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Home My WebLink About15-298f � 1 �t III Ci CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX IDENTIFICATION NO / c5� J— 't (Office Use On ?y - APPLICATION FOR TAXICAB! MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) Lailure to rortTpfefe_Yhe "re udred" infarmaPion will result in denial of the application 1. Name (REQUIRED) I Y ) G r t 2. Address (REQUIRED) ( 4 13 �> f 3. Contact Information (REQUIRED) Email: (All written communication sent 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: _ Cell Phone; 6. Have you ever been arrested / charged with any misdemganors and/or felonias in this State or elsewhere? Tvpeofoffense Set CCH F.s gdJt �tehq,( - -,qz zap Dw k 6 Where When 0i 1 Ciu�r1 L` �rN> I nr. I What happened to the charge? (Circle one) ' r I Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? Y'e S Type of offense Where When What happened to the charge? Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other J 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ \Jtbs 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) A \ _ G I-� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIF[r4D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE C�[Ek REMW r .r You must apply for an individual Department of Criminal Investigation Report (form available,uPotLrequesty. (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ° 02/2015 C� APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her y c Ify tha� I aye issued to me by the Iowa Da t ent of Transportation a valid Chauffeur's license number J �- L� `l l0 issued on 15, a01 'expiring on f)) I understand that if I falsely answer any questions in this application, that this application may be denied. I gre 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 ofApplicant��/� WjU)PA 1 J Date G S� STATE OF IOWA ) COUNTY OF JOHNSON 1 y r �h 1 \1 Subscribed and sworn to before me b C'ns,.k.,A �V�;-��1„Q�\ on this 1 ~ day of and for 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 fCode). Expiration date of Chauffe is license L J 1%i ! Z 2 Si nature of Police Chief or ee 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. Sigrliatare of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update r_t ate C) J ClerPJTAXIDRUB DGE PPL92014.me,ded.DOC 0312015 www.iowadot. Ov SJA4APTER I SIPCiPIEP: I (U'TONIEF iR!VEUP...e�A.� Office of Driver Services PO Box 9204 1 Des Moines. i'.4 50301 PhOcal 515-244-9124 1 GGG-532-9128 1 Pay: 515.239-1837 www. iovtadot.giy Certified Abstract of Driving Record Inquiry Date: 12/8/2015 DL/ID #: Customer n': 4470052 Class: Name: Mitchell, Martha Irene Audit #: Address: 633 BEACH VIEW OR Issue Date: 12/08/2015 COL Permit Endorsements: Expiration Date: City/State: IOWA crry, IA 522465899 Endorsements: Mailing Address: 633 BEACH VIEW DR Restrictions: NONE DL Status: Restriction Mailing IOWA CITY, 1A 522465899 Supplement: City/State: CDL Permit Status: EEG Date of Birth: 10/22/1971 None Sex: F None Convictions 0138E849611A) CDL Permit Class: None D CDL Permit Issue Date: None 9624604 CDL Permit Expiration None Driving While Barred Date: IA 12/08/2015 COL Permit Endorsements: None 10/22/2022 CDL Permit Restrictions: None 3 ID Status: VAL NONE DL Status: VAL None CDL Status: None 'lA CDL Permit Status: EEG ..02/10/2014 COL Cert Status: None IIA CDL Med Status: None History Information C+tatian Dan. Canvlctloc Datm ACD Explanation Cnenty SUR 09/20)2006 12/20/2006 821 Driving While Barred 'Johnson IA 07/12/2011 10/20/2011 820 Driving While Suspended, Denied, Cancelled Revoked Johnson IA 12/04/2011 01/04/2012 851 No Driver's License ,Johnson IA Sanctions iype E"ectixe End _ ACD Explanation. occurrence JUN JUR Barred Barred _u - OS/28/200J '-05/26/2011 .. 1 W01 _'Habitualn Offentler ]A yA Suspended p 12/16/2011 12/14/2012 12 '.D27 :Violation of Probation IA Suspended 02/11/2012 :02/09/2013 D27 Violation of Probation 'lA Suspended 06/25/2012 ..02/10/2014 B63 Fall to Refile SR22 IIA lA Suspended 11/07/2012 ;03/11/2014 D53 Non -Payment of Iowa Fine I)A IA Suspended .11/07/2012 ',03/11/2014 .D53 Non -Payment or Iowa Fine IA -]A Name: MRChell, Martha Irene OL/ID: 013BBE496 Pursuant to Iowa Code 4321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby rertify that I am the custodian of the records held by the Office of Driver 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: Mitchell, Martha Irene DL/ID: 013888496 r..J q •• 12/8/2015 d, C7 IOWA•='' yrA e D. 0. T. g? q••",'rtrt'nn pggA�ru`==— Office of D,var Sid,lces =�- --- Iowa Department of Trairspartation CD Name: Mitchell, Martha Irene DL/ID: 013888496 F,uec, ii_ [vI.) 7:)inrviC,o uiv u iiininai investigation No, )IIi r. n ---.