HomeMy WebLinkAbout20-0211 � 1
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CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 522 40-1 82 6
(3 19) 356-5040
(319) 3S6-5497 FAX
1. Name (REQUIRED) L
IDENTIFICATION NO.. 2n - h oZ I
(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
2. Address (REQUIRED) I 7 K fC3 1 1 t{ S4, A� �I 1- (' -:PA C---Z21f0
3. Contact Information (REQUIRED) Email: o)c ✓IP�1PCa�, �� i a7 n1 Iyv(I Kell Phone: Yil0- SAS --67
(All written communicationent via email)
4a. Driver's License expiration date (REQUIRED) ()z/061 /Q �C
b. Taxicab Business Name (REQUIRED) �,/- 110 vi [ t / 6
5. Prior experience in transportation of passengers: IJ (D
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? /go
Type of offense Where When
C.
What happened to the charge? (Circle one) %Jo
Convicted Dismissed Deferred Suspended Plead Guilty --After �-D
7. Have you been arrested / charged with any traffic offenses in the last five years?d
Type of offense Where VVfi'en -?
n,
What happened to the charge? (Circle one) N d
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�rou ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s)
PAGE
04/2018
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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).
ereby ic%r7 that I hU ei �sued1 �amg�by e Iowa Department of Transportation a valid Driver's license number
L sed on I2444�20xpiring on [a ZO,24. I understand that if
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 pro ' ions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applican= -�2_ Date 3
*44\ k\} k\flf4lflff114l4!11111f4f;fffff111f}\1ff4444\f1H1f4}#}k11ff4\1!!!l144}1111fff4ffH1f4fH1fHf\1M441fYff4f1114fffffle'lyrff4f\f4y{f{f11N4f
STATE OF IOWA )
COUNTY OF JOHNSON )
Syypbscribed and sworn to before me by �a �� eM2_ C� on this day of
Y�la rrh 7 0 20
ASHLEY A JAY PIAT'
k�A'E cnmmisslon No. 785030 Notary Public in An t State n
14,2020
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; Eiealth-olr welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Driver's licenser—ee �7 C3
Si ature ce 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.
l 2-0 Z O
of City Clerk or 4esignee N Dat
Office Use Only
Approved application
DCI report
State certified driving record
Website update
GentrrAXIMvanoc�P=i�.Doc 04/2018
i 10WADOT
SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov
Driver & rdomiTioaLon Sarvicos
PO Box 92491 Des lAolnes. IA E4305-9204
Phone 515-714-9724 1 Fax 515239-1837
Certified Abstract of Driving Record
Inquiry Date: 2/18/2020 DL/ID #: 117AC6801(IA) Customer #: 5204456
Name: Cavin, Darlene Faye Class: C 10 Status: None
Address: 2167 KEOKUK ST Audit #: 2498605 DL Status: VAL
APT 1
City/State: IOWA CITY, IA
522407108
Issue Date: 01/26/2018
Expiration Date: 02/09/2026
Endorsements: NONE
Mailing Address:
2167 KEOKUK ST
Restrictions:
APT 1
,tel
Date of Birth:
Mailing
IOWA CITY, IA
Sex:
City/State:
522407108
@CaPIC
02/09/1990
F
History Information
CLEAR DRIVING RECORD
Name: Cavin, Darlene Faye DL/ID: 117AC6801
CDL Status: None
CDL Cert Status: None
CDL Med Status: None
Restriction None
Supplement:
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Pursuant to Iowa Code 4321.10, 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: Cavin, Darlene Faye DL/ID: 117AC6801
2/18/2020
c
Driver & Identification Services
Iowa Department of Transporation
Feb -24.202 I,:-"" : 46AM
1012hwav - T wvw Cab
DC IOWA No.1413P. 4/5
fAM=2,w r. V2M
STATE OF IOWA
Criminal History Record Check
Request Forin
MFax -completed fours to:
Iowa Division of Criminal 113ves4stiom
8,417POrt Operation Bureau, In moor
ZIS E, 71b Strast
DooXelass, low, go319
($25) 7254066
(515) 725-6080 FAX
M
DCI Account Number., 9967,v
Smd xgEjjj& to!
Nome Yewcab of iows,
Address P.O. Box 429
IOWA low 92244
Phone 19 338 9777
Fax
319 359 4142
As of A seuch of the Provided name and date
K�wo o7& Criminal MAOXY Record famd with Da
13 Iowa Criminal History Record attached, DCI #
DCI initials -01--,
DCI -77 (UpdaW 0636.2018)
Received Time Feb.18. 2020 2:04PM No -0584
17- 7R -7s
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Feb.24.2020 11:47AM DCl IOWA No.1413 P. 5/5
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:
hitp:l/www.iowasexoffender.com/. However, even though some information is available
on this site, the actual records forJuventles 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).
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