The URL can be used to link to this page

Home My WebLink About21-036� r � CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (319)356-5040 IDENTIFICATION NO. 2 � - (D3 6 (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 (319)356-5497 FAX G 1. Name (REQUIRED) E�1Mt� �1Lrbt� 2. Address (REQUIRED) 0'7),1 °lir` SL I �i�..r�t�S 1 1 Ah 3. Contact Information (REQUIRED) Email: .&vyCell Phone:�77 2qt;'- 4a. Driver's License expiration date (REQUIRED) � DI V V %7- 6, S b. Taxicab Business Name (REQUIRED) �>2 S cs- ` VytA')P r' 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? 0— yoe of offense Where When Q _ w What happened to the charge? (Circle one) = M Convicted Dismissed Deferred Suspended Plead Guilty he c.3 C3 7. Have you been arrested/ charged with any traffic offenses in the last five years? on Type of offense Where When What happened to the charge? (Circle one) 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 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 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 I have issued to me by the Iowa Department of Transportation a valid Driver's license number I U1 V U issued on expiring onI understand that if I falsely answer any questions in this application, that this app cation may be denied. Il al g )eW 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 provisions of Title 5, Chapter 2, of the Ci Code. (Needs to be signed in front of a Notary Public) Signature of Applicant cZ�/6 Date J STATE OF IOWA ) COUNTY OF JOHNSON ) Commission No. 785030 My Commission Expires on this % G'� day of c� I have reviewed this application, DCI report, and the State certified driving record of this app P&iR am-have4sierrnined that there is no information which would indicate that the issuance would be detrimental to the sa![ ,, heMh or fMre of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). m m = Expiration date of Driver's license /o zfz/,?o z ,-:3z ca 0 .0 S' nature of PoliceChie 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. of Office Use Only Approved application DCI report State certified driving record Website update 20 D , I Da e r.�,wrazroan�anocenarisao,ea�nsmaa oa: 042018 JUL/Ju I. I y [v[i I I: Z]rwq USI IUwH iuo 7ooY yr. yl/004 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, 1't Floor 215 E. 7" Street Des Moines, Iowa $0319 (515)725-6066 (515) 725-6080 Fax an Iowa Q-iminal t>7o Reowd. Check on: Waiverinjorfnation: Without a signed waiv be releasable, per Code of Iowa, Chapter 692.2. obtain a waiver sipmatore from the snhiert of A Widver Release; J homby give pennisyion for the above Invenigatim (Dict), Any eriminal hl9mty date concerning me t Wdiver Signature; of DCI AccountNronbec t.,l U c '), .( (Keppliaable) From: City of Iowa Ci City Clark's Oface 41C E. Washlneton Sltreet ti Iowa City, Iia 5224i C-) Phone; 319.356.5041 Fax: 319-356-5497 cz Mddle Name lreeomm.nAwt of the'r,! te(d, a complete criminal hletory record may not P41'Mii0rx,r6rord information, as allowed by law, always !9 conduct as lode c*111al history rewrd check with tlia Division of Oiminal V the D,('{, ,d606 released as alloiwd by law. vara Criminal History Record Check Results As of l 9 a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI # DCI initials DCI -77 (08/25/10) Received Time Jul. 14. 2021 4:18PM No -5108 (DCI we only) OF IOWA/DPS JUL 15 2021 OF CRIMINAL Jul. iY. zui I:[Jrm Ubl IUWA 110. 7007 r. iv 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. htto://www.iowasexoffender.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 confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). 0 C- �r— r x i�> � r.✓ O l0 Q10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN '-��'r° ��ot tc�v PO Box 9?ti. phone 515-244.9124 Fax 51523-I837 Certified Abstract of Driving Record Inquiry Date: 7/21/2021 DL/ID #: 101VV7265 (IA) Customer #: 4284936 Name: Berry, Emma Diane Class: C ID Status: None Address: 10249TH ST SE Audit#: 4736704 DL Status: VAL Issue Date: 06/16/2020 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration Date: 10/17/2027 CDL Cert Status: None 524012406 Endorsements: NONE CDL Med Status: None Mailing Address: 10249TH ST SE Restrictions: Corrective Lenses Restriction None Supplement: Date of Birth: 10/17/1985 Mailing CEDAR RAPIDS, lA Sex: F CRY/State: 524012406 O History InformationDC7 ay � -< CLEAR DRIVING RECORD �� W CD :-'0 = m Name: Berry, Emma Diane DL/ID: 10IW7265 D Zjlz O LO 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: Berry, Emma Diane DL/ID: 101W7265 7/21/2021 Driver & Identification Services Iowa Department of Transporation �Ci 4 mac_