Loading...
HomeMy WebLinkAbout16-0301 r t w ley rlll���, 41 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. J(p-- (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 First 2. Address (REQUIRED) \aC)to 3. Contact Information (REQUIRED) Email: Middle Last <l.Cacr Cell Phone: via email) l 4a. Chauffeur's License expiration date (REQUIRED) O 0 —O a a b. Taxicab Business Name (REQUIRED) _`{ Pll s .�Cr. b nF 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? Type of offense Where owe When l it Fns4tnc. c1F �� �•.� �c>`rr� �.t,a t�-.e � 'i<'. `t5 What happened to the /char�Circle one) � Convicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? UC,\ Type of offense What happened to the charge? (Circle one) Where When 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? 1dO Type of offense Where When h.J g\ 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the rljme(s),. DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERD a i TIFIE DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW C.ri You must apply for an individual Department of Criminal Investigation Report (form available upoth request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby cetify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ��i(_4-\ �� issued on r ,a-O'T-A expiring onoa/U3 (aoa� . 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 j �7j L U-0 Date a - f '� - t o STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this Iq day of m' rol" I Notary l and for the State f Iowa 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license Signature of Poli f 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. SignAture of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ate t clerkrFAXIoRN6ADGEA.PPLe2014amend.d.00c 0312015 o��Feo.i7. 2016 3 0 0 P .. ab c, Div of Criminal Investigation .c,v •rrr. STATE OF IOWA Criminal History Record Check Request Form (FAX)319339271.Ne' 7333 P. 1/ 1005 Too Iowa Division Of Criminal Inv05tlgatlon Support Operations Bureau, 1'1 Floor 215Z Ta Stroet Des Maine$, lawn 50319 (515) 725.6066 (515)725-6080 Fax DC1 Account Number: _,9967•F aropplleeble) From, Xa)leW Cab of Iowa Ci P.O. Box 428 Iowa City, TA—. 52244 (319) 338-9177 Phone: Fax; (319) 339-7302 We L171aemale Tom^ Waiverinfarmallon Without a rlgnod walver from the sub cct otthe a Ob reltaro a able, per Coda of Iowa, Chpptar 691.2, For co. molete crlmtnpl hl toru0et, u complgte crlmtnel history record 'Pay not oblata a Waiver nature from the rub act of the Co U06tr Y record Intor511at10n, ea allowed by law, n.lwnys Waiver Release: I hereby give parmis310n The tho above raqueslfng olpcinl to conduct en Iowa o )nvcslir*lion (DCO, My criminal hluury data *once a ms Iha1 h lnalelelned by Ih0 Del may be rolaaaed os e11100WOR by la chuck W)Ih the Division orCeiminal Waiver Slenalure: ,� / Ar� 11'1 Pki w As ofLEZJ ,-, a scorch of the provided name and date of birth revealed: y� No Iowa Criminal History Record fotmd with DCS /D Iowa Criminal History Record attached, DCT f! -- c:: oCi Initlals DCI -77 (08/25/10) Received Time Feb. 10, 2016 _ 2:50PM No, 7073 oai�_°_,�,_• Zvio2 3gr)Pm ab �Uiv of Criminal Invesligatiun (Fax)aissssvaNc 7333 P. 2/10 »,.a5 DCI Account Number 996']-F TGI Ic1ra Devlaion of Criminal lrlvolligatlon (Irbpplfeebtej �` Support t7 trew ons Bureau, P Floor 1tr°ml Fellow Cab orlowa Clty 21S 1 , Te Striae P.O, ox 428 Des Moines, reale 40719 (515) 725-5066 Iowa City, IA, d22d4 (515)'729-6080 Fax (319) 338-9777 Phone: I am re ucstln an Iowa Criminal Iliisto Reoord Check on; Fail (319) 339-- Last Nm aa m.ndua F1rst Name (mnd.to Middle Napie recommended) P'ts Of 131rth (mindere) e p, Crehdor (mand.a SociabSocur! Number roeommended) a � 3•. 