The URL can be used to link to this page

Home My WebLink About16-082VIII CITY OF IOWA CITY 110 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. (Office Use Only) 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 Middle Last 3. Contact Information (REQUIRED) Email: S21 e i.y rl e ✓so�Ev s Gan Cell Phone:3/r/—rr r— qla / (All written communication sent via email) 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) R Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When What happened tithe ic a g (Srcle one) L 0 rts- ` J1 2 dc) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? 111, 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? 46 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 themame(sf DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE -VIEW .11 You must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereb ce tify that I h v issued to me by the Iowa De artmept of Transportation vali C uffeur's license number �S✓ C C �/ issued ono' 6 / expiring on�I understand that if 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 ot,�itle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applican/ Datgr� d a'� ***********xx**x**x*ww*+x+w*+*++++*+****x£*xxxx**x*xxxxxxxxx*xx***xxx*xxx*xxx*xx+xxxxxxxx*****wwwxwwww++x*£++*x*******xxk*x***xx*xxxx**xxxxxw+** STATE OF IOWA ) COUNTYOFJOHNSON ) sworn to before me by �� ,, o (_ . �)Q 730✓v�, on this j day of 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of-fif is license ignature of Police Ch1 o.rAesignee 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. Signat f City Clerk or designee Date P�- Office Use Only - Approved application DCI report r4, State certified driving record Website update o cierkrrAXIDRNBADGE PPL92014.m.nded.Doc 03(2015 C4 10WA00T SNIARTER I SOMPLEF I CUSTOMER DRIVER 1P{WiS7.i0�Nt C tat. 0�1 Office of Driver Services PO Box 92041 Des Moira=, IA W306 -9i Phare- 515-24&c1241800-532-1121 1 Fax: 516-239-1837 www. ov,aootgov Certified Abstract of Driving Record Inquiry Date: 4/5/2016 Dil #: 255CC3772(IA) Customer #: 3745296 Class: D Name: Newsom, Cheryl Lynn Audit #: 9904463 Address: 1 APOLLO PL Issue Date: 04/01/2016 ID Status: VAL Expiration Date: 11/28/2018 City/State: IOWA CITY, IA 522403001 Endorsements: 3 Mailing 1 APOLLO PL Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522403001 Supplement: City/State: Date of Birth: 11/28/1954 Sex: F History Information Convictions CDL Permit Class: None CDL Permit Issue Date: None CDL Permit Expiration None Date: 4/5/2016 CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: VAL DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None :ltatian Crate Conviction Date ACD Explanation County JOR 12/11/2005 ',08/03/2005 'A20 '.Operating While Intoxicated Johnson '.IA Operating While Intoxicated Test Refusal/Test failure Violations )c"'rrari ".CD Expianotion TUR 12/11/2005 A98 - OWI Test Failure -- ]A Sanctions ry"e Effectige End ADD Explanation Occurrence Jur TUR tevoked X06/30/2005 12/27/2005 -A98 OWI Test Failure ❑A °IA Name: Newsom, Cheryl Lynn DL/ID: 255CC3772 Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, 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 1 have been authorized by the Director of the Iowa Department of Transportation to so certify. - In witness whereof, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date ry c n B/`�i - e �p0: • �4 4/5/2016 IOWA Driver Services _m of _ aDepartment Transportation Iowa O Name: Newsom, Cheryl Lynn Dil 255CC3772 oA/�Apr.,B. 20162 �Dlv of Criminal Investigation No 1999 P. 1 "'1 (✓:AX)319338271.� ' ,,,J2l002 n MuSTATE , IOWA i Criminal History Record Check Ta: Iowa DIY1310h of Criminal lnvestlgatlon Support 0peratlon3 Eureaa, In Floor 115 E, Ya Street Des Moines, Iowa 50319 (515)725.6066 (515)'725.6080 Fax" I am remuestinp A. t..w. rm...1..e ve..__. DCX Account Number; 9967-F (![applicable) Fromt Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA, 52244 (319) 33B-9777 - - Phone: Fax: (319) 339,7302 _ __ _ ....—.—. Last Natno (nrondat ) •�--u,M �a.W4 VIA First Name mandomVY Mitldlo Name reoommeb4ed e. KISO/>7 r L Date of Birth (mandcr/ayy)jT Gender mandom Social Beourl Number(recommended) QC ! 7J ❑Male P'F'emalo WalverXrformaffon; Without a signed waiver from the subject of the regpost, a oomplgte prlminal history record may not be releasable, per Code or lows, Chapter 692,2. For fpmhlcte criminal history,recor(1 information, as allowed by law, always Obtain a walver sl nature from the subject art'ra uestr %�a/V8r giv it8l8f1Se:1 hereby e permhslon Por the above requeanng or ieial io wndudl an Iowa orlminol history reoerd cheok whh the Divlaton ofCriallna( Invese[sailon (D GO. A.9hktory data conceming me thnl la maintained by the DCl may be mleaaed as allawad bylaw, Waiver signalurer xuwn !gjanilulat Aisrory.Kecora unecK xesui (DofWo onlyY' As of }o a search of the provided name and date of birth revealed: ~' J -L; .. ❑ No Iowa Criminal history Record found with DCI, f) Iowa Criminal History Record attached, DCI # 3 \A DCI initials DCI -77 (0812$/10) Received Time Apr. 7, 2016 3:.54PN No. 1391 Apr..,8. 2016 3:41PM Div of Criminal Invesh gah on No, 1999 P 2 IOWA CRIMINAL HISTORY DCT 00324387 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED - 2016/04/08 DCT:00324387 NAME: NEWSOM,CHERYL LYN NEWSOM,CHERYL LYNN NEWSOME,CHERYL LYN DOE SEX RAC HGT WGT EYE HAIR SKN PDB 19541128 F W 504 160 GRN BRO MED MO ADDITIONAL IDENTIFIERS SC RF ARM TAT CHEST CCH RECORD *** 01 ARRESTED 19841109 AGENCY: CHARGE NO- 01 ARREST DATA NOT RECEIVED TRK#: L26916401 COURT DISPOSITION AGENCY: COUNT NO- 01 IA STATUTE: IA715-6 FALSE USE OF FINANCIAL INSTRUMENT CHARGE CLASS: FELONY CONVICTION TRK#: L26916401 SENTENCE PRISON l0Y CUSTODY AGENCY: IA052015M OAKDALE IMCC A 19841109 RECEIVED CRIMINAL COMMITMENT CUSTODY AGENCY: IA077015G ADULT PAROLE SVC B 19850919 PAROLED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19890810 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 02 ARRESTED 20050211 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE YA32IJ-2 OWI TRK#: 101433801 CHARGE NO. 02 IA STATUTE IA124.401 POSSESS PRECURSORS TO MANUFACTURE METH TRK#: 101433802 _. .._J ...6. COURT DISPOSITION - .,• AGENCY: IA052015J JOHNSON CO DIST COURT_' COUNT NO- 02 IA STATUTE: IA321J.2(A) OPER v9H WH TNT (OWE) / IST OFFENSE CD COURT CASE ID: 06521 FECR071465 Apr., B. 2016 3:41PM Dlv of Criminal Investigation DCS 00324387 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101433801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT JAIL 4811 20050803 FINE $1000 20050803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(3) DISTRIBUTION OF EPHEDRINE COURT CASE ID; 06521 FECR071485 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 101433002 SENTENCE DISP EFF DAT SUSPENDED JAIL 365D 20050803 JAIL 365D 20050603 FINE $250 20050503 PROBATION lY 20050803 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. NE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION m No. 1999 P. 3