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Home My WebLink About19-079CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. R- 0 (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) Failure to complete the "required" information will result in denial of the application Last First Middle 1. Name (REQUIRED) iy�L llF� I�0.LE r �/.IsryE' 2. Address (REQUIRED) Cou-p--r t 7pwFlG}r2A Sa1�o 3. Contact Information (REQUIRED) Email: Ge I Phone: All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) L4 -a _`i - a O a 0 b. Taxicab Business Name (REQUIRED) \4JP-7 LLOW `r}8 Oh T-DWp- C',4 -V 5. Prior experience in transportation of passengers: Site a-1--5 o—� W c" 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? _Type of offense Where When ti O a: What happened to the charge? (Circle one) Convicted Dismissed eferred Suspended Plead Guilty ` Other,) 7. Have you been arrested / charged with any traffic offenses in the last five years? "0 Tvce of offense What happened to the charge? (Circle one) Where When 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? Q O Tvce of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name PTf yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 I 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 Iowa Department of Transportation a valid Driver's license number —SS�4 oo!l P issued on _Ll -0I - 16 expiring on 4-Z-.1o3D . 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 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date ( I - L4 - J -O ( 9 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by J� dVtu (� Qom/ on this day of Nov 2019 „ ASHLEY A JAY-PLATZ ' Notary Pu li n rthe My Commission Expires r--> I have reviewed this application, DCI report, and the State certified driving record of this applicantagd Fin a detecniined that there is no information which would indicate that the issuance would be detrimental to the safe(y,,health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license7 / � J ,9,0 Sign of P 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. - �1-14 Signature of City Clerk or designee Date Approved application Office Use Only DCI report State certified driving record Website update CAWTAXIDRNRADGEAPPL92018ameMeO. DOC 04/2018 I STATE OF IOWA Criminal History Record Check Request Form DCI Account Number; 9967-F (iftppllmble) , Mail or Fax completed forms to! Send results to: Iowa blviaion of Crlminal Inveselgation Support Operations Bureau. l" Floor 215 E. 7i6 Street Des Moines, Iowa 50319 (515) 725066 (515)725-6090 Fax I am reouestine an Iowa Criminal Rktolry Reoord Check on: Name 'Yellow Cab of Iowa Ci p Address . P.O. Hots 429 Iowa City, Iowa 5224 t n Phone (319)338-9777 •: Fax 319-359-4I42 _ :.li'� (+Iii" G� W'1 iL �, �tr�l�•�I;xl i'ri'i�i�L�. tY1 J.i I.I rI I.. 1. SN 1�E K1F-7-E ��?R:0�9I'�ast...... .'. �'c?�J.,....'•.._..=E\�N9F�,::�_s'.�=.�=i=3+.jeiA'. a�/»ri�� llaWQl`�1Ci' L4 l — ~ S ❑Male ®Female "4 to - - i 17 p a,. v n may: �, Piw S ��4 , i� M �s gC9s ",� y�'�r ,�,r�' d��lni�vr�uauou.r7491runs�s pJ 11w� 7•-�� r 41^ �'•tt�'Lt ?Y N'. do fir= � 'I�..�J is�y �,r� 4 . 1tl�at@ •_ , u ,,. MA tt [e4tsE roll" llr 'iC vR . .:n 1 � �T ` J -1 > " � WOK'+m L•t•• . . LUh'A %iZ LMIMIU L115 LUX S' ,RCl:U1'U l,UWVA;II L V!SUl S oN,pnp 11111 MM,... �p W6 OW 1`pP`i 'PtVL �'S.........EOfip C, 4, �, C 03 i As of 16 - —I , a search of the provided name and date of birtlFi it lad -mo - r, m �0 ,—. o No Iowa Criminal history Record found with DCT =w»H Ifo d x ',nom. ❑ JG Iowa Criminal history Record attached, DCT #`� r eripr' -0o Pert . .... DCI initialsf °rgrr .Sec •Ori DCI.77 (updated 06.26-2018) Received Time Ott, 21. 2019 2:04PM No. 5076 PW1oft 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: litto://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 P 00 .D G Y W I hereby certify that I served this notice of disciplinary action on the above listed employee on (date) Vt/2�I , at (time) l 1�M boars. Signed 8� I, the above named employee, hereby certify that I have received a copy of this disciplinary action. Signed- . 0 , , C 1G'V" 00T .gov SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot VFW" 8 k"Warl" SMIC" PO Bot 9001 I Des Moines. IASOOD&WU Prom: 515.244-9124 1 Fax: 51523&18$7 Certified Abstract of Driving Record Inquiry Date: 10/24/2019 DL/ID #: 554XX0048(IA) Customer #: 3971082 Name: Snyder, Janet Class: D ID Status: EXP Address: 9 DUNUGGAN CT Audit #: 1403405 DL Status: VAL Issue Date: 11/01/2016 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 04/25/2020 522402831 Endorsements: Chauffeur 3 Mailing Address: 9 DUNUGGAN CT Restrictions: Corrective Lenses Date of Birth: 04/25/1951 CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Mailing IOWA CITY, IA Sex: F City/State: 522402831 0 History Information o� _ Cn Accidents - Accident involvement indicated does NOT mean the indigi al lavas fault or given a citation.<rn -Q M Accident Date Case Number JUR 09/07/2016 939682 W IA 09/27/2019 1135636 IA 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: A • . Name: Snyder, Janet DL/ID: 554XX0048 10/24/2019 A�Vhf- Afylij- Driver & Identification Services Iowa Department of Transporation ry _o O `a r- w