-•--• 12/l0/2Ory6 17:4r- p343 r.U04/004 Doc10, 2014 4:15PM Div of Criminal Inve0 iga(ion No.3662 p P.....__ _ �i .ano/zory6 )6;t_ ,.aa� '/003 11 F,aD<{. 9. 1015 9:0IAI4� .r+Div v1 Criminal )nvesliBalion z/oa/zoa No.34303aoE STATE OF IOWA jt Ica►I',_�' 'I Rerord Chetik DO Awulil Nun1To1; NOb',Z, /` re, lawn plvltlan of CNITAnl Inv (ifapplic+0 t) J 6mpporl 0peveilal{s Dorpaµ lr1rvoer tl from: Cltv�oyye�y 116 fi. 711 Slrerl Clly C1Cl'h'C O fRe ` Do M61jwslowj. 5o319 410 E, Wasbin ton 8freel'^: (515) 719-6066 TO Ip PZIA FO (519)127-6ada rev lone [ice, Cs aypdp T S NbA5E _ URIS FUkNy 319x96-9gg♦�— eK; UV ",Bluer (ittommil" U d lCt l I I old ale1 1114i J l 1, Melo isnivelrnJorninfl0/1. Wghouledgned+ralrctGramlorlab etto �� be roleop•ble, ppr Cpda ofrower CAa0 or 691.3, Fpr so lef c ImG al hlsto9y lcor4 of Irmbl(ee'u, llolrpd Dy lON aw, elweyel obillnowelver11 naluref omll+csubetlpfihere ucll, K/nfvel' %l elCRf6' 1 At/eDYei✓s panniul+n ler @e net.7e9ugtlnl plf old to w+dpq +n ti,h prirnAl+l a4larncal eAtek Iron me Alddsu elG nJnal Invellifsl{re (PCU. Ant n7neinsl Ahtap•Am �eonm/ml�n/{/mol/b/��lll m.+m'd�f/p'dje� rimes nelmq•lu/pY+ted �7 �lJoatO�iYlnq /BIYeI'sTIPhO[urn• ' As vP_ _ _ ] —� a Mjleh of fhc provide) nople and date of b)tlh reveehd: No IoN•a Crilninol History ltecoyd found %.i(l) DCI t•: ❑ lo,va Criminal HisioayRecord allathed, DCl if /n. perilalinis W uc1-771asv1sgo) Rectiv<d Time Dae, 8. 2015 1:31PM No. 3367 Neetivod Time Dec. 10, 2014 NMI No -3633 Rectived Time Dec 10, 2015 4:37PM No.3075 Vec. I I. Lul9 H, iuhiv1 UIV 01 b1 I III IIdI 111 v t S l lg d l l a 11 Fr _.•i.-. " ... ... v.. .-. v Clem Dtt.l0, 2015 4:15PM Div of Criminal Investigation From;C:,ry of lewp Oily CIerK OIIIOe ,IC 3686497 Au. if `4 I. 1 12/10/2016 17:46 V343 F.003/00< No. 3682 P. 2/3 12/10/2016 16:13 11341 F•O02/003 STATE OF IOWA Critninal History Recolyd Check Reques( Form 'PU: (eN'a Divi9tUD of CI'Imioal lIB'eeligation Support (lpere(ionr Dnres% I° Floor 215 E, 7" 5(reet Des Moines, lotra 50319 (516)725.6066 (515) 725-6000 14► DC) Aecounl Nulnbtr; �jc . % 7— (ifappliea6lc) , rrom: L", orlowe 01�__ City Clerh'.t• o1Gto 9164. Wash)II ton Sour M_ Iowa CIt ' In ;2190 Phakt 399.356.5091 _ raa;; 31956.5997 I Atli re uesttu an Iowa C5 itninal Histol Record Cheok Oil: LastNalne mandala ) FltslNan10 fmnd&tol Middle,Narne(n<bnlnuaaoai �Shg ire vv� 0 -- 9,�-IC-1`1I ❑NIale (figrusile -3q 6- 6q-�b�3 WaluerlflfOrr+rnflon; W(lhoulit signed WaiverfromthesubJectol(ht request, eeompletecrllninalldrtoryrecord May not be releasnble, per Code orlorra, Chapler 692,2, rot, coninjere criminal history record informs(1o0, Atli) GlApej by Isle, ehvliys obtain a waiver signature from the e9hl gee r u,. .... ,..d waiver$elegsel l hereby give pemlislionfat lbs about ngltuline omcill to"Adabi an lotus erimi dlllnoy le4prd cluck.ldW the UNiaion o(CriminJ Inrn+igatimi(DCI). My crinlieel history dais eonuming 111101inonmincd by die DCO Ally be tchl as•nomad by a. _ WniverSigtirthrre; e/�pfC;7tx _ fl�Q��Q�l, lU Iowa Criminal Histor iiecord Cfleck Ttesults tuae,eanly) , A9 ot� a search of the Provided nulne and date of birth revealed; rix • n s No lows Criminal Hjslory Re -cord found wish C)CI , C. U` lnlva Crililinid Ris(uu Record allached, DCl1(_ .r r a DC) WO—alshW l)CI-77 (0 12s/j0) Received Time Dec, 1D. 2015 2:03PM No, 3633 Received Time Dec. 10. 