The URL can be used to link to this page

Home My WebLink About16-256� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED, IDENTIFICATION NO.J (O Ice Use nly) 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 3. Contact Information (REQUIRED) Email: V! f4lAtckIpJ IS2 %9 Tio 1p 9TAdl Cell Phone: 3 tiq Sy IIS 39 (All w tten communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 0.004k 'S SipGrS a¢t,'p. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? S_ TVDe of offense Where When towsAi L Se r hj� e a o 1313 What happened to the charge?(Circle one) Not onvicted> Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years?S Type of offense mus , iv; n A 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) Where When / 6civ,or What happened to the charge? (Circle one) Cn —: (G mvicted —'Dismissed Deferred Suspended Plead Guilty�c;06ft d Has your driver's license or chauffeur's license been suspended or revoked in the last five-year.? 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) HP01 07/2016 o w t rDrt,�vvv�5c� aoOD avo� .d(4ccA AcA-5 300! C � '4ec�rdS �J c{� � � . cO- k , 444ce+ 1ASbt-'n a o \3 Ceder CIS APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I er yacerlityha I have issued to me by the Iowa epartment of Transports ion a valid Driver's license number �tl 411r%� issued on 7 /�o expiring on �_q�i3i�. I understand that if I falsely answer any questions in this application, that this ap lication 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 AILW31 I Date /I i e5 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by N) 0' r� w ; p - _ L • LLi Ile rc9 on this I day of I 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 -/ /f /2o Signature of Police Chief 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. i t42r:2 < . Sigliature of City Clerk or designee Approved application DCI report State certified driving record Website update Date Office Use Only co g^.. r- Cled,/TAXIDRIVBADGEAWL9201Aam ed.DOC 07/2016 Iowa Department of Transportation Office Of DoiM Servicrls (W Free) BOD -532.1121 PO Ow 9.2134, Dts MmBs, IA 5MD&9204 515.244-9124 FAX: 515.239.11337 Certified Abstract of Driving Record Inquiry Date: 11/4/2016 DL/ID #: 782ZZ9129 (IA) Customer #: 5058595 Name: Willard, Virginia Class: D ID Status: VAL 3UR Louise Cancelled under in 35-55 mph 07/06/2016 W00 Address: 219 BLACKFOOT Audit #: 1186126 OL Status: VAL 04/04/2016 TRL B64 No Insurance Card Johnson IA 04/04/2016 05/04/2016 Issue Date: 07/28/2016 CDL Status: None City/State: OWACITY IA Expiration Date: 09/09/2021 CDL Cert Status: None Cancelled Revoked Endorsements: 3 CDL Med Status: None Mailing Address: 219 BLACKFOOT Restrictions: NONE Restriction None TRL Supplement: Date of Birth: 9/9/1976 Mailing IOWA CITY, IA Sex: F City/State: 522409205 History Information Convictions Citation Date Conviction Date ACD Explanation County IUR 11/07/2013 12/20/2013 S92 Speed (10 mph & Linn IA 3UR Cancelled under in 35-55 mph 07/06/2016 W00 Not Entitled to IA IA zone 04/04/2016 05/04/2016 B64 No Insurance Card Johnson IA 04/04/2016 05/04/2016 B20 Driving While Johnson IA Suspended, Denied, Cancelled Revoked Sanctions Type Effective End ACD Explanation Occurrence )UR 3UR Cancelled 04/22/2014 07/06/2016 W00 Not Entitled to IA IA Issuance Name: Willard, Virginia Louise DL/ID: 782ZZ9129 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: 11/4/2016 Name: Willard, Virginia Louise DL/ID: 782ZZ9129 Office of Driver Services Iowa Department of Transporation Nov, 9, 2016 2:52PM Div of Criminal Investigation 11/..