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Home My WebLink About15-297� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. lava 52240- 1 826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) 3. Contact Information (F IDENTIFICATION NO. C.1_5 —Q q (Office Use Only) APPLICATION FOR TAXICAB i 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 4a. Chauffeur's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _Vf- 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonias in this State or elsewhere? Tyoeofoffense See Ccr{ F. rydd it",, "W ere Zc�D bw JC 6 When g What happened to the charge? (Circle one) 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? 'ylrS Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATECtATIAED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RI VIEWI--,-! You must apply for an individual Department of Criminal Investigation Report (form available upsi? request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her c tha I ayye issued to me by the Iowa Department of Transportation a valid Chauffeur's license number lD issued on l d $ ?6l' expiring on a I lb o� U) e I understand that if I falsely answer any questions in this application, that this application may be denied. Igra` ed 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) tp Signature of Applican/)� n V r tel/ t Date ; U fj� STATE OF IOWA ) COUNTY OF JOHNSON ) 1 � Subscribed and sworn to before me by Cns� n �r�r�V�;��1 Q.t\ on this 1� h day of in and forihe State of Iowa 317 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 Chauffe is license �7/� "?0 2, Signature of Police Chief or ee 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. SigSig ce of City Clerk or designee ate Office Use Only ; - � Approved application ti DCI report State certified driving record o Website update ClaWTAxIDRWBADGEAPPL92014amended DOC 03/2015 C't'; 4. . �. D O 1� it3i�t3t.C,�Q"v ,. S,AAA FBI 1 51MPLgF I CUS TO Nfff DPIVEN.rra..•,.._— Office of Driver Services PO Bax 9204 Des Moines, GA 50306-9204 Ptime: 515-244-9124 i 800-532-1121 1 l 5.15-239-1837 v, Wim olWaaaf.gvv Certified Abstract of Driving Record Inquiry Data: 12/8/2015 DL/ID #: Customer #: 4470052 Class: Name: Mitchell, Martha Irene Audit #: Address: 633 BEACH VIEW DR Issue Date: 12/06/2015 COL Permit Endorsements: Expiration Date: City/State: IOWA CI i IA 522465899 Endorsements: Mailing Address: 633 BEACH VIEW DR Restrictions: NONE DL Status: Restriction Mailing IOWA CITY, ]A 522465899 Supplement: City/state: Cl Permit Status: ELG Date of Birth: 10/22/1971 None Sox: F None Convictions 0135BB496 (IA) Cl Permit Class: None D CDL Permit Issue Date: None 9624604 Cl Permit Expiration None Driving While Barred Date: IA 12/06/2015 COL Permit Endorsements: None 10/22/2022 CDL Permit Restrictions: None 3 ID Status: VAL NONE DL Status: VAL None Cl Status: None IA Cl Permit Status: ELG ,02/10/2014 Cl Cert Status: None IIA Cl Med Status: None History Information Citation Date Cunvlctice Date ACD Explanation County all 09/20/2006 12/20/2006 821 Driving While Barred Johnson IA 07/D/2011 10/20/2011 820 Driving While Suspended, Barred, Cancelled, Revoked Johnson IA 12/04/2011 .01/04/2012 B51 No Driver's License Johnson IA Sanctions Type Eftact,N. End ACD Explanation Occuaence IVR )UR Barred _ __.. p5/28/2000 J _. _05/26/2011 _...... 