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Home My WebLink About16-251CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)-356-5040 (319)356-5497 FAX 1. Name (REQUIRED) 1 2. Address (REQUIRED) 3. Contact Information (REQU IDENTIFICATION NO. -as (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 Email: (All 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa Middle U . 5e4(s10y*ndD.COAiCell Phone: 3VY � � 6TZ communication nnJsent via email) r 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 00& Convicted Dismissed Deferred Suspended Plead Guilty _ Other rE2 rT Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When o What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty rn -�l Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? & tJ 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 the name(s) 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 hereb certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number W) A:: A' � (W )-dif issued on expiring on /0—�--/ 9 . 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 provis ns of itle 5, C apter 2, of the City Code. (Needs to be signed in /front of a Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by -f-N mpLt_�m_ L ' e 5 on this day of � )r„).f waee r ZalLs _ /1 r l in and for the State of 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 or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license / 01- /2-i12 �f! Date Signature of Police Chief or designee 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. Sig tune of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update ae�awoarvanocena Ml4a�.DOC 07/2016 r.> ate ae�awoarvanocena Ml4a�.DOC 07/2016 r.> q r— *z �� M r _.: R3 ae�awoarvanocena Ml4a�.DOC 07/2016 Nov, J. LUIb Y:91HNI Uiv of W iminai lnvesligallon Fravnwt,y ur .uwn .-.y JIa/k vogue em--u--e. NO. /J00, r. I/L to/2a/2015 19:61 90 . _/002 Criminal Record Check Request Form To: Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E. 7"' Street Des Moines, Iowa 40319 (515)725-6066 (515)725-6000 Fax 1 romreeaio r..o Tnma f`rinvnnl A'ietn.v Rpenrei Chenlr nn• DCI Account 14wriber: (if nppiieehle) From; City of Iowa City City CIerIPs office 410 E. Washington Street Iowa Cily, Iq 52240 Phare: 319-356.5041 .Fax; 319-356-5497 Last Name (mandatory) First Nanle (nnctndaioW Middle Natue (reconsmendcd) SF'LP IS < 561��t{� Lv�'t^gtrn� Date of Birth (mandatary) Gender (Inarrdatory) Social Security Number (reconsmmded) (D D 9 Dmale EweAiale3 ^7 iO" tj 1) qc1 WaLVer Information., Without a signed waiver from lire subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record Information, as allowed by law, always . obtain a waiver signature from the subject of the request. if,'ai vBr ReieQse; t herebygive permission for rhe above requesting official to Do* nduct an )ova criminal History retard checK irirh rhe Division of Crimipal fnvestigarion(DCI). Any criminal history data eanaemin uthal is maimeined by ilia ACJ maybe released as alloa'edby lase. WaiverSignaiare: - Iowa Criminal History Record Check Results (DCT use only) As of a search of the provided name and date of birth revealed: ® No Iowa Criminal history Record found with DCI , Iowa Criminal history Record attached, DMI DCI iniL10IS -r C U1:1-// (UE/Lw1U) Received Time Oc1.28, 2016 11:38AM No -6375 Nov. 3• 2016 9;h1AM Div of criminal Investigation 110. 000 r. uL 4 IOWA CRIMINAL HISTORY DCS 00777734 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2016/11/03 DCI:00777734 NAME: SEALS,SOPHIA LORRAINE DOB SEX RAC HGT WGT EYE HAIR SKN POS 19721009 F B 506 195 SRO BLR IL ADDITIONAL IDENTIFIERS TAT BACK TAT L SHLD CCH RECORD **• O1 ARRESTED 20060602 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA715A.6 CREDIT CARD FRAUD TRK#; 101882401 COURT DISPOSITION AGENCYi IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA714.2(5) THEFT 5TH DEGREE - 1976 COURT CASE ID: 06621 AOCR076201 CHARGE CLASS; MISDEMEANOR CONVICTION TROT 101882401 SENTENCE DISP EFF DAT FINE $65 20070504 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 Page 1 of 2 -'e�'NUViADOT www,iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines. [150306-9204 Phone: 515-244-91241 BOD -532-1121 1 Fax: 515-239-1837 www.iowadot.gov Inquiry Date: Customer Name: 11/3/2016 YkY.Y.iYF] Certified Abstract of Driving Record DL/ID #: 960AA9824 (IA) CDL Permit Class: None Class: D Seals, Sophia Lorraine Audit #: 9450095 Address: 60 PENN OAKS DR APT 4 Issue Date: 09/25/2015 10/9/1972 Expiration 10/09/2019 Sex: Date: CDL Permit City/State: NORTH LIBERTY, IA Endorsements: 3 523179462 EXP Mailing 60 PENN OAKS DR APT 4 Restrictions: NONE Address: Restriction None Mailing NORTH LIBERTY IA Supplement: City/State: 523179462 Date of 10/9/1972 Birth: None Sex: F History Information CLEAR DRIVING RECORD Name: Seals, Sophia Lorraine DL/ID: 960AA9824 CDL Permit Issue None Date: CDL Permit None Expiration Date: None CDL Permit None Endorsements: of CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit ELG Status: of CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Code §321.10, I, 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 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: " •�v/��p 11/3/2016 IOWA *°' D. O.T.;�< �y�f• ;� o f% 7f '••••"•$ Office Driver Services RRIIIE�,--- of " Iowa Department of Transportation Name: Seals, Sophia Lorraine DL/ID: 960AA9824 11/3/2016