— -,. , dL -.., ,— Cab .. i ..-na , . ay STATE OF Criminal History', a Request) To; Iowa Divlelon ofCrlminal lnvestlgatlon Support Operations Bureau, I" Floor 215Z 7" street Des Molnet, Iowa 5o319 (515)72S.6066 --01725.6080 Fax I am requesting en Iowa Criminal History Record Cheek nn- (FAx)31933827No 7159 Pr. 202/002 IOWA Zecord Check DCI Account Number;_9967-?+ (ireppuceble) From( Yellow Cab of Iowa Cltv P,O. Box 428 Iowa City, IA. 5 2244 (319) 338-9777 Phonal Faxl (319) 339-7302 Last Name (manduen PJWNarMe mendalery a Middle Name eoammehiled) 1rJ'111 ci�-� V r i n� CA -I Loo I Se, Da to of Birth pnannd�alo Gondar Imarlel i Social- Stiourity Number itecornmande I �� l 7�„',�p O1Vzale �emala Oa 3 56 0 a S� rrasver uUormar(on: without a signed waiver from the subject drlhe regNeat, a complete erlminal hlslory record may no be Malleable, per Code oflowa, Chapter 692.2. For comolbte crimial hittery-record Information, ss allowed by law, always obtain a waiver atonaium renin Om entj hlnn* nr th.-ne..oer Walver Ralease; i hereby give. permisslon for the above requesting omalal Io eandael an rows criminal binaryrecord cheek with rhe Drvlslon of Criminal Invssliyelion (OCO. Any criminal hhlorydais concerning me Ihas Is mainnlned by rhe CEI may be teleased as allowed by law, Waiver Slguature; CAL As of.. �� a search of the provided El No Iowa Criminal History Record found with Iowa Criminal History Record attaobed, DCI DCI initials DCI -77 (08/25/10) Received Time Nov, 4, 2016 1:58PM No. 7497 and date of birth revealed: (DCI use only) Nov. 9. 2016 2:53PM Div of Criminal Investigation IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:00628661 NAME: OINNY SLATCHER,VIRGINIA SLATCHER,VIRGINIA LOUISE WILLARD,VIRGINIA LOISE WILLARD,VIROINIA LOVISH WILLARD,VIRINIA LOUISE DOB SEX RAC HGT WGT 19760904 F W 506 340 19760909 DCI 00628661 PAGE 1 OF 4 DATE PRINTED - 2016/11/09 EYE HAIR SKN POB BRO BLK FAR NA ADDITIONAL IDENTIFIERS PHOTO AVAILAELE: Y TAT L ANKL TAT L AGR TAT L SHLD TAT R ANKL ? TAT R WRS r' TAT UL ARM t' CCH RECORD *** 01 ARRESTED 20000829 AGENCY: IA0530100 ANAMOSA PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: 039745101: CHARGE NO- 02 IA STATUTE IA726-6-1A CHILD ENDANGERMENT TRK#: 039745102 COURT DISPOSITION AGENCY: IA053015'J JONES CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT ,OWI CHARGE CLASS: MfSDEMEAMOR CONVICTION TRK#: 039745101; SENTENCE PLEAD GUILTY SUSPENDED JAIL ?: 30D FINE $1000 COURT DISPOSITION ?• AGENCY: IA0530151T JONES CO DIST COURT COUNT NO- 02 IA STATUTE: IA726-6(3) CHILD ENDANGERMENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 039745102' SENTENCE j PLEAD GUILTY i SUSPENDED JAIL 1200 FINE $500 02 ARRESTED 20010317. DISP EFF DAT 20010216 20010216 20010216 DISP EFF DAT 20010216 20010216 20010216 No. 7159 P. 3 Nov. 9, 2016 2:53PM Div of Criminal Investigation No. 1159 P. 4 AGENCY: IA0570100 CEDAR RAPIDS Pr) CHARGE NO- 01 d IA STATUTE IA'/00-2A-4 ASSAULT ON PEACE OFFICER TRK#: 501054601 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 i. IA STATUTE: IA719.1 (ALMS) INTERFERENCE WITH OFFICIAL ACTS CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 501054601 IA STATUTE