1 1��% ❑Ma1e �/ WatverXn orNrarlom, L»Fohlale Wlthout a signed rvalvar from the subJcct of the re watt be releaeahec, per Cods Of10wa, Chapter 692.2, Bor co oblaln a waiver sl nefure trp—�lllfltg erlmCnal history record ntorm tion taalallorved bydaw, always Information to the rub act of the re ucst. WatveY R0194Set I hereby give permission Ibr he above (cuertln e Inraaeeil0n(i)CD• Mycrlminolhhtarydataconoemi.... reQ7"IngrItpedytocondurinn(oua J erlmfnalhlneryre0erd Check wflh the Dlvfslon orCrlminal I QQ y Ihho DC may be rofeucd u .dewed by JAW, Waiver Signature; _ t 114 1 A t" 1 h Y L_ n As of �„�Cj-,� �„ a search of the provided name and date of birth revealed; No Iowa Criminal History MCaOrd found with DCJ Iowa Criminal History Record attached, DCT# 5�SOBF. i DO Initials •1 J DCI -77 (08123/10) Received Time FeV 10. 2016 2:50PM No.7073 r„ Mcf. rf only) Cb' ?i q TXT J A 02v-re0,17. ZU16� 3;OlPM ab Div of Criminal Investigation (FAX)3M3827CNo' 7333 P. —05 As of Z�,�•�ica-----___ a Search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCT r e:' Iowa Criminal History Record attached, OCI # 3 ( �x DCI lnitlels r DCI -77 (08/25/10) Received Time Feb. 10. 2016 2:50PM No.7073 DCI DCT A000unt Number; —9967.F To: Iowa Division dtCrlmina) investigation gropp;iceblc) Support Operations Duraau, V Floor 315 R. 7' Straw Prom: Yellow Cab of Tows Cl D" Moines, Iowa 50319 P.O. Box 428 (515) 72y6066 Fax, Xowa Clty, L4. 52244 ((515)'725-6080 (319) 338.9777 Pnonor 4� -"` Yy FA X1 (37f9) 339-7302 I am re uastin an Iowa Criminal Histo Record Check an; Last IYAmO mmdamry) Hirst Name mandaio )' Middle NamC (recam'mcnded) u�C�n Dare of Hirth mended ) Gehdeb menden SOCIah$OCUri N11 rIlbCP (racnmmanded a ❑Maceemal0_/� Wnlver Informallon; Without be a signed waiver from the subject of the roqueel, a compiglo yrttnlnal hletory rcaord gray not ahreln aswalvep sl nature from the s bIyal loeot 2 the Forcomnlate criminal hidInformallon, as allowed by Lowe oast Always WalW jje/eaSe;1 hereby Blvd pemslsrlon for Iha above requ,,,,n, dlnalel ld aanduv An lows criminal hisldry roaord check wllh ]he Dl InvellBallaa (DCO. My criminal hh1my due aonde nB rnr (her 1,melnmined by Iha Del may ba lelearad vhlan of Cominel Walver57vhah., ., t %/-) 0 0� , — r. u 4110mu by low. — rti ' As of Z�,�•�ica-----___ a Search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCT r e:' Iowa Criminal History Record attached, OCI # 3 ( �x DCI lnitlels r DCI -77 (08/25/10) Received Time Feb. 10. 2016 2:50PM No.7073 (DCI uta aniy) a° 4� -"` Yy Fe b.lj'. 2016 3:01 PM Div of Criminal Investigation No. 7333 P. 9/10 DCI:00356308 NAME: CASTILLI,SUSAN CASTILLI,SUBAN LEE CASTILLO,SUSAN LASCHKS, SUSAN LEE MIELL,SUSAN LSE MISLL,SUSIE 1302 SEX RAC 19670203 F W ADDITIONAL IDENTIFIERS SC L CHK SC L FOR SC R LEG SC R SHLD SC R THOM TAT CHEST 01 ARRESTED 19870103 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY HOT WGT 506 130 CCH RECORD w++ DCI 00756308 PAGE 1 OF 2 DATE PRINTED - 2016/02/15 EYE HAIR SKN POB SRO WIN MED IA AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L31555901 COURT DISPOSITION AGENCY. IA052015J JOHNSON CO DIST COURT COUNT NO� 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31555901 SENTENCE JAIL 2D FINE $500 02 ARRESTED 19911111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRK#; L31556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE; IA321J.2(B) OPER VSH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: L31556001 SUESTANCF A9USE EVALUATION SENTENCE JAIL 71) FINE $750 DISP EFF DAT 19870220 19870220 Fe b. 15. 