HomeMy WebLinkAbout19-100l
C1� F IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(319) 3S6-5040
(319) 356-5497 FAX
1. Name (REQUIRED) _
2. Address (REQUIRED)
3. Contact Information (R
IDENTIFICATION NO. I Ci - 1 b0
(Office Use Only)
APPLICATION FOR TAXICAB I 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
4a. Driver's License expiration date (REQ[
b. Taxicab Business Name (REQUIRED)
5. Prior
12
Of
• i.
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?
What happened to the charge? (Circle one) � - _ N i -f
r-.
Convicted is ,e Deferred Suspended Plead Guilty Oth��'
7. Have you been arrested / charged wiff any traffic offenses in the last five years? ,
What happened to the charge? (Circle one)
—
Convicted s sse )Deferred Suspended Plead Guilty Other
8. Has your driver's license or chauffeur's [(cerise been suspended or revoked in the last five years?
9. Have you ver applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
FAUE FUK Kt:UUIKED 51UNAI UKE AND
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�e ,that I have issued to me by the Iowa DepartTent of Transportation a valid Driver's license number
W i issued on f k T /D xpiring on 1-o? � . 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 Tide 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
STATE OF IOWA )
COUNTY OF JOHNSON )
I have reviewed this application, DCI report, and the State certified driving record of this applicahidnd hsvb detgunined that
there is no information which would indicate that the issuance would be detrimental to the safety7,bealth b? welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code). o r I
N
Expirationbe ' 4icense �� Z? Z�'z'� o
rs
�
/�of
97
Sign'Oee 6f Police 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.
Of
Office Use Only
Approved application
DCI report
State certified driving record
Website update
/a -moo -I 4
Date
G1e*N"1DRIVBADGEAPPL9201 "nd DOC 04/2018
17JDec.19.2019 11:09AMCab DCI IOWA
o7Q3183387k 2586 P. 11031003
STATE OF IOWA
Criminal History Record Check
Request Form
` DCI Account Number: 9967-F
• (ieappliable)
Mail or Fax completed 4=e Coto: 92nd results to:
low*olyw en 1Vame Yalldvwgob ni•IowaCU*
Support Operations Bureau, l" Floor
215 E. 76 Street Address P.O. Box 428
Des.Moines, Iowa 50319
(515)725-6D66 Iowa City, Iowa $2244
(515) 4254080 Fat
Phone (319)33&9777
Fax 319-3594142
ivna...,AusaUua.,n„w.svrVXLUUUa-U%,1LV%;A1% sus w4 only)
As of 1 R ( a search of the provided name and reueaf d ,,
4 �1`ATE r .)FS
No Iowa Criminal History Record found with DC1 ; ;nl I
4i) r
❑ Iowa Criminal History Record attached, DCT # •'i
DCT initials iW �( ti
DCT -77 (updated 06-26-2018)
Page 1 oft
Received Time Dec. 16, 2019 2:33PM No, 2146
C410WADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN www.lowad0}ov
Driver & 1da1pMRadon Ssrvic"
Pt1Box 92tM I Des kidney. IA 500069201
Phone : $15,244-9124 1 Fax 515-239.1W
Certified Abstract of Driving Record
Inquiry Date: 12/16/2019 DL/ID #: 769YY1455(IA) Customer #: 1075822
Name: Hutchison, Kimberly Class: C ID Status: None
Ann
Address: 1512 1ST AVEleT Audit #: 3369183 DL Status: VAL
303N
Issue Date: 11/07/2018 CDL Status: None
City/State: CORALVILLE, IA Expiration Date: 01/20/2024 CDL Cert Status: None
522414001
Endorsements: NONE CDL Med Status: None
Mailing Address: 1512 1ST AVEcCT Restrictions: NONE Restriction None
303N Supplement:
Date of Birth: 01/20/1968
Mailing CORALVILLE, IA Sex: F
City/State: 522414001
History Information
Accidents - Accident involvement indicated does NOT mean the individual Was at
fault or given a citation. c
Accident Date
Case Number
TUR
12 24 2017
1024210
IA �
Name: Hutchison, Kimberly Ann DL/ID: 769YY1455
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:
Name: Hutchison, Kimberly Ann DL/ID: 769YY1455
12/16/2019
Driver & Identification Services
Iowa Department of Transporation
ti
C e
N
R
O
r✓7