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Home My WebLink About20-048� r t .•�� + Mt�y1�'-�7®JJ'��i CITY OF IOWA CITY 410 East Washington Street Imsa City. louya 52240.1826 (3 19) 356.5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. ZO — 0(-� g (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 to complete the "required" information will result in denial of the application the "required" information will result in denial of the application Last _r v"( 4 f First Middle Q_i 2. Address (REQUIRED) —50�j ,�� r 04 c 20(ZCAiV t '0 4.- ;y da - 5 k 3. Contact Information (REQUIRED) Email: Cell Phone:�j(� (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) I A CL n b. Taxicab Business Name (REQUIRED) i14 1-73 5, Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? �j_ Type of offense Where When MN. 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? Type of offense Where When What happened to the charge? (Circle one) n Ni�G 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? 1 J D Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Nc� (SECOND PAGE FOR REQUIRED 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 hereby certify that 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number I `apt fiC_ 3; ��> issued on t„ 'A,",A-i texpiring on '1 - `l - Dt):Af3 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 limes 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 y a.Q ,_ `c�•.— - Date I V �k4 - J� 1fYf1f 1tMkY 1YRM 4111 # 1YYMYYYf fYYh1MYYiM#IM fY1111 fN1f 1##YfYYMfYYMYYY #Y IYf 1fYYYfiYiM4MYf ff f f MiYf MkYfY##1YMfYYYY+IMMIfI,If Mf1f fflfYYf 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._ ffMMMMMfM1#fY1 FffMflff/MfYHtfM1 MMMMMYf1YdlNMilMMttiflff�fifflGiyflflfNMMMMYMYM 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 Driver's license 67 -0 Lt - Z Signature of Police Chief or designee C AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE QATE LISTED BELOW. & F I res Dat Office Use Only Approved application DCI report State certified driving record Website update CIaMrA%IDRNBADGEAPPL92010amended OGC 04/2019 C,JIGWADOT SMARTER I SIMPLER I (USTOMER DRIVEN www•lawadogov DMW S RWKWaaam Swim Pt) Bar 92M i Des Mohs, IA 6030&WN Phtxte515-244-9124 1 Fall. 515-288-tii87 Certified Abstract of Driving Record Inquiry Date: 10/5/2020 DL/ID 7f: 129AC3200 (IA) Customer #: 5234945 Name: Lanier, Cyntonia Class: C ID Status: VAL Latrice Address: 304 4th Ave Apt 35 Audit tF: 1911264 DL Status: VAL Issue Date: 06/23/2017 CDL Status: None City/State: Coralville, IA Expiration Date: 07/04/2022 CDL Cert Status: None 522412598 Endorsements: NONE CDL Med Status: None Mailing Address: 304 4th Ave Apt 35 Restrictions: NONE Restriction ..:None Supplement: Date of Birth: 07/04/1975 Mailing Coralville, IA Sex: F " of City/State: 522412598 r— History Information Convictions r Citation Date Conviction Date I ACD Ex lanation iCounty JUR 112/20/2017 102/0912018 S92 Seed Johnson IA Name: Lanier, Cyntonia Latrice DL/ID: 129AC3200 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: U S.+.0 EnT OF rH� ry9, yo- U O�F7C�Af nnf.�3�� 10/5/2020 OL Driver & Identification Services /nwa ftnnarfmnnt of Trancnnratinn ya- < m