HomeMy WebLinkAbout20-039� r
A :
.:.®I%'
m�
CITY OF IOWA CITY
410 Easl Washington $treci
Iowa City, lolva S2240-1826
(3 19) 356-5040
(319) 356-5497 FAX
1. Name (REQUIRED)
2. Address (REQUIRED) —
IDENTIFICATION NO. 20-03q
(Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday)
Failure to complete the "required" information will result in denial of the application
Last
First
Middle
r/Jam I-
3.
3. Contact Information (REQUIRED) Email: otvv�� sr. �e✓�pll®%oi wdl1,ComCell Phone: 31 r 59y -3896
All written communication sent via email)
4a. Driver's License expiration date (REQL
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers: LV RG � E Ll t Lo C Ab c f It L.,j A
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? No
Type of offense
W here
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended Plead Guilty
Have you been arrested / charged with any traffic offenses in the last five years?
When
Other
Type of offense Where When
SPEED P>a-MTOta CoutLi-J IA o�'o$/aoao
What happened to the charge? (Circle one)
Convicted Dismissed Deferred Suspended 4leiGuil Other
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 14 o
Type of offense
Where
When
0
9. Have you ever applied to be an Iowa City taxi driver using a different name l yes, please provide the name(s)
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
0412018
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 herebyy certify that I have Issued to me by the Iowa Department of Transportation a valid Driver's license number
S l Y,1� o 4 t issued on Ob o; oao expiring on v ("5 Boa I understand that if I
falsely answer any questions in this application, that this app scat on 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 1 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 Cade. (Needs to be signed In front of a Notary Public)
Signature of Applicant'
Date 10L-17100-;, 0
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by
on this day of
Notary Public In and for the State of Iowa
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 resk
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Driver's license
Signature of Police Chief or designee
(dt�-7.7i0
Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM T412 DATE LISTED BELOW.
Date
Approved application Office Use Only
DCI report
State certified driving record
Website update
CIONTAXORWBnooeAPPLe20 toemended.00e
0412018
101Oct. 5. 2020 3:OOPMcab DC1 IOWA
fArAI9339,No.7933 P. 2i3u003
STATE OF IOWA,
Criminal Ilistory Record Check
Request Form
.; r•1.�
DCT Aceount Number; 1 I a- �7
oomn
Marl or Fax 0f ivd�b4)
feted ms's to: S�_�nsults to:
Iowa Dtrfsioa of CTIM nal MaTesagaaft
Support Opcmtisns Buren, 10 Poor
us IL"Street
Da Motor, Iowa 50319
(515) 7256066
(515) 7254080 Iris
OQM at
As oftea >
,, a searcl of the provided name and date of birth revealed; i o z
l Ly�tM1l No Iowa Criminal Hratory itccord found with DCI 00
of Crim......�a O e g
3c a�.•' .. ... CrI O R
v V
�p W p LL
❑ Iowa Criminal gistory rwi�r
DCT # A ' incl ? 5' r O
DCT _ ? istIts:1.
DCI -77 (updated 06-26-2018)
Page 1 oft
Received Time Oct. I. 2020 11:05AM No. 7516
C,410WADOT ww iowadot ov
SMARTER I SIMPLER I CUSTOMER DRIVEN g
DrMM 6 Noe AVIcatlon Services
PO Box 92D41 Des Moines. IA 5030&9201
Phone 515244-91241 Fax 515239-1837
Certified Abstract of Driving Record
Inquiry Date:
10/1/2020
DL/ID #:
554XX0048(IA)
Customer #:
3971082
Name:
Snyder, Janet
Class:
D
ID Status:
EXP
Address:
9 DUNUGGAN CT
Audit #:
4709855
DL Status:
VAL
Issue Date:
06/03/2020
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration Date:
04/25/2026
CDL Cert Status:
None
522402831
Endorsements:
Chauffeur 3
CDL Med Status:
None
Mailing Address:
9 DUNUGGAN CT
Restrictions:
Corrective Lenses
Restriction
None
Supplement:
Date of Birth:
04/25/1951
Mailing
IOWA CITY, IA
Sex:
F
City/State:
522402831
History Information
Convictions
Citation Date
Conviction Date
ACD
Ex Ianation
lCounty
JUR
102/08/2020
102121/2020
592
ISpeed
jBenton
IIA
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Name: Snyder, Janet DL/ID: 554XXOD48
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:
y
3
m
n
m
I ,I; 1
d
C!AJ-
f Y, I'Y. T
O
r
0
7" IOW,
0
n