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Home My WebLink About21-048CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 826 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) d; 2. Address (REQUIRED) _ IDENTIFICATION NO. 41 — (Office Gse ON 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 &Wf First Ash lej Middle MGrce 3. Contact Information (REQUIRED) Email: sent via email) 4a. Driver's License expiration date (REQUIRED) OO I—IP91 aba.y b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: Cell Phone: 03 !!)33G - )4SG) V(\\\t.k& 0 ciiatr--,r1- doh 0 U 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? h1Q Type of offense What happened to the charge? (Circle one) W IA Convicted Dismissed Deferred Suspended Plead Guilty Other Where When ca) O ..,..,`.',. ra 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where ,5i2 W N10 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? t\J0 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 04/2018 • i 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). hereby certify that I have issued to me by the Iowa D�paqm�entof Transportation a v lid Driver's license number 5� 8LlC�loSq� issued on ualuti 1_T expiring on o l 9I dI I understand that if I falsely answer any questions in this application, that this applicati n may be denied. I agre 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 ap lication, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the pro 'sion of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican Date I 0 G CO STATE OF IOWA ) n t COUNTY OF JOHNSON ) n ter- ;.. Subscribed and sworn to before me by A 51-11t,r is day of - o1 7y a 1 a WERpY a. MW0 I .-)A. _ . G .1 A .'w. cjn Public indnd for the State 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 % /� gL G� r fi Sigq tW eA P,dlice Chief 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. �1�,Q _k LP ) I I C f, Le� to 6 __2_1 Signature of City Clerk Idesignee D to +++f1M411flRii#fii#*##*+#*##*+if11f44411l111111111ffi!*i##!f#fti*#'Rl1f!!####!###!*###iif##tf!!it###*i#kf+**#*#fi4*ifffi#111f4f4f11f44f4*##i*ifi Office Use Only Approved application DCI report State certified driving record Website update OWTMORNBADGEAPPL9201 U.nda .DOC 04/2018 C410WADOTwwwiowad v SMARTER I SIMPLER I CUSTOMER DRIVEN 0 g0 Driver & Idendlicatlon BNvices PO Box 9201 I Des Moines. IA 5030&92M Plane. 515244,91241 Fax 515239-iw7 Certified Abstract of Driving Record Inquiry Date: 10/15/2021 DL/ID #: 528AG6592(IA) Customer #: 5735281 Name: Blair, Ashley Marie Class: C ID Status: EXP Address: 929 Boston Way Apt Audit #: 2534245 OL Status: VAL 12 Issue Date: 02/09/2018 CDL Status: None City/state: Coralville, IA Expiration Date: 01/29/2024 CDL Cert Status: None 522413140 Endorsements: NONE CDL Med Status: None Mailing Address: 929 Boston Way Apt Restrictions: Corrective Lenses Restriction None 12 Supplement: Date of Birth: 01/29/1995 Mallin Coralville, IA Sex: F City/slate: 522413140 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/03/2017 04/13/2017 S92 Speed Johnson IA 02/08/2019 03/08/2019 S93 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation, Accident Date I Case Number )UR 102/08/2019 1096687 IA N _ Ar [] —r Name: Blair, Ashley Marie DL/ID: 52SAG6592 D J C-)71 �O Pursuant to Iowa Code 4321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Depa r it of Transp : 'I n, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that this tri=nd accurate copy of an official record currently In the custody of said Office, and that I have been authorized by recd? of the-lf;wa Department of Transportation to so certify. '� Ul W 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: .t Name: Blair, Ashley Marie DL/ID: 528AG6592 10/15/2021 \J Driver & Identification Services Iowa Department of Transporation r+ 0 N CD ` C O � as a D U1 Cl) fA)M933121uo r.utul002 s, n1 to STATE OF IOWA Criminal History FRecord Cheek R Ttt l gr%11� �? Iowa Dumont or Criminal lbvestlgatlon Support Operations Bureau, l's Floor 215 & T" Street Des MOM03, Iowa 90,319 (515)725-6066 (515) 725.6080 Fax . I = reQuesting an Iowa Criminal I•Iist Record Cheo 0 is rlc; Account Number: 9967-F SAL410sults to: Name Yellow Cab of Iowa Ci Address P,O,Box428 Iowa tatty, Iowa 52244 i Phone (319)338-9777 Fax . 319-3594142 lOWa l-I7Q1111tr1 nXStUI-V &CCUFLI <.ILUUK.ASVDNa6II (UooeM11,1 co w As of n'1 �-� a search of rho provided name and date of birthrmraealod;� pqj z emomm��rNuai o No Iowa Geminal History Record found with 17CT � °�� ri na! ��."' a K e e of C mi ThL 0El ..r .... ••. �pN 9 r Q Tows Criminal k3xstory Record attached, DCT 1`< `�.,�`_minal •: m � DCI initials = g 1o`N? reg�lts s a o r pw DO -77 (updated 06-26.2018) nuemuamrn�usa Page �of2 ..�lJiLLY ..;�: y �. tan. - • � ea (qq S ❑Male iFexnale l { - I •we ( •:� rr. i [ may_.. OMNI!, 8'8 + MKI A :{0 8 ' i ll i Fi- .� xlSt h , �1+"�[� 'S.:J�'7{5i 1•�( fk-',n..J ; h„�'._r� Gi�-. �+J wNEb7.Sh�dU%d'tl ladw " fa Reps' Y` � '� �^"�•r. r,�,J�i`asK �>� �' J .'; .�'•: y . � . 4 w t.• f' �M%�jl'� �.�( 2 �'tiIT-T�; Cry a. S z!' ••l�•,4 y`�r��` i'y'1 .0 T ..=x •�'.nL 'Yy � •++.'...T - '.Sin + lOWa l-I7Q1111tr1 nXStUI-V &CCUFLI <.ILUUK.ASVDNa6II (UooeM11,1 co w As of n'1 �-� a search of rho provided name and date of birthrmraealod;� pqj z emomm��rNuai o No Iowa Geminal History Record found with 17CT � °�� ri na! ��."' a K e e of C mi ThL 0El ..r .... ••. �pN 9 r Q Tows Criminal k3xstory Record attached, DCT 1`< `�.,�`_minal •: m � DCI initials = g 1o`N? reg�lts s a o r pw DO -77 (updated 06-26.2018) nuemuamrn�usa Page �of2 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 isnot sufficienfto 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. http://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).