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Home My WebLink About16-1511 - t war®4 It 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. JLC7-15-1 (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 rst Last 2. Address (REQUIRED) 7 an --Cno Ih .moi S, Co jw\_l A S � M163 V 3. Contact Information (REQUIRED) Email: il�t^o ,o„� I F„n �, �„h ,' rcn. Cell Phone: 3/r1436 t t (All written con4munica4'dsent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 6] Prior experience in transportation of pa r,r+s(U Rmp �) � 015-- -161 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Pileadlty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? N ( ) 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? �DO 9 Tyoe of offense Where 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes When please provide the ppm 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). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number fi� j ✓ !, issued on 'I t- 1 -I4 expiring on L- 11 . a d . 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) � n. Signature of Applicant Date C9" I (- STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by LA e. r i e±e.C5z) A on this day of A -u -r u c .f `ZO/ LD 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). of river's license or designee � 2 Z 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. Lf - -K_ Si a ure of City Clerk or designee Office Use Only, r, µ, mV+ .., ..... pol W Approved application DCI report folk State certified driving record f Website update ciEr�✓rr�ioRivenocr�.PP�szo�aa,ne„aea.00c 0712016 F,,Hug. 7: SIJ b,v 41 [h PIVI C1 eYUly of Criminal Inve511g t 1 c P oa ioaizona as,No, 9908,e; v-". So2(OD2 STATE ATE OF 20 5°C tS 0 Requegt parnrh 1'u: Iowa Division of Criminal Snvesligafi0n Support 61jeratinan liuvean, 1" Moor 215 E. 71° Stroet Den 16 Ohles, Iowa 50314 (515)')25-6066 (51.5) M-60SU Fax, 1 am requesti j' an 10Wa Criminal History Record Check on DCA Account Number: t-(—O-C=� Grapl,rtanle) Prom: _Cl of Iowa City ___ City Clerhls Office -±10F Wasbin cw )Il stree€ _Iowa Ci1V, TA 52240 Phare; 319-356-5041 Fax: 319-366-5497 ----� — -- — Last Name. (mandatary) -- First NarnC (,nandslory)�1d111C 1rlTatrie (rtcGmmended) 0 V�tSuV)� k3aoca ate of Birth (m ndamty) _ Gebder (manaaTo -) 5il Secur% p l(��,UnClJher( ecuinmEnded nmale emale D j (/ Waiver Inforrrtatioll. Without a signed waiver Prom the sub)ect of the request, a complete crilninsl his(ory record may not be releasable, per Code of 10,72, Chapter 692.2, For complete a,Iminal history retard informa(ion, as allowed by )aa�, ahvays Obtain a w21veF S1Qnaturc from the suhient nrvh. W17iVer IZeieaSe: I hereby give permission for The above «Guesting afliciel to conduct an Iowa Criminal hislM record check ,villi the Division or Criminal hwesligaiinn (PCI). Any erimlual hislory dala ennceming ou Th IV I mainraint b Im DC iffy be «leased as alloud bylaw, —� - Waiver Signature; -- Iowa r11}11I1aHisf01'V Record Cheek Les17lfs --- -- _ fu *)Zr:e only) As of _ a search of the provided name and date of birth revealed: ® No Iowa Ciimina) ldislor, Record found with DCI J - YYY t UJ lu Iowa Criminal History Record attached, DCl # � � � �1 �� `r r — � �ij :J it 1JC1iuilials- ,_! DC1-77 (08/25/10) Received Time Aug. 3. 2016 3:05PM No 0662 Rug. 7YUI6 4:2i)l'm Uiv of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00797997 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00797997 2016/08/05 NAME: DICKENS,CHERYL JUNE PETERSON,CHERYL JUNE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19600614 F W 511 325 BLU FRO FAR IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCN RECORD www 01 ARRESTED 20070301 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- O1 IA STATUTE XA124,401(5) POSSESSION OF A CONTROLLED SUBSTANCE TRK#: 1A000XF01 COURT DISPOSITION AGENCY: IA052015,7 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.414 POSSESSION OF DRUG PARAPHERNALIA COURT CASE ID: 06521 SRCR078311 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1ADOOXF01 SENTENCE DISP EFF DAT FINE $100 20070606 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 'IO 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.9908 P. 6 , OnT WWW,lowadoLgov SMARTER I SIMPLER I CUSTOMER DRIVENd.,.E Office of Driver Services PO Box 92041 Des Mofnes, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 viwiii-madot.gov Certified Abstract of Driving Record Inquiry Date: 8/3/2016 DL/ID #: 556YY1175 (IA) CDL Permit Class: None Customer #: 3689501 Class: D CDL Permit Issue Date: None Name: Peterson, Cheryl June Audit #: 8610921 CDL Permit Expiration None Sanctions Type Effective End ACD Explanation Occurrence JUR Date: Suspended 03/03/2009 10/05/201.4 D53 Non -Payment of Iowa Fine IA Address: 2221 MUSCATINE AVE APT 2 Issue Date: 11/12/2014 CDL Permit None IA Suspended 08/27/2009 10/21/2014 D53 Fail to Satisfy Non -Iowa Citation PA Endorsements: Suspended 08/27/2009 01/21/2014 D53 Fail to Satisfy Non -Iowa Citation PA IA Expiration Date: 06/14/2022 CDL Permit None IA ,.,.0 Restrictions: Name: Peterson, Cheryl June DL/ID: 556YY1175 City/State: IOWA CITY, IA 522406636 Endorsements: 3 ID Status: VAL Mailing 2221 MUSCATINE AVE APL 2 Restrictions: Corrective Lenses DL Status: VAL Address: tm i In witness whereof, I have caused my sig na[ureond the seal of the Department to be set upon this document, at Ankeny, Iowa this date Restriction None CDL Status: None Mailing IOWA CITY, IA 522406636 Supplement: CDL Permit Status: El City/State: Date of Birth: 6/14/1960 Office of Driver Services Iowa Department of Transportation CDL Cert Status: None Sex: F CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 09/27/2008 11/19/2008 B61 VlulaOon of Accident Requirements Johnson IA OS/31/2015 07/07/2015 592 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/27/2008 466934 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 03/03/2009 10/05/201.4 D53 Non -Payment of Iowa Fine IA IA Suspended 03/03/2009 07/08/2013 D53 Non -Payment of Iowa Fine IA IA Suspended 06/12/2009 09/08/2009 WOl Habitual Violator IA IA Suspended 08/27/2009 10/21/2014 D53 Fail to Satisfy Non -Iowa Citation PA IA Suspended 08/27/2009 01/21/2014 D53 Fail to Satisfy Non -Iowa Citation PA IA Suspended 08/27/2009 01/21/2014 D53 Fail to Satisfy Non -Iowa Citation PA IA Suspended 01/20/2010 10/05/2014 D53 Non -Payment of Iowa Fine IA IA ,.,.0 Name: Peterson, Cheryl June DL/ID: 556YY1175 Pursuant to Iowa Code 4321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do i ceruify [haA Pam the custodian a the records held by the Office of Driver Services, that this is a true and accurate copy or an official record currently In the custody of said offfce;Igwi that I have bees authorized by the Director of the Iowa Department of Transportation to so certify. ---- tm i In witness whereof, I have caused my sig na[ureond the seal of the Department to be set upon this document, at Ankeny, Iowa this date ,f-saa'" '... 14,O ��. 8/3/2016 IOWA e: zy f j� Office of Driver Services Iowa Department of Transportation