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Home My WebLink About20-011f CITY OF 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 (RI IDENTIFICATION NO. 2V - d (Office Use Only) 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 4a. Driver's License expiration date (REQU b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State el"Jvhere?' _Type of offense Where dVhe . .n CJI What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? �—r C,—Y��S Type of offense Wherer, /n�.. When Ziy M q w6j ug / /- / - What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Otherlatk 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? y V Tvoe of offense Where When 9. Have�ou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 04/2018 5 1p 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 cert that 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number 4/S5 7 issued on /-�5,texpiring on ,2- 7 y Q. 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 provision of Title 5, Chapte^2, of theCity Code. (Needs to be signed in front of a Notary Public) WwrX ,Date STATE OF IOWA COUNTY OF JOHNSON ) "' Subscribed and sworn to before z , me by �% w rr� N.A-Qf r )LI&D on_this"' _ day c �4� 2.b 2r:. .'1 n n Com\ eN\- -- co 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 Dri li / LC' oZ-G3-?OLo Signa of 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 City Clerk Approved application DCI report State certified driving record Website update cx,1rAX1DarvenocEAPPL9M1MMraod ooc Office Use Only Date 04/2018 Jan. 31. 2020 1:38PM DCI IOWA 011clrcvcv id:ao ronvw Cab No.8179 P, 1/2 (FAX)31933021vo r.VV21002 STATE OF IOWA Criminal History Record Check Request Form " DCT Account Number: 9967-P Qfpppdeable) Mail or Fax completed forms to: Send results to: Iowa Division of Criminal Investigation Support Operations Bureau, 111 Floor 215 IC. 7'y Street Des Moines, Iowa 50319 (515) 725.4066 (515) 725-6000 Fax I am r2guestine an Iowa Criminal Aistory Record Check on: Name Volldw.4ab of Iowa city Address h.0. Box 428 Iowa Cityi Iowa 52244 Phone 1 338,9777 Fax 319 999 4141 ti •'11 '. sy. "�'h',JAr�":'li!�r:� (DCtuoc ouly�7j '.a: ol."'f'1.:ilo In' -"i I {JL'::92C 1i 11'Q. Ifff."UMN � NO e � Z t • it r4 �{'�i ! flk li\�S�Y.�� 1 1 r Ir � ♦ Y i r 16.Mi^�y�o �1�� }�4 IOr t Je { 1 ,fit -1 1 r r r. { �7. O to > is 3�+t�df �t"r9r >n'ir'M6-F 'flr�".��i{, r�i9��' 4'!1 r JGt ♦ rosy i rI'.. .m As of a search of the providod nano and data of both revealed: No Iowa Cfiminal History Record found with ACI ❑ Iowa Criminal History Rocord attaa ad, DCI # DCI initials' DCI -77 (updated 06-26-2018) Received Time Jan. 27. 2020 2:37PM No. Ml Paso 1 oft (DCtuoc ouly�7j � roti O Z c 0';, LU LL .., r O to > is Paso 1 oft v • Jan. 31, 2020 I:39PM DCI IOWA No. 8179 P. 2/2 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 confidentlal 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: hitp://www.lowasexoffender.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 confidentlal juvenAe records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). M s C10WA00T WWWA wadot,gou SMARTER 1 SIMPLER I CUSTOMER DRIYEN DrWW & ICNMr10at10n 5tltiieaf PO Box 92041 Des Wines- IA 50306-02W Phone 515-244-9124 1 Fax 515-239-te37 Certified Abstract of Driving Record Inquiry Date: 1/27/2020 DL/ID #: 450AS4557(IA) Name: Cathery, Tammie Class: C Sandra CDL Med Status: ons Address: 429 Southgate Ave Audit #: 4504557 Restriction -1 c jvon6�> Issue Date: 01/25/2020 City/State: Iowa City IA Expiration Date: 11/21/2028 522404461 y CJf Endorsements: NONE Mailing Address: 429 Southgate Ave Restrictions: NONE Date of Birth: 11/21/1972 Mailing Iowa CIty IA Sex: F City/State: 522404401 History Information CLEAR DRIVING RECORD Name: Cathery, Tammie Sandra DL/ID: 450AS4557 Customer #: 6992386 ID Status: None DL Status: VAL CDL Status: NonC N CDL Cert Status:.. Non ri CDL Med Status: ons —_ ---NC Restriction -1 c jvon6�> r Supplement: fir— rn y CJf r 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: Cathery, Tammle Sandra DL/ID: 4SOAS4557 1/27/2020 Driver & Identification Services Iowa Department of Transporation