'W Ol _... Habitual Offender ]A ]A Suspended 12/16/2011 .12/14/2012 D27 iViolation of Probation IA Suspended 02/11/2012 02/09/2013 D27 Violation of Probation ' IA Suspended 06/25/2012 ,02/10/2014 B63 Fall to Refile SR22 IIA '.IA Suspended 11/07/2012 .03/11/2014 D53 Non -Payment of Iowa Fine 'IA IA Suspended 11/07/2012 03/11/2014 :D53 Non -Payment of Iowa Fine :IA IA Name: Mitchell, Martha Irene DL/ID: 013BB8496 Pursuant to Iowa Code 4321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 am the custodian afire retards 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: �2 il 121BY2015 sem: IOWA':='FIT fel •�'e r.. Y ®f r11� AAIYEN Office of Drive Se vlces ... pe , Iowa Department of Transportation _. __:,.� •-.� n..; Name: Machell, Martha Irene DL/ID: 013668496 q �_ FdeC11 1D15V y: J1 HV�c, orUIV G1 �r lml na.I_J—n V_$tlgd?1011 j 11 12/10/¢o16 17:4 gs43A 0041004 PreDec, 10. 2015- 4:liP.M Div of Criminal InveslrBalion No. 3682 P. 3/3 ._._... _ el ir.• vi..-.. ...,, ..�-.-__. 12/10/2016 16:1- ,.04, P„Otc. 3, 2D15� 9:OIAM�Pr1Dir of Criminal Invesliealian N'o.3430 +2/06/2016 14:4- .,g4a , ,.,�✓COR STATE OF 10W.A C-0111inal %stoly Record Check ” c DCI Accoval N411rbr1: e4002� (ihvp 'cc; lows Olvlrlaa At Crh0lnal 111VIAl�orlcn rinE al Bnlq,erl0pel•e(,6,Icpurtau,10,rip 0r 17TowQ(yeflowaCClty 1y. 7" Simi CI(y Cleplt'r 0m"— 246o Del MoOter, lows. 90319 q10 E, wash in pion fllrta (slsl7xs-co(a /rS IDP G IF Rowe c( sys�p (515)725-0000 Lai - _ A N, Pbonc; 319-x56,011 P UR IS FUhily� 3194,0.9gg7 '�— eK; I, 11 — &°� 1��, a Jell ch 011"tho providod nomo and dale of birth eeveeled. - o No fovea C1i,nin01 His(ay liecard found with DCI ws 1 amtFZ 101Va L1111111IA1 Iiislply Rccord ahaohed, DL'I 1J25 IM I'liliAls I)C677 (06/25/10) r- Rectivtd Time Dec, 6. 2015 1,31PM No. 3367 J Received Time Dec. 10. 2015 2:03PM No. 3633 Received Time Dec 10, 2015 4:37PM No. 3075 Uec 11. 2015 N: Dec. 10. 2015 4 FrO mlClly OI IDbiP RAM Uiv of Criminal Investigation —,> Cl ern ..,..ter cid' as o e Pai :15PM Div of Cfiminal Invesligaticn filly 0I611t olllce 319 36664 P7 Vo,jll4 r. I 12/10/2316 17:45 W343 P.003/004 ho.3682 P. 2/3 12/10/2016 16:13 N341 C,n021003 STATE OF IOWA Criminal History Rcco, d Check Ftequesi Form To: Iowa Dlvlslor, of Crhnioal IllvViNgaliml Satrpurt Upereefuns Bureau, 1" Fluor 215 E,1" Street Des Molncs, Iowa 50319 (5[5)125.6066 (515) 725-6080 Rea I sill reoueseine en lnlua rt i,„i,..l 1J:r-,•...•n,.___j - DQ Accouul Nombtr; (if teVlicfihl,) Prdtrf: City Clorldh• Ulfrca _410 4, washiLg oll 5treot �_ Iowa CII • LA 51240 Fhoue: 319.3565041 _ 1 a ; 319156.5-97 ` Lastn�inn,e mnnd—foI.I First mudr1�lalqNfiddle (rwNfeoUnpm�lrbn4eoral S �astNe._ rName n� Tate Ofh4A (mandato I e MaName mendnoly) cialSecuitener ltrrconin,nd,o 3LI 6 — 6LI`10�3 rfruvef•trl/0rrrftrrl04u wllhoul a signed waiver from thesubf ect of (he request, a complete Criminal pillory record may not beraleseable, per Code of lowli, Chapter 692,2, Foros molefe eeinlinal history record imformatlon, as ailolled by taw, always 01110in . WOiyae lien.fil— R-.— 1h- WitiverRefeare:)hefebygiwapemlileionfotlllcatovC/oglluliogolyichllacande i")all, "j dlllpop leeefdCheck+\dUl hetlNidionof6imiml InvefligaUml (DCO. My eri.final bislory da(a eonuming Ihu Iceby Ills [ Nry be mha of a0e+ve0 by l w•. Wrtivel Sigrlaltere: ll _I .lDP,��L. lU -.��v�v vge.v��awJ4tW (bC14fa nalrl AP of a search of the provided Dame and dale of birth revcaltd; _ 'a NP Iowa Criminal Ilis(ory Record found lvilh DC) 10)','a Crinlinid )elistu{;y Record otlacbed, DCI ii_ b � � 0i I'i,' -j O DCI -77 (Dwsll0) Received Time Dec, 10. 2015 2:03PM No, 3633 Received Time Dec, 10. 2015 4i37PM No. 305 )60 11. 