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Home My WebLink About16-271� r , • M1rllmr�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. - Z (Office UseOnly) 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 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date b. Taxicab Business Name (REQU Cell Phone 3)q 3n JO via email) 5. Prior experience in transportation of passengers: -2 Qcn b 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where What happened to the charge? ' cle one) on ed Dismissed Deferred Suspended Plead Guilty Have you been arrested c arged with any traffic offenses in the last five years? Type of offense When Other When What happened to the charge? (Circle one) Dai V nai1lrj e -J 7oklow' 3 r -7) )-7 I I I onvicted ismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? INC) 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) IVU 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 R/ao /aooLe (D(A)f Jfn� marred LAS ia9/aa owe �,- bye lc)/g- �-�Ookecl Bu, r IA ql.�i b 314�`b 6 C A r r',O- 4 �o44u-, +aV�j 3-ohnq�nyv k� �) So vU &Y (4-Y & cc J, Ocnrrj e)CA r rej APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I here ertify the haygissued to me by the Iowa D partment of Transportation a