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Home My WebLink About19-054` IDENTIFICATION NO. J97— r 1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER Police De artment review must be made between 8 a.m. to 3 CITY OF IOWA CITY ( P p.m., Monday - Friday) 410 East Washington street Failure to complete the "required" information will result in denial of the application Iowa City, Iowa 52240-1826 (3 19) 356-5040 Last First Middle (3 19) 356-5497 FAX \ .1,^ 1. Name (REQUIRED) V�1 Y2`\ V`-, \`�� \ l.\Y� 1,� 1U� CON, 1' `o e5� G 2. Address (REQUIRED) Z"��Z L01Q St ,-C, \J \ki � C O 1 y , I )WQ SEAD 3. Contact Information (REQUIRED) Email: mO WAj Itc j jq- QC U410a 0UhMeli Phone: A -15 � (All written communication se /ai t via email) 4a. Driver's License expiration date (REQUIREY) J -2`-U2— J b. Taxicab Business Name (REQUIRED) `1 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? Type of offense Where When p, - What What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspend(dPlead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? D Tvpe of offense khere When 1� 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? 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) 0 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 h re ce lthat_ I have issued to me by the Iowa Department of Transportati n a valid Drivers license number ', 1�0 7 �) I issued on )01 f�expiring on 3 p . 1 understand that f I falsely answer any questions in this application, that this ap icati n may be denied. I abreef 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 of a Notary Public) Signature of Applicant Date 2 I r.,ww.wr.ww.,..ww.wwwr.w,..w.w..ww.www,www,w.,w...,,..,,.r.rrrr..rrr..rr.rr,r.rrrr..ww.www.www.wwwww,.,w.,rrrrww.www....rrrrrrr..wwwwwww».rr.r STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M a.L, tee. t Va i -n on this ;Lj day of .�LA. 2019 < 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 Driver'§,Ymnsp__�__ 0)3 "U Chief or designee o7zr -/f 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. -7 -06 Ig Signatuq of ity Clerk or d signee / ' Date wwwwwwrwrr+wwwwwwwwwwwwrwrw+wwxwwww+wwwww+www:wwrwwwe+(+wJwwwar+rrrwrwrrrrrrrrrrrrrrrrrwrwrrrrrrwrrwwrrwwwwwwrr+rrrrwwwewrwwwrwwwrwrrrrrewwwwsw+r Office Use Only Approved application DCI report State certified driving record Website update CTed, IDRN DGP PL92018emended.DOC 04/2018 FroJul. 19.2UI9v 9;9HRMctorkUU1 IUWR alM 36666®7 07/12/2018 13c2No, U777387r- 1/4:/002 STATE!'r u r2 IOWA Y l� � Criminal 0 Request Form' To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 71' Street Den Moines, Iowa 50319 (915) 735-6066 (515) 725-6080 Fox I am reeuestintr an Tnwa r'riminal Ta,'.t. v 12nrnrA elheAl ..- DCT Account Number: q0049--/ (Jhppueabic) From: City orlowa City City Clerk's Office 410 E. Washington Street Iowa Cify, 1A 52740 Phone; 319-356.50d1 Far. 319356-5497 Last Name(mmdetory) First Name mammmy) Middle Name(mmmmended WINfiZ �CL�.O Olh ► -es 0. Date of Birth (mandatm((y)) Gender mandatory) Social SecurityNumber (mcammuldra) � �j II '' D� —1 q `7 ❑Male Female WaiVer Ynf0rnfflfi0nl Without a signed waiver from the subject of the roguest, n complete criminal history record may not he releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed by law, always obtain a waiver signature from the subject of the request Waiver RCI60Se;1 hereby give permission floc the above requea ft official io conduct an Iowa criminal histoyrecurd check with fbaDivisien ofCrimind lovestigatian (DCO. Any criminal history date ce in t r lamaintaihod by the D me be mimed as allowed bylaw, WefverSignafore: Iowa Criminal History Record Check Results (DCtmeonly) F.. As of ::�]' (!n-/�." I a search of the provided name and date of'o munaunntn,,,, a �Qapedf ., No Iowa Criminal History Record found with DCI est z Iowa criminal c5—J tr 0 history results a ❑ Iowa Criminal History Record attached, DCT # 1-; 0 ' i� c DCl initials ,Ne4 •• 0 ��s` o ///r DCI -77 (08/25/10) n00° Received Time Jul, 12. 2019 1:13PM No. 9499 ARTS FA Page 1 of 2 C,J10WA00T wwwkwadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Drier & identification Servim PO BOX 9704) Des MlosIM IA 5IX10fr9204 Pilate: 515244.9124 1 Faic 515-239.1837 Inquiry Date: Customer Name: 7/12/2019 5722079 Certified Abstract of Driving Record DL/ID #: 450AF6771 (IA) CDL Permit Class: None Class: C White, Mahogany Miesha Audit*: 3295599 Address: 2332 Lakeside Dr Issue Date: 10/16/2018 Expiration 03/05/2023 Endorsements: Date: CDL Permit City/State: Iowa City, IA 522406757 Endorsements: NONE Mailing 2332 Lakeside Dr Restrictions: Corrective Lenses Address: Restriction None Mailing Iowa City, IA 522406757 Supplement: ELG City/State: CDL Cert Status: Date of 3/5/1994 Birth: Sex: F History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation IUR County 11/15/2014 01/15/2015 515 Speed JIL Name: White, Mahogany Miesha DL/ID: 450AF6771 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: 7/12/2019 Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 7/12/2019 A II -\_ 31 Name: White, Mahogany Miesha DL/ID: 450AF6771 (IA) Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistoryleertifieddrivingrecord.aspx 7/12/2019