2016 3:01 PM Div of CrimloaI lovestigatloo 03 ARRESTED 19950612 AGENCY: IA0530000 JONES CO SO CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESS TON/CONTROLLED SUBSTANCE TRK#: 014024302 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 02 IA STATUTE: IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014024302 SENTENCE FINE $250 04 ARRESTED 19970512 AGENCY: IA0520200 CHARGE NO- 01 OWI 2ND OFFENSE TRK#: 028039201 COURT DISPOSITION AGENCY: IA052015J COUNT NO- 01 IOWA CITY PD IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE: IA321J.2(B) OPER VRH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 028039201 LICENSE REVOKED SENTENCE SUSPENDED JAIL lY 355D JAIL 365D FINE $750 PROBATION 2Y DCT 00356308 PAGE 2 OF 2 DISP EEE DAT 19970617 DISP EFF DAT 19970813 19970813 1997DB13 19970813 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, 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 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 INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 7333 P. 10/10 Fe b. I§ 2016 3 00 PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI ;00356308 NAME: CASTILLI,SUSAN CASTILLI,SUSAN LEE CASTILLO,SUSAN LASCHKE,SUSAN LEE MIELL,8USAN LER MIBLL,SVSIE DOB SEX RAC HOT WGT EYE 19670203 F W 506 130 BRO ADDITIONAL IDENTIFIERS SC L CHH SC L FOR SC R LEO SC R SHLD SC R THGH TAT CHEST CCH RECORD "' DCS 00356308 PAGE 1 OF 2 DATE PRINTED - 2016/02/15 HAIR SKN POB BLN MED IA Ol ARRESTED 19870103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L31556901 COURT DISP091TION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J,2 OPER VEH WH INT Owl CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31555901 SENTENCE .TAIL 2D FINE $500 02 ARRESTED 19911111 AGENCY: tA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRK#: L31556001 COURT DISPOSITION AGENCY- IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(8) OPER VEH WH INT (OWI) / 214D OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31556001 SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7D FINE $750 D15P EFF PAT 19870220 19870220 No. 7333 P. 3/10 •, r Feb. lb. 2016 3:00 PM Div of Criminal fnvestlgation No. 7333 P. 4/10 03 ARRESTED 19950612 AGENCY: IA0530000 JONES CO SO CHARGE NO- 02 IA STATUTE IA124-401-3 P09E991ON/CONTROLLED SUBSTANCE TRK#: 014024302 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 02 IA STATUTE; IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIJUANA CHARGE CLASS; MISDEMEANOR CONVICTION TRK#: 014024302 SENTENCE FINE $250 04 ARRESTED 19970512 AGENCY: IA0520200 CHARGE NO- 01 OWI 2ND OFFENSE TRK#: 028039201 COURT DISPOSITION AGENCY; IA052015J COUNT NO- 01 IOWA CITY PD IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE; IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 028039201 LICENSE REVOKED SENTENCE SUSPENDED JAIL 1Y 355D JAIL 365D FINE $750 PROBATION 2Y DCI 00356308 PAGE 2 OF 2 DISP EFF DAT 19970617 DISP EFF DAT 19970813 19970813 199'70813 19970813 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. 