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Home My WebLink About19-046.o C(� F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) 3. Contact Information (RE IDENTIFICATION NO. -A c! -�t�l� ED ^(OffigpUse Only) T� 2 APPLICATION FOR TAXICAB / MOTORIZED PEDIC /ELE 1541 /ER (Police Department review must be made between 8 a.m. tonday Friday) Last First Middle n n 4a. Driver's License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When %A 4-L, 3 - 10 - z -1-:o What happened to the charge? (Circle one) Convicted Dismissed DeferreSus end Plead Guilty Other Zoo) detervecl 7. Have you been arrested / charged with any traffic offenses in the last five years? ln0 2 G6ll n � S Type of offense Where When 7r iT What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? V10 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) SIGNATURE 04/2018 / Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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). I hereby certify_that I have issued to me by the IowaDeartm&et of Transportati n a valid 1`�rver's license number issued o expiring on I understand that if I falsely ahswer any questions in this application, that this a ion may be denied. I gre #hatin ing thin application, 1 consent to allow agents or mployee of the City of Iowa City, Iowa, in their discretion, to examine arm and fjecords and documents relating tc this p kation, ajoffTTofther agree that, if authorization to be a taxicab cKWS^is granted tto comply at all times with all of the provisi n 5, ha er 2, of the City Code. (Needs to be signed in fr�iof a Notar�ip*blic) r- r' Signature of Applicant Date cn STATE OF IOWA ) COUNTY OF JOHNSON ) Subscrib.11 and sworn to before me by nc171 A� i>en - 141 Gk\ on this 1 ` + day of �0 5 -4 WdrqPub is in -a6W,6e State of Iowa Z6.3 A9 iagwnN uoisslwwo0 z 3N10 31\1I r ° 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 Dr'v license i� SigrlatGre of Police Chief or designee v' /0-Z6-?,azs 6-/7_/g 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. J� ��L (o —1%-19 Signature of City Clerkor designee Date Office Use Only Approved application DCI report State certified driving record Website update Derv✓r IDRivanoceAPP0201Ua de .DDC 04/2018 t=roJun, 13. 2019 3;31PMa,o,..DCI IOWA a�• ase�.as l , 06/06/2019 13:31No, 5534, '..1/3/002 STATE OF IOWA Criminal History Recpri d Check; Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7'a Street Des Moinesi Iowa 50319 (515) 725-6066 (515) 725-6080 Fox Iam renuearina an Town Crimin.l'4rioan... 1)....A f'4. —1, .1J DC[AccountNumber: ,'1'I 0 apple 1 `� J From: Cit oiIowaCilr .:.in r'f1 sty Ra -1 Vs Office - m " 410 E. Washington t CJD Iowa City, IA Will Phone: 319-356.5041 Fax: 319-356.5497 Last Name (nuadatory) First Name (mandatory) 1VIidd[e Name (r onwataea ()3`1% '' As of a search of the provided n �•p ' of pealed e a VTArAL-4cts-4k c.YS Re&ItjX pl�rvN Date of Birth (mandato Gender mand.lo) Social SecleriNumber moron .") 10 I Z(Q I\GI l S ❑Male �7s —n 14- � CM Female Waiver Information: Without a signed waiver from the subject A the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For core I e criminal history record information, as allowed by law, always obtain a waiver sillhature, from the sub ect of the request �'010"'11uaUnol4ab itt, Waiver Release: I hereby give permission Por abo a®ling a0ii to co �iDQilplif o ord check with aro Division of Criminal Invuligstion(DO), My criminal history data wa ringlri lamainfai pl+ytl� w h111, ase law. •'; Waiver Signature: T a i ' C V p 1\4JaA ' ••' a CI use only) j ()3`1% '' As of a search of the provided n �•p ' of pealed e a �, o rbinumnnnnlw` _ to Z ❑ No Iowa Criminal History Record found with DCI o z CM Q ( LU U Iowa Criminal History Record attached, DCT # %�� w > Q DCI initials_ Ut..l-/ / l UbtLD11 U) Received Time Jun. 5. 