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Home My WebLink About21-011., I t:i 1 -art' Nyiy/®r�11 CITY OF IOWA CITY 410 East Washington Street lowa City. Idea 52240-1826 13191356-5040 13191 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. 2-1 - O � � (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 appiicatlan Last 2. Address (REQUIRED) Li L,3 3. Contact Information (REQUIRED) Email: (AII written 4e. Driver's License expiration date (REQUIRED) ` b. Taxicab Business Name (REQUIRED) C�- '1)10 5. Prior experience in transportation of passengers: First /4/ Middle Lin n Z Cell Phone: 8. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? 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 ofoffense t\ iJAP20 When Iowa City Iowa What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other I / /—j- 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ��— Tvoe of offense Where When 9. Have you ever applied to bean Iowa City taxi driverusing a different name? If yes, please provide the name(s) r i 0412018 Page 2 FILED MAR 0 5 2021 APPLICATION FOR TAXICAB VEHICLE DRIVER Clerk DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) City REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW IoW a City, IOWA You must apply for an Individual Department of Criminal Investigation Report (form available upon request). I hereby certify that I have issued to me by the Iowa Department of Transportation a v lid. rive understand that If I 's license number D to r q h , ( Issued on `j iRxplring on 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 CityIowa, 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of App IIcaI It !_ Date it ftlfitfNtl44i4tN14}}1RNt441it4YN}t4444Ni4fY444f M*Ie4fXXX}fkffikitl44fYY1,4444t4f4Ii}44}4tl�fif44i444444tXX}4M44i ltXftXff44XHk444i44}4MY44} STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of or Iowa tlffttX4}tk.. 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 62, 6 2- 2-- 7— g—ignatu're of Ploilce Chief or designee Dr 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. Office Use Only Approved application DCI report State certified driving record Website update ®O —OE�' —1-1 Date CWWA%IORNBADGFAPPL970I8amanded.DOC 04/2018 w#ar, 1. 2621 12:12PMab DCI IOWA fAg01 =2No.6254 P. 1/2900Q STATE OF IOWA Criminal History Record Check Request Form Mai ar Fu aomnleted forma tae 1MD1VbWA aT(78eLa1 Lnatlgatfaa �a am@%I11"IAR051011 ~' City Clerk am "saw Au Iowa City,.lowa DCI Acw=tNumber. 9967-F qtr OWN"10) Name Yopgm * d if" qb Ad&VM 1P.0.1u ori isga aty.lewu 32141 Placa DCI -77 C%AMd 06-26-2018) Page 1 oft Received Time Feb. 26. 2021 1 02Pk No. 6037 Mar. 1.2021 12:13PM DCI IOWA No -6254 P. 2/2 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidentiai 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. h1to.11www.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 confidentfai juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). MAR 0 5 1011 C1ty Clerk Iowa City, Iowa 410WADOTA0 SMARTER I SIMPLER I CUSTOMER DRIVEN www.lowadot.gov Drtvwr & Idwxlm3tlon smixms PO Box 92U I Des Manes, IA 5030&WU Phone 515-244-91241 Fax 515239-1&47 Certified Abstract of Driving Record Inquiry Date: 3/1/2021 DL/ID #: 060CC9569(IA) Customer #: 4499601 Name: Carroll, Karen Lynn Class: D ID Status: EXP Address: 2429 WHISPERING Audit #: 4588768 DL Status: VAL MEADOW DR Issue Date: 02/25/2020 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 03/04/2028 CDL Cert Status: None 522406807 Endorsements: Chauffeur CDL Med Status: None Mailing Address: 2429 WHISPERING Restrictions: NONE Restriction None MEADOW DR Supplement: Date of Birth: 03/04/1978 Mailing IOWA CIT', IA Sex: F City/State: 522406807 History Information CLEAR DRIVING RECORD MAR 0 5 2021 Name: Carroll, Karen Lynn DL/ID: 060CC9569 City Clerk Iowa City, Iowa 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: C Name: Carroll, Karen Lynn DL/ID: 060CC9569 3/1/2021 c� Driver & Identification Services Iowa Department of Transporation