2015 4:37PM No. 3075 Vec.il LU19 N;)UHIYI viv of �,riminai invesiiga,ion IOWA CRIMINAL HISTORY DCI 00643779 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2015/12/11 OCI-00643779 NAME: SEALS,MARTHA IRBNE DOB SEK RAC HGT WOT EYE HAIR SKN POB 19711022 F B 505 220 SRO SLK OAK IL ADDITIONAL IDENTIPISRS PHOTO AVAILABLE: Y TAT BACK TAT R ARM TAT R SHLD CCH RECORD +** 01 ARRESTED 20010504 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA32IJ-2 owl TRK#; 100231001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA 2(A) OPER VEH WX INT (OWI) / 1ST OFFENSE COURT CASE ID! 06521 OWCRO58729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100231001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D COMMUNITY SERVICE 25H REVOKED 02 ARRESTED 20020912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 Owl 2ND OFFENSE TRK#: 100655601 COURT DISPOSITION / AGENCY: IA052015J JOHNSON CO DIST COURT ✓ COUNT NO- 01 IA STATUTE; IA321J.2(A) OPER VRH WR INT (Owl) / IST OFFENSE COURT CASE ID: 06521 OWCRO63252 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100655601 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 3651) REVOKED JAIL 7D DISP EFF DAT 20010628 20010628 20010626 20020603 Nu. 3I19 r. 11 c.: C77 (7') r.� y....w DISP EFF DAT APPEAL 20030417 2003101x_.'"^ 20030417 - CD 20040604"� CVIJ 7;3vMI 0 1 V 01 k,fIIII inaI 1 11 V BS LIga LI U ll DCT 00643779 PAGE 2 OF 4 IYVI ) / I R J FINE $1000 ✓ 03 ARRESTED 20021006 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-21 DRIVING WHILE REVOKED TRK#: 100681101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE ID: 06521 SRCROG3497 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100681101 SENTENCE DISP EFF DAT FINE $1D00 20030417 04 ARRESTED 20031017 / AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVE WHILE BARRED TRK#: 100903901 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- Ol IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1976 COURT CASE ID: 06521 AGCRO66791 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100983901 SENTENCE DISP EFF DAT JAIL 71) 20040312 FINE $500 20040312 05 ARRESTED 20040224 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVE WHILE BARRED TRK#' 101096301 COURT DISPOSITION AGENCY: IAO52015J TOAMSON CO DIST COURT COUNT NO- 01 IA STATUTEi IA321.561 '"":, <-'• _ t Yui DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 r -'-• C'J �....-...w COURT CASE ID: 06521 AGCR067915 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101096301 SENTENCE DISP EFF DAT JAIL 71) 20040312 " .- Gi U6C. III LU17 7•IVnIPl U I V 01 bI116111dI I I V C V li,dl I 1111 FINE $500 06 ARRESTED 20060126 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED TRK#: 101.765501. COURT D25P09ITION AGENCY: 1A0520150 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321.174A OPERATION OF MOTOR VEHICLE WITH EXPIRED LICENSE COURT CASE ID: 06521 AGCR074975 CHARGE CLASS: SCHEDULED TRAFFIC VIOLATION TRK#: 1.01765501 SENTENCE FINE $50 07 ARRESTED 20060901 AGENCY: IA0460000 IOWA CO $O CHARGE NO- 01 IA STATUTE 1A321,561 DRIVING WHILE BARRED TRK#: 0761.83801 COURT DISPOSITION AGENCY: IA046015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA321,561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1976 COURT CASE ID. 06461 AOCROO9124 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 076163801 SENTENCE SUSPENDED JAIL 120D JAIL 120D FINE $625 COURT COSTS P909ATION 08 ARRESTED 20060920 AGENCY: 1AD520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321,561 DRIVING WHILE BARRED TRK#: 101901101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE 1D: 06521 AGCR077279 CHARGE CLASS: MISDEMEANOR CONVICTION DCI 00643779 PAGE 3 OF 4 20040312 DISP EFF DAT 20060505 IN V J J I Y I. 4 DISP EFF DAT APPEAL DATE 20070531 20090531 20070531 20070531 20070531 20070531 rR, �j S p UfC LU 17 7 ]UrtiYl u I v u UIIII 111GI 111veD 18alIuI DCI 00643779 PAGE 4 OF 4 TRK#: 101981101 h� SENTENCE DISP EFF DAT FINE $650 20061220 09 ARRESTED 20080304 AGENCY: IA052DSCO NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 TRK#: 1AO03K401 COURT DIOP091TION AGENCY: IA052015.7 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER • 1978 COURT CASE ID: 06521 ACCR002542 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A0031(401. SENTENCE DISP EFF DAT SUSPENDED FINE $625 20060523 FINE $625 20080523 SUSPENDED PRISON 2Y 20080523 PROBATION 2Y 20080523 SUPERVISED PRISON 2Y 20080523 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OP OVILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCS. IN THE ABSENCE OR FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIR14 OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOVIRY. DIVISION OF CRIMINAL INVESTIGATION IY U. JI 14 I. 7 h� CFl ,kms