1015 9:3DAM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCS 00643779 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2015/12/11 DCI.00643779 NAME: SEALS,MARTHA IRENE DOB SEX RAC HGT WGT EYE HAIR Sm POB 19711022 F B 505 220 SRO ELK DRK IL No. 9114 N. 1 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y T'A'T BACK TAT R ARM TAT R SHLD CCH RECORD +** 01 ARRESTED 20010504 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA32IJ-2 OWI TRK#: 100231001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA32Y.2(A) OPER VEH WH INT (OWI) / 1ST OFFENSE COURT CASE ID: 06521 OWCRO58729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100231001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010626 PROBATION 365D 20010626 COMMUNITY SERVICE 25H 20010626 REVOKED 20020603 02 ARRESTED 20020912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRK#: 100655601 COURT DISPOSITION / AGENCY: IA052015J JOHNSON CO DIST COURT ✓ COUNT NO- 01 IA STATUTE; IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCRO63252 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100655601 �~ DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT APPEAL .OlATZ pEPERRED JUDGEMENT 20030417 20033,01,7<-;. [s PROBATION 365k3 20030417 - - —' REVOKED 20040604 - JAIL 7D O Uec. II. ) 0 1 h 9:31)AM U i v o7 Gr1rrioaI I n v e s I i g a t i on DCI 00643779 PAGE 2 OF 4 IV 0.7!14 Y. FINE $1000 <r+ ✓ 03 ARRESTED 20021006 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-21 �. 9 DRIVING WHILE REVOKED TRK#: 1006811.01 COURT DISPOSITION AGENCY: IAO52015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE ID: 06521 SRCR063497 CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 100601101 SENTENCE DISP EFF DAT FINE $1000 20030417 04 ARRESTED 20031017 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVE WHILE BARRED TRK#: 100983901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1976 COURT CASE ID: 06521 AOCRO66791 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100983901 SENTENCE DISP EFF OAT JAIL 7D 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: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 ACCR067915 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101096301 SENTENCE DISP EFF DAT JAIL 70 20040312 IV 0.7!14 Y. <r+ �. 9 1) 11 , 1UI� 9:3UAll 0 1 v of Grimioal lovesI19ation FINE $500 06 ARRESTED 20060128 AGENCY: IA0520200 CORALVILLE PD CHARGE NO- Ol SA STATUTE IA321. 551 DRIVING WHILE BARRED TRK#: 101765501 COURT DISPOSITION AGENCY: TAOS2015J 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#: a01765501 SENTENCE FINE $50 07 ARRESTED 20060901 AGENCY; IA0480000 IOWA CO 50 CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED TRK#: 076183807. COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06481 AGCRO09124 CHARGE CLASS: MISDEMEANOR CONVICTION TRX#: 076183801 _ SENTENCE SUSPENDED JAIL 120D JAIL 120D FINE $625 COURT COSTS PROBATION 08 ARRESTED 20060920 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- Ol IA STATU'T'E 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 OFFENORR - 1976 COURT CASE ID: 06521 ACCRO77279 CHARGE CLASS; MISDEMEANOR CONVICTION DCI 00643779 PAGE 3 OF 4 20040112 DISP EFF DAT 20060505 190 3114 r, 4 DIS? EFF DAT APPEAL DATE 20070531 20090531 2007CS31 20070531 20070531. 20070531 ry u� E 7 C' C3 Uee.11. 1015 9,3UHIVi Div of Criminal InvesIIgaI10n IN 0. DCI 00643779 PAGE 4 OF 4 TRK#: 101961101 SENTENCE DISP EFF DAT FINE $650 20061220 09 ARRESTED 20080304 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1575 TRK#: 1A003K401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AOCROO2542 CHARGE CLASS, MISDEMEANOR CONVICTION TRK#: 1A003K401 SENTENCE DISP EFF DAT SUSPENDED FINE $625 20000523 FINE $625 20090523 SUSPENDED PRISON 2Y 20000523 PROBATION 2Y 20060523 SUPERVISED PRISON 2Y 20000523 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVIESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INOUIRY. DIVISION OF CRIMINAL INVESTIGATION w