The URL can be used to link to this page

Home My WebLink About22-001 IDENTIFICATION NO. 2 2- 0 01 1 (Office Use Only) c-zratarlika.,1 ovogropir �,,,�� APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) CITY OF IOWA CITY 4 I 0 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1 826 (319) 356-5040 Last First Middle (319) 356-5497 FAX 1. Name (REQUIRED) r1in CzA.651 DeAnne /, 1 2. Address (REQUIRED) ��•� 15k `.�f Ct.\- 3. Contact Information (REQUIRED) Email: �i CG�skSMA' 1$40 G Cell Phone:(All written s munication sent via mail) 4a. Driver's License expiration date(REQUIRED) a6 /as igN1Y-17 b. Taxicab Business Name (REQUIRED) 'P&SAI. ?otA( 5. Prior experience in transportation of passengers: 1('ajni nit e c loccurab 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? /v 6 Type of offense Where When 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? 4e,5 Type of offense Where When SCCAti-l' ;C.KC.� A 121Q1s4 IA, 01240 3 kicars ova eo ev1/61.2 , happened to the charge? one aept'0C--- C M What ha PP 9 ( �F� Convicted Dismissed Deferred Suspended Plead Guilty Other A r 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? I V O 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) No (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 4a TALI y $1 issued on 07/i7/i9 expiring on 06/22/a 7 . 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 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 Applicant Date Q 3//S/01.oZ ************************************************************************************************************************************************ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Ca55 ;c9-k--I "--Zttoft. e.5 4ek on this / 5 day of ikA viirFiunv s iuAVER Notary Public in d for the State of to a C• ommission Number 728,28 2 • My Co missi[Jonn Expires I have reviewed this application, DCI report, and the State certified driving record of this applicant and havedetermined 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 OWat7 4467 ey DSigna re Chief or designee ate 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. -1/2 ../c , , 1 A..x., 1 --3 Signature of City CIerK or esignee D to ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXI DRI VBADG EAPPL92018amended.DOC 04/2018 , ,, or i .. . t ' D 4..w.1, , www.lowadotgov ' SMARTER I SIMPLER I CUSTOMER ORIiVEP Driver&:Identification Services PO BOx 92041 Des Widnes,IA 511306,9204 Ptmmne:.015-244-9/241 Fax;01 183±. Certified Abstract of Driving Record Inquiry Date: 3/15/2022 DL/ID#: 928AL1481 (IA) Customer#: 6382194 Name: Smith,Cassidy Class: C ID Status: None Deanne Address: 723 1ST ST Audit#: 4006222 DL Status: VAL Issue Date: 07/17/2019 CDL Status: None City/State: DE WITT,IA Expiration Date: 06/28/2027 CDL Cert Status: None 527421903 Endorsements: NONE CDL Med Status: None Mailing Address: 723 1ST ST Restrictions: NONE Restriction None Supplement: Date of Birth: 06/28/2001 r-.., .. Mailing DE WITT, IA Sex: F =', ,"' City/State: 527421903 History Information :w. , t- a Convictions - 7 _ , ` ' '' Citation Date Conviction Date ACD Explanation County 5UR.rr.- — 09/14/2018 10/04/2018 S92 Speed (10 mph& Clinton IA under in 35-55 mph zone) 08/05/2019 08/27/2019 S92 Speed Cedar IA 09/18/2019 10/09/2019 F04 Seat Belt Violation Clinton IA Name:Smith, Cassidy Deanne DL/ID:928AL1481 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: r ,. -jn4$ <-AiN STATE OF IOWA � '� Criminal History Record Check R a Request Form 3 k .l DCI Account Number: (if applicable) Mail or Fax completed forms to: Send results to: Iowa Division of Criminal Investigation Name Ct., 5,7 Support Operations Bureau,1s Floor A 215 E.7th Street Address 2 C)d 2- 5 t�' A.it S E Des Moines,Iowa 50319 (515)725-6066 Lc 4.1 R e p t'Js l IA S a 7c3 (515)725-6080 Fax 3((( 3 c o 7 7 2 Phone Fax I am requesting an Iowa Criminal History Record Check on: Last Name(mandatory) First Name(mandatory) -.. Middle Name(recommended) Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) w,a /Z/V2,a o ( ❑Male ?Female 3 ReleaseAuthorization•-Without a"signed release from the subject of the)request,a complete crioi�nal"iiii§Iory record.m'ay not be releasable,per Code of Iowa,.Chapter 692.2.For complete criminal history record informatSon,,as Wowed iby law, always obtain a signed release from the subject of the request. ***This form(DCI-77)is the only approved release authorization form for thisipurpase** : " ' Release Authorization: I hereby give permission for the above requesting official to conduct an Iowa criminal history'record cheek with the-Division;of Criminal Investigation(DCI). Any criminal history data concerning me that is maintained by the DCI maybe released as allowed by law. Iaanderstandthis can include 'information'concerning completed-deferred judgments and arrests without dispositions. .4 Release Authorization Signature: ))y'pii,C.4_' Iowa Criminal History Record Check Results - (DCI use only) As of , a search of the provided name and dZ.ate of britkreyealed: e V S. C ry 1/1,, ° -t -•i ''• �q.5 -.1 20f e`fir = O - o Iowa Criminal History Record found with DCI %� , E� �0.z �.� o '�,''0 m ®Sectbo ,,,,N,��'v®``�� ❑ Iowa Criminal History Record attached,DCI# °►++ttotaaattnu� < ..o cn DCI initials 'i. DCI-77(updated 06-26-2018) Page 1 of 2