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Home My WebLink About21-019CITY OF IOWA CITY 410 Ease Wasliinglon 5treel Iotva City. Iowa 5 2 240-1 82 6 (3 19) 356-5040 (319)356-5497 FAX 1. Name ('EQU!RED) 2. Address (REQ'JIRED IDENTIFICATION NO. (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" inr'ormatior, will result in denial of the application Last First Middle 3. Contact Information (REQUIRED) Email: Ictll }3vv�Qtva011��+✓r""bell Phone: 3iy S`a�% 3fi86 II wr`ittten communication sent via email) 4a. Driver's License expiration date (REQUIRE--, 4 -a f5 opo �-L b. Taxicab Business Name (REQUIRED) S�JIC L L-dtu C A 13 OF -T u o- Qi N 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? NO Tat -3c46 0.r, Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead� 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 you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 What happened to the charge? (Circle one) `r-, Y Convicted Dismissed Deferred Suspended Plead Guilty Other; -::4 Lo 7. Have you been arrested / charged with any traffic offenses in the last five years? V �S Type of offense Where When 1,,-5cwf-v What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended ead� 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 you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER REPORT AND STATE CERTIFIED DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) 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). a Til expiring on 4's I understand that if I I hereby certify that I have issued to me by the Iowa Depa ent of Transportation valid Driver's license number T� r�r LR _issued on falsely answer any questions In this application, that this appI cat on may be denied. I agree that in making this application, 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) Date 3 31� Signature of Applicant ra.aaf f.af of of aaa rraaara+lf aafaNrfNaafN+lNf 1Narraaa aNNaaNaaaNaN+afNaNaNeNNNaaaaa*YNlfaarlNaaaNarNfN'Y+aNNN aNNNaNYeNN STATE OF IOWA ) COUNTY OF JOHNSON ) day of on this Subscribed and sworn to before me by NNNaNNNaaNxNN,lfaaaaN++:F .Naa+a+aa+wNa+afaaf aaaN 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/ z `r /Z 6 Si nature of Police Chi4odrcresignee 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. Q L' Sig re of City rk or designee �. , �n }#tfNN1NN1NkkNN NNfkNilN4NNNYNNfNN11NNNN1NfNNM1NNafffafNN11NN1tfNfRfNfMp�rT1 2r fafffifffNN' Office Use Only _o _�o a Approved application i- DCI report ut State certified drMng record 00 Website update eb,urixroRNawcrAPKDMrefm„dld.00c 041201 B pyMar_25.2D21 9:20AMC&b DCI 106' grAM=Lko.9506 P..1 a, STATE OF IOWA Crtminal History Record Check Request Form I Iowa Dividsn of Criminal loves[Glstion Support Opentious Bureau, 11 Moor 215 F. 76 Street Da Motets, Iowa $0319 (515) 7256066 (SIS) 7256086 Pax DCI Account Number, 9967-F (f ambable) end moult far Naas Y6110WXab of lows CI Address P.O. Bax 424 N � � _Io.raOb.INNnao Phone(319) 37M1i/ n Vat M43994141 � o a ,1.puM.n........n y.:. An of --�rx_, a search of the provided name eusDt�p4plec �n Lowa C•iminpl History Record found with lit- lam criminal historyresults: ❑ Iowa Criminal History Rocord attached, DCL a— DCI Wdala( /%ry� c�rnarlAa •Stet o4 DCI -77 (updated 06-26-2018) Received Time Mar. 24, 2021 9:21AM No. 9355 (= w oaw OF IOWAIDP8 MAR 8 4 2021 C.RwtNAL INVEST Paye I oft Mar. 25. 2021 9:20AM DCI IOWA No. 9506 P. 2 DISCLAIMER This response can only include public criminal history data. Underlowa 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: htta✓/www.iowasexoffender.com1. 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 confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). o ti Q �n r- co C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WV11/V.IOWi3dOt.gC)V Drivel B Identification Smites PO Box 92041 Des IAyines. IA 503C642111 Phone 515244-9124 1 FaX 5152%-1837 Certified Abstract of Driving Record Inquiry Date: 3/24/2021 DL/ID #: 554XX0048(IA) Customer #: 3971082 Name: Snyder, Janet Class: D ID Status: EXP Address: 9 DUNUGGAN CT Audit #: 4709855 DL Status: VAL r. Issue Date: 06/03/2020 CDL Status: None City/State: IOWA CIT', IA Expiration Date: 04/25/2026 522402831 Mailing Address: 9 DUNUGGAN CT Mailing City/State: Convictions IOWA CITY, IA 522402831 Endorsements: Chauffeur 3 Restrictions: Corrective Lenses Date of Birth: 04/25/1951 Sex: F History Information CDL Cert Status: None ACD CDL Med Status: None'i JUR Restriction -. - N06U �r Supplement: '-' ;iu # —i C7 E r. D 00 Citation Date Conviction Date ACD Ex lanation Count JUR 02/08/2020 102/21/202() S92 5 eed Benton IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number _ JUR 09/07/2016 1939682 IIA 09/27/2019 1135636 IA Name: Snyder, Janet DL/ID: 554XX0048 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: Snyder, Janet DL/ID: 554XX0048 3/24/2021 Driver & Identification Services Iowa Department of 7ransporation ti O z n �n rri :!r o� a a00 T " 1 4 00