2019 1:20PM No.4161 Jun, 13. 2019 3:37PM DCI IOWA IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00639845 NAME: HICKS,REGINA ANN THALKEN,RBGINA ANN THALKEN-HICKS,REGINA ANN DOB SEX RAC HGT WGT EYE 19651026 F W 507 160 BRO DCI 00639848 PAGE 1 OF 2 DATE PRINTED - 2019/06/13 HAIR SKN POB BRO FAR CA No.5534 P. 2/3 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y N SC L CHK TAT ABDOM p `D TAT L WRS D TAT R HIP TAT R SHLD --1 n CCH RECORD Q 01 ARRESTED/TAKEN INTO CUSTODY 20010310 C?70 AGENCY: IA0520200 IOWA CITY PD y CHARGE NO- 01 IA STATUTE IA124-401 CJI POSSESSION CONTROLLED SUBSTANCE/SCHEDULE I TRK#: 100180901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 SRCROSS209 CHARGE CLASS: NON CONVICTION TRK#: 100180901 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010817 PROBATION SY 20010817 COMMUNITY SERVICE 20H 20010817 DISCHARGED FROM 20021022 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20090905 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE TRK#: IA0070BOl COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / 18T OFFENSE COURT CASE ID: 06521 OWCROSS327 CHARGE CLASS. MISDEMEANOR CONVICTION TRK#: IA0070BOI DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT Jun.13.2019 3:38PM DCI IOWA No.5534 P. 3/3 DCI 00639649 PAGE 2 OF 2 JAIL 2D 20091202 FINE $1250 20091202 An arrest without disposition is not an indication of guilt. This record o maintained by the Iowa Division Of Criminal Investigation, Bureau Of _ ,a Identification is a public record but can only he released to non-law CD 1-- enforcement agencies by the DCI. This response can only include public criminal history data. Under Iowa 1an n J most juvenile records are confidential. Confidential juvenile court records m v rn if any, cannot be included in this response. A signed release authorizatior677 �.✓ is not sufficient to obtain this information from the Division of Criminal •,.•-„� •• Investigation. In order to request the release of confidential juvenile cm records, if any, an application must be filed pursuant to Iowa Code section 232.147(19). 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(16). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION C� ".�WINADOT R-1-W SMARTER I SIMPLER II (US TOME R OR; YE}I W41Mf•IOWB(jQ�.gOV Drivar & Iderdirte]tion Servicts PO BO 5X341 Des fftnes- IA 6XX6-<j204 Phcne 515-211-91241Fax 515-7,V-18.97 Certified Abstract of Driving Record o Inquiry Date: 6/3/2019 DL/ID #: 431XX9040 (IA) Name: Thalken-Hicks, Class: D CDL Cert Statin ;Plone�.O Regina Ann CDL Med Status: ' None IA Address: 1527 ROCHESTER Audit #: 2864263 Johnson AVE Issue Date: 06/05/2018 City/State: IOWA CITY, IA Expiration Date: 10/26/2025 522453135 Endorsements: Chauffeur 3 Mailing Address: 1527 ROCHESTER Restrictions: Corrective Lenses AVE Date of Birth: 10/26/1965 Mailing IOWA CITY, IA Sex: F City/State: 522453135 History Information Convictions .o Customer #:fin 626 Conviction Date ID Status: �e Explanation DL Status: ::� C-VAL JUR CDL Status: 12/02/2009 CDL Cert Statin ;Plone�.O �••i CDL Med Status: ' None IA Restriction None 11/20/2015 Supplement: Seed Citation Date Conviction Date ACD Explanation County JUR 09/08/2009 12/02/2009 A20 Operating While Intoxicated Johnson IA 10/2812015 11/20/2015 S92 Seed Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR CountvI 109/08/2009 IA98 OWI Test Failure 11A Johnson Sanctions Type Effective End ACD Explanation Occurrence JUR 3UR Revoked 09/19/2009 03/17/2010 IA98 I OWI Test Failure IA IA Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 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: ,p4AENT Qy Name: Thalken-Hicks, Regina Ann DL/ID: 431XX9040 6/3/2019 �1#C•r Driver & Identification Services Iowa Department of Transporation N O T C7 C 1 j ---4 n '� X. M O % �D v cn