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HomeMy WebLinkAbout18-105IDENTIFICATION NO. l a -, I o 95- 1 r (Office Use Only) ._ APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City. Iowa 5 22 40-1 826 (319) 356-5040 (319) 356-5497 FAX First Middle Last C 1. Name (REQUIRED) _ )N\,I-bI—(' �� (�onlE� 2. Address (REQUIRED) �Jy N V CaC�I! ,i TtrwP CjTy i �Pe S� J-`( U 3. Contact Information (REQUIRED) Email: jcyhe�SnydfyaUll@ Kur✓1aid•"tell Phone: 3li-Strq-38B(. 'All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) NE 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 010 _Type of offense Where When N L� What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? yV-S Type of offense i, "Aev 35 Where When Ac-c�6 iNo gt,ANAE> 93478a- _-1�0NE15t0 Co,-LuTd W7 1001t, What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Guil ' Other"� II 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? IV O Type of offense Where When q0- 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERJJFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW ... You must apply for an individual Department of Criminal Investigation Report (form available up" requesfj. v Vis: n hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number __TP1 55�{ V oO�: issued on filo f ao b expiring on `F/.a-0`:Lo-.'.' I understand that if falsely answer any questions in this application, that this application may be denied. I agree that in making`tf)s 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 of a Notary Public) Signature of ApplicanV�_ _ % �iµ a(� f Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Tu n y 5A �A cje.�_ on this 5 day of kJNA__kae.! z:ui8 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 date of river's ieense —y7 Sig a of Police Chief or designee d`( - zd - Ze Z -e ��- OJ -4 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. Sign ure of City ClerV or designee Office Use Only Approved application DCI report State certified driving record Website update i /- S -i W, Date CIeM/TNaDRIVMDGEAPPL92018amende .DOC 04/2018 UCL LY.ZUIJ I U : U ) A M Uiv of Criminal Investigation 10/2612018 09:41 Yellow Cab �.I.. STATE OF IOWA Criminal History.Recolyd Check. 3, , ' Request l orm No. 0 13 1 P. 1/2 fA )319 339 2708 P.0021002 To: Iowa Division of Criminal Investigation Support Operations Bureau, 1" Floor 21511. 7e° Street Iles Moines, Iowa $0319 (515)725-6066.„ (515) 725-6080 Fax I am requesting an Iowa Criminal History Record Chcek nn - DCI Aecoupt Number. (if aDPliuble) From: 'Yellow Cab of Iowa Cl P.O. Box 428 Iowa City, IA,. 52244 (319) 338-9777 Phone: Irex. (319) 339-7302 Laet Name mandatory) Irirat Namti m Middle Name tnoemmendea SNYISFt, Date of Birth (minaawry> Gender mandatory) Soolel Securi Nurabel (tocommmaea> Li 'p-5- L 95 ©Pyiale ®Female 3.a7 -' r to ` 31, 1 Waiver I'nformatlon: Without a signed waiver from the subject of the rogNest, a oompieta criminal history record spay not be releasable, per Code of Iowa, Chapter 692.2, For comnlete history criminal record laformstton, as allowed bylaw, always obtain a waiver signature from the auD ectpf the reguest Waiver Release, i hereby gtva Parmissiao fpr theebove regaauing oRioIIl to conduct an low& eiiminal history record check wlrh the Divistee of Criminal Invesdgotien (DCI). My atminal history data wnu la j me that is maintainedby the DM may be released d,llowati by law. Waiver Signature: As of M^zi� 1 klr , a S=Cli. of the provided name and date of birth No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History P',poord attaohed,'DCI # DCI i6ials DCI -77 (08125/10). D ... :...A T:-, 0 U into n•ob A1A tl„ n69A VCT-Zy-Zvio Iv:WM uiv oT criminal Investigation No.0131 P. 2/2 DISCLAIMER This response can only include public criminal history data, Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowasexoffender.com/. However, even though some Information Is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Q v� G C- + �... ;"' uT 1410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadotgov Pmar 6 IduitltlieaiBon axvlon PO %X 9201 I Des Wrim IA 5030&WU phone 515-24"124IFaX SIS2WISST Inquiry Date: Name: Address: City/State: Certified Abstract of Driving Record 10/26/2018 DL/ID #: 554XX0048(IA) Customer #: Snyder, Janet Class: D ID Status: 9 DUNUGGAN CT Audit #: 1403405 DL Status: Issue Date: 11/01/2016 CDL Status: IOWA CITY, IA Expiration Date: 04/25/2020 522402831 Endorsements: Chauffeur 3 Mailing Address: 9 DUNUGGAN Ci Restrictions: Mailing City/State: Convictions Date of Birth: IOWA CITU, IA Sex: 522402831 Corrective Lenses 04/25/1951 F History Information 3971082 EXP VAL None CDL Cert Status: None CDL Med Status: Nonce 0 Restriction „None Supplement: C:y �n Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Snyder, Janet DL/ID: 554XX0048 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: 10/26/2018 Iowa Government onlina State of Iowa - Department of Transporta8on Electf•otiir Pr vnie/rt Solutions Exit Confirmation Please keep a record of your Confirmation Number, or print this page for your records. Confirmation Number IOWDOT006334035 Payment Details Description Department of Transportation http://www.iowadot.gov/ Payment Amount $7.00 Payment Date 10/26/2018 Status PROCESSED Payment Method Payer Name Janet Snyder Card Number *4155 Card Type Visa Approval Code 693059 Confirmation Email yellowcabic@gmail.com Billing Address Address 1 P.O. Box 428 City/Town Iowa City State/Province/Region IA Zip/Postal Code 52244 Country USA https://epayment.epymtservice.com/main/paymentconfirmationtpaymentConflrmafion?_id= 23-2-C78A24E9386CB06BF8E7E7112B47C5EA III