515)725-6080 Bax on; \�-VQ' DCX Account Number:—99674 • (If appllceblc) Froml Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 (;19) 338-9777 Phone; Fax.- '(319) 339-7302 1 Bate of litrtll (m.npetoM-rC:ehder rvarver information Without a signed waiver from the subject, of the request, a complgte crlmival history record may not be releasable, per Code of Iowa. Chapter 692.2. For wmblete criminal history•reeor(1 informgtiop, as allowed by law, always o-btain a waiver signature from the subleet.of rho r,.,i.,..r Waiver REleaSe; I hucbyglVe p.m Won for the above roqucsting official Toeonducl N Iowa criminal 50ty record check with the Division ofCrimtnal Invesll[vion (DCO. Anycdmihal hlatoty data concern `mel/IN ' ma/I I eed�by the bel may be rel Isw. Wafoer shmature: /1( (DCI ale only) As of � � ' � � a'searc$of the provided name and date of birth revealed: - tt No Iowa Climinel ;-list+ Record found with DCI Iowa Criminal Mstory Record attanhed,=19 DCI iriitials� DCI -77 (08125/10) Received Time Jul. 5. 2018 1:35PN}:.No, 1615 os L � ::uwaaa- WQ..ULIIY IN&UUu 1'e7 " Male Female 52,3— q (� 9 .q rvarver information Without a signed waiver from the subject, of the request, a complgte crlmival history record may not be releasable, per Code of Iowa. Chapter 692.2. For wmblete criminal history•reeor(1 informgtiop, as allowed by law, always o-btain a waiver signature from the subleet.of rho r,.,i.,..r Waiver REleaSe; I hucbyglVe p.m Won for the above roqucsting official Toeonducl N Iowa criminal 50ty record check with the Division ofCrimtnal Invesll[vion (DCO. Anycdmihal hlatoty data concern `mel/IN ' ma/I I eed�by the bel may be rel Isw. Wafoer shmature: /1( (DCI ale only) As of � � ' � � a'searc$of the provided name and date of birth revealed: - tt No Iowa Climinel ;-list+ Record found with DCI Iowa Criminal Mstory Record attanhed,=19 DCI iriitials� DCI -77 (08125/10) Received Time Jul. 5. 2018 1:35PN}:.No, 1615 0401 QT FILED SMARTER I SIMPLER I CUSTOMER DRIVEN Driver S merttrteanion services POW n92M Phone 8-1837 t .a Certified Abstract of Driving Record Inquiry Date: 7/3/2018 DL/ID #: 450AF6771(IA) Customer #: 5722079 Name: White, Mahogany Class: C ID Status: None Miesha Address: 2411 BARTELT RD Audit #: 2557057 DL Status: VAL APT 2A Issue Date: 02/16/2018 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 03/05/2023 CDL Cert Status: None 522462706 Endorsements: NONE CDL Med Status: None Mailing Address: 2411 BARTELT RD Restrictions: Corrective Lenses Restriction None APT 2A Supplement: Date of Birth: 03/05/1994 Mailing IOWA CITY, IA Sex: F City/State: 522462706 History Information Convictions Citation Date Conviction Date ACD Explanation lCounty ]UR 11/15/2014 of 15 2015 S15 Seed I IL Name: White, Mahogany Miesha DL/ID: 450AF6771 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: 7/3/2018 Driver & Identification Services Iowa Department of Transporation Name: White, Mahogany Miesha DL/ID: 450AF6771 FILED 2018 JUL 13 All ro; 4 s to CITCITY IOWA