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 A88ENCE 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 INQUIRY, DIVISION OF CRIMINAL INVESTIGATION \ y c-, Fu ca 02,1 201.6 20161s 3:O1PN�ae Div of C, �minaI Investigatloo No 7333 p 5/10 •� (FAX)31933827Ldu r. uuJi J05 STATE OF IOWA Criminal History Record Check �pROgUest Form Tor Iowa Mvlslon Of Criminal Investigation Support Operations Bureau, 1" Floor 215 $, T" Strout Des Moines, ►o$va 50319 (515) 725-6066 (515)•725.6080 Fax DCI Aeoeunt Number; 9967-F Prom: IlrFppllcebls) From: Yellow Cab olIowa CI P.O. Hex 42$ Phonol Fazl % ©Malo 215emnle Iowa MY, 1A, 52244 (319) 338.9777 (3X9) 339-7302 •• -• ublo, par Code Without a sl- waiver from the eublout of the request, a oompigto Criminal history rocord may not be ralenaebler per Code of lolva, Chnpter 492,2, For complete erlminal hlrtory.reoord Information, oblaln n waiver sl nature 11•om the sub ecl of the ro uest. n, as Allowed bylaw, pJways W'71Ver i{eIeare:1 hereby siva permlrsloa ter Ilio above requonling oalalal to Invertlaellan (OCl), eonduolIrlowsoriminllblalolAnyerlminolhlstorydstecenaemin6me ryoord shack wllh the Dlvlllan of CrlminllIal if mAlnllincd by the [Kf pity be ")owed m allowed by IaW, h Waiver Signature, As of a Search of the provided name and date of birth revesl'nd: U7. ❑ No Iowa CFlminai History Record found with DCI c' C'3 4\ Iowa Crilnilial history Record attaolled, DCI 9 DCI initials — DCI -77 (08125110) -Received Time Feb, 10. 2016 2:50PM NO - 7073 Feb.1.52016 3�01PM DCI :00356308 NAME. CASTILLI,SUSAN CASTILLI,SUSAN LEE CASTILLO,SUSAN LASCHKE,SUSAN LEE MIELL,SUSAN LEE MIELL,SUBIE DOB SEX RAO 19670203 F W ADDITIONAL IDENTIFIERS SC L CHK SC L FOR SC R LEG $0 R 5HLD SC R THGH TAT CHEST Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY HGT WOT EYE 506 130 BRO CCH RECORD **+ DCI 00356308 PAGE 1 OF 2 DATE PRINTED - 2016/02/15 HAIR 8" POB BLN MED IA 01 ARRESTED 19870103 AGENCY! IA0520200 IOWA CITY PD CHARGE NO—, 01 IA STATUTE IA321J-2 OWI TRK#: L31555901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTEe IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31555901 SENTENCE JAIL 20 FINE $500 02 ARRESTED 19911.111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO— 01 IA STATUTE IA321.T-2 OWI/2ND OFFENSE TRK#: L31556001 COURT DISPU9ITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; L31556001 SUBSTANCE ADUSE EVALUATION SENTENCE JAIL 7D FINE $750 DISP EFF DHT 19870220 19870220 No. 7333 P. 6/10 J m C[C Q9 Feb.15 2016 3:01PM Div of Criminal Investigation 03 ARRRSTBD 19950612 AGENCY! IA0530000 JONES CO SO CHARGE No- 02 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE TRK#: 014024302 COURT DISPOSITION AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 02 IA STATUTE; IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRA#(; 014024302 SENTENCE FINE $250 04 ARBBSTBD 19970512 AGENCY! IA0520200 CHARGE NO- 01 OWI 2ND OFFENSE TRK#r 028039201 COURT DISPOSITION AGENCY; IA052015J COUNT NO� 01 IOWA CITY PD IA STATUTE IA321J-2 JOHNSON CO DIST COURT IA STATUTE: IA321J,2(B) OPER VBH WH INT (DNI) / 2ND OFFENSE CHARGE CLASS; MISDEMEANOR CONVICTION TRKY: 028039201 LICENSE REVOKED SENTENCE SUSPENDED JAIL lY 355D JAIL 365D FINE $750 PROBATION 2Y DCI 00356308 PAGE 2 OF 2 DISP EFF DAT 19970617 DISP EFF DAT 19970813 19970813 19970813 19970813 No. 7333 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, 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 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 INQUIRY, ` DIVISION OF CRIMINAL INVESTIGATION -.1 "J cn ,, P - 7/10 CIowa Department of Transportation oftetfOrrvef&ervwm (iollFrees WO 5311121 PO GMWN. des 110008S, to 502106 9M515-244-9124 AW FAX- 515239 1831 Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 03/03/2011 621528 IA 05/09/2012 685189 1A Name: Phelps, Susan Lee DL/ID: 846AA4543 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify 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. N In witness whereof, I have caused my signature and the seal of the Department to be set upon this dacument,..