SENTENCE OWI PLEAD GUILTY FINE Y, $250 COURT COSTS CHARGE NO- 02 • COURT DISPOSITION IA726.6(3) AGENCY: IA057015�J LIMN CO DIST COURT COUNT NO- 02 i IA STATUTE: IA123-46 PUBLIC INTOXICATION CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 5010546021 SENTENCE i PLEAD GUILTY FINE $50 03 ARRESTED 20010321 AGENCY: IA053OObO JONES CO SO CHARGE NO- 01 IA STATUTE IA321J.2(A) OWI TRK#: 057360901 CHARGE NO- 02 • IA STATUTE IA726.6(3) CHILE ENDANGRRNRNT/ NO INJURY TRK#: 05736090$ COURT DISPOSITION i AGENCY: IA053015J JONES CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) 1. OPER VER WE INT- (OWI) / IST OFFENSE COURT CASE IDt 06531 OWCROO2662 CHARGE CLASS: MESDEMEANOR CONVICTION TRK#: 057360901 SENTENCE SUSPENDED JAIL '' 30D JAIL 3013 FINE +. $500 PROBATION 2Y COURT DISPOSITION AGENCY: IA0530155 JONES CO DIST COURT COUNT NO- 02 IA STATUTE: IA726.6(3) CHILD ENDANGERMENT/NO INJURY - 1985 r. r DCI 00628661 PAGE 2 OF 4 DISP EFF DAT 20010816 20010816 20010816 DISP EFF DAT 20010816 20010816 DISP EEE DAT 20010017 20010817 20010817 20010817 Nov. 9. 2016 2:53PM Div of Criminal Investigation No,7159 P. 5 i COURT CASE ID: 66531 OWCRO02662 CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: 057360902, SENTENCE SUSPENDED JAIL 120D JAIL 120D PR09ATION 2Y 04 ARRESTED 20020804 AGENCY: IA031C1Q0 DUBUQUE PD CHARGE NO- 01 IA STATUTE IA123.46 CONSUMPTION/ INTOXICATION TRK#: 300310101 COURT DISPOSITION AGENCY: IA031015J DUBUQUE CO DIST COURT COUNT NO- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 01311 SMCROS2165 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ 300310101,' SENTENCE JAIL 1D FINE COURT DISPOSITION AGENCY: IA031019J DUBUQUE CO DIST COURT COUNT NO- 01 IA STATUTE: IA123,46 CONSUMPTION / INTOXICATION - 1970 COURT CASE ID: 01311 SMCRO52165 CHARGE CLASS: MI.SDEMEANOR CONVICTION TRK#: 300310102L. SENTENCE i JAIL 11 1D 05 ARRESTED 2006071A AGENCY: IA057O000 LINN CO SO CHARGE NO- 01 IA STATUTE IA124.401(5) POSSESS CONTROLLED SUBSTANCE TRK#: 50367440i COURT DISPOSITION AGENCY: IA05701$9 LINN CO DIST COURT COUNT NO- 01 ! IA STATUTE: IA124,401(5) POSS99SION OF A"CONTROLLED SUBSTANCE COURT CASE ID: 06571 SRCRO60166 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 503674401 LICENSE REVOKED4- DCI 00628661 PAGE 3 OF 4 DISP EFF DAT 20010817 20010817 20010817 DISP EFF DAT 20020813 20020813 DISP EFF DAT 20020813 Nov, 9, 2016 2:53PM Div of Criminal Investigation No. 1159 P. 6 SENTENCE TIME SERVED JAIL FINE COURT DISPOSITION AGENCY+ IA057015J COUNT NO- 02 2D 2D $250 LINN CO DIST COURT IA STATUTE: IA716.8(1) TRESPASS - t 200 COURT CASE ID: 06571 SRCRO60186 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 503674402, SENTENCE TIME SERVED 2D JAIL 2D FINE $50 DCX 00628661 PAGE 4 OF 4 DISP EFF DAT 20061127 20061127 20061127 DISP EFF DAT 20061127 20061121 20061129 06 ARRESTED 20130425 AGENCY: IA0520160 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA706.2A(2)(A) DOMESTIC ABUSE ASSAULT TRX#: 1AOOGLFO� COURT DISPOSITION AGENCY: IA052015k7 JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE: IA708.2(6) ASSAULT COURT CASE ID: .06521 SMSM094091 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00GLF01.; SENTENCE 1318P EFF DAT TIME SERVED 5D 20130430 SUSPENDED JAIL 14D 20130430 JAIL 19D 20130430 PROBATION t lY 20130430 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, I `DIVISION OF CRIMINAL INVESTIGATION