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HomeMy WebLinkAbout19-057IDENTIFICATION NO. - r 1 _ 1 (Office UseOnly) 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 52240-1826 (319) 356-5040 Last First Middle (319) 356-5497 FAX I�/� f 1. Name (REQUIRED) _Vlc` �'* � \ �� y 2. Address (REQUIRED) e)� J) W cooe \ -/ 1 f 3. Contact Information (REQUIRED) Email: d l�0.Q�� V\O(•�c 1C+t�U+tq,I-elltell Phone: -9 012 W 34(Q (All �w7r1 en communication se via email) 4a. Driver's License expiration date (REQUIRED) L - e (- 2 Z b. Taxicab Business Name (REQUIRED) ,�(I oco On ID 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?r� Type of offense Where W hen - 0 v r What happened to the charge? (Circle one) 1 Convicted Dismissed Deferred Suspended Plead Guilty Other r l 7. Have you been arrested/ charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred When Suspended Plead Guilty Other -PI y 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 nCity taxi driver using a different name? If yes, please provide the name(s) VN O FUR KLQUIRED 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). hereby certify that I have issued to me by the Iowa eeartment of Transportation a valid Driver's license number 2 a(`✓ l a issued on ' LC: -t 9 expiring on -7 - ( (_ 22 . I understand that if 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 y/Chapter,Z, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date _T_ ( 9 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of 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's license 7 Signa re P Fe Chief or designee 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. CleiWrAXIMNIIADGEAPPL92018..e ded.GOC 04/2018 Signa ure of City Clerk q esignee Date Office Use Only E2 Approved application ZEC-) c " DCI report > G, State certified driving record�— Website update= �c� —4 �z o r cn CleiWrAXIMNIIADGEAPPL92018..e ded.GOC 04/2018 Aug. 1.2019 3:28PM DCI IOWA 0912612o1B 14:15 Y0110W Cab 2 nm r 2241 P �uu21 M0319338 002 i STATE_ OF IOWA Criminal History Record Check. Request Form a N I CI AcoouX Number: 996 To:Iowa Division orCriadnai Invessjgatfon From; Yellow Cab off6*a L;�v ' Support Operations Bureau, in FloorP.C+. Box 4Z8Y t 215 T. 7'" Street --I Det Moines, Iowa 90319 (515) 723-6066 Iowa City, IA. 5 —: t4;o x (515) 725-6090 Fax (319) 338 9777CD phone• cn . Fax: (319) 339-7302 I am req11e4tine an Iowa Criminal Last Name m(aww.,b FYt st Name (ms aatmy) ' middle Naruo (rwommand.d) Date of Birth (mmdamry) _Gender (manearory) ;Social• yeculri rocommmaea ©� �� —• � ;..( �{' � �Ma1e C I' •r6ele �PIumb 3 S — 15 `t ` � �P Waiver Informafton: Without s signed jyaiver from the subs ect of the request a complgte criminal history record [pay not be roleasable, per Code oflowa, Chapter 692.2. For complete criminal history record informelion, as allowed by law, always obtain a waiverst nature'from the 'sub ect,4f the r uest: waiver.ReleaSe: T hcmbygtve Permbsion far rhe ebovc rcquaning officlal COX= an Iowa otiminal history mooN aheokwith dte Division of Criminal Invea[iga[lon (DC!). Any criminal M1inory doh eonccming me[hat' lure ped [ DQ ma ro)eaaed as elloweil by IoW. wPatvsrsl nature:• .to Criminal Histo Record Check ResuPts , - a of "`m.,' , \o`a tip .... .. OC,,T use only) As of a searcta bf the provided nerne and data of b a5aaled: IgWAlDPS Iowa cr Psn�ia No Iowa Criminal IIi'stoYy Record found with DCI S :history esul JbI (6,2019_ l' %a ' •...P V.pp Q}��jt11NAl. INVE'.- Iowa Criminal History' I`ecord attached,"DCI # °,,,, z>r'aIt'lon ,,,,• DCI iilitiels _ DCI -77 (08/25110) Received Time JU1.26, 2019 2:08PM No. 1781 Aug. 1.2019 3:28PM DCI IOWA No.2741 P. 2/2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confldentlal. Confldentlal 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 confldentlal 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). N a_ O T--f Gn �r J �•-�- I =<m x. F cn 410WADOT4 SMARTER I SIMPLE 1NWWIQWcit�pt gOV R I CUSTOMER DRIVEN Driver & 10xrtlDeation Smile" PO Bot 9M I Das IAoinBL IA 503069201 Phone 515-24491241 Fax. 51521837 Certified Abstract of Driving Record Inquiry Date: 7/26/2019 DL/ID #: 250CC9193(IA) Customer #: 4649263 Name: Horton, Angel Joy Class: D ID Status: None Address: 2437. PETSEL PL APT Audit #: 3935354 DL Status: VAL 3 Issue Date: 06/20/2019 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 07/04/2022 CDL Cert Status: None 522463613 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 2437 PETSEL PL APT Restrictions: NONE Restriction None 3 Supplement: Date of Birth: 07/04/1989 Mailing IOWA CITY, IA Sex: F City/State: 522463613 History Information CLEAR DRIVING RECORD Name: Horton, Angel Joy DL/ID: 25OCC9193 N C Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Dep�ment o1ranspartAtion, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that i%C71 tnli and aaatnate copy of an official record currently in the custody of said Office, and that I have been authorized byr rhe^r9ireciff oft Iowa Department of Transportation to so certify. r'T8 In witness whereof, I have caused my signature and the seal of the Department to be set upon this doclMl7en�t, at�Ankeny, Iowa this date: .5:' -gr Cr Name: Horton, Angel Joy DL/ID: 25OCC9193 7/26/2019 Driver & Identification Services Iowa Department of Transporation