`4,@ Ankeny, Iowa this date: - •' �l r Vf rll 2/11/2016 •.�•• IOWA D. Q. T. i` % Office of Driver Services Iowa Department of Transporation Certified Abstract of Driving Record Inquiry Date: 2/11/2016 DL/ID #: 846AA4543 (IA) Customer #: 5084794 Name: Phelps, Susan Lee Class: D ID Status: EXP Address: 1206 E COURT ST Audit #: 7769558 DL Status: VAL Issue Date: 02/07/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/03/2022 CDL Cert Status: None 522403234 Endorsements: 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522403234 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number ]UR 03/03/2011 621528 IA 05/09/2012 685189 1A Name: Phelps, Susan Lee DL/ID: 846AA4543 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify 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. N In witness whereof, I have caused my signature and the seal of the Department to be set upon this dacument,..`4,@ Ankeny, Iowa this date: - •' �l r Vf rll 2/11/2016 •.�•• IOWA D. Q. T. i` % Office of Driver Services Iowa Department of Transporation Name: Phelps, Susan Lee DL/ID: 846AA4543 h> Cl ._. Iowa Department of Transportation i! thr5E Oi CJrevrr �c rvic 11011 F mej Z'A1tk 91 " 1111 P,7? 8iia 12i)P1 UCS Winn , aA 50J06 12,51 516-244-91,24 h?altillA, 239 18'3( Certified Abstract of Driving Record Inquiry Date: 2/11/2016 DL/ID #: 846AA4543 (IA) Customer At: 5084794 Name: Phelps, Susan Lee Class: ❑ ID Status: EXP Address: 1206 E COURT 5T Audit #: 7769558 DL Status: VAL Iowa Department of Transporatlon Issue Date: 02/07/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/03/2022 CDL Cert Status: None 522403234 Endorsements: 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522403234 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR 03/03/2011 621528 IA 05/09/2012 685189 IA Name: Phelps, Susan Lee DL/ID: 846AA4543 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify 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, 4 Ankeny, Iowa this date: c" s 'yry�fyhirif�t*t t�- • l,0 2/11/2016AF `a... Office of Driver Services Iowa Department of Transporatlon r Iowa Department of Transportation C rii of @.jwv tL"r N:es { Poll Freel t x) h { 7 1121 P0 61w K(A. €Ics m1 iw;, Sal riwm 022 515-244-9124 i-AX 515 23 4 183 7 Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Certified Abstract of Driving Record JIUR Inquiry Date: 2/11/2016 DL/ID #: 846AA4543(IA) Customer #: 5084794 Name: Phelps, Susan Lee Class: D ID Status: EXP Address: 1206 E COURT ST Audit #: 7769558 DL Status: VAL Issue Date: 02/07/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/03/2022 CDL Cert Status: None Iowa Department of Transporation 522403234 Endorsements: 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522403234 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JIUR 03/03/2011 621528 IA 05/09 2012 685189 IA Name: Phelps, Susan Lee DL/ID: 846AA4543 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify 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�nkeny, Iowa this date: t�Txw,IIFrMyil 2/11/2016 _- e7 to s IOWA J 99 e i'+r. 8811 Office of Driver Services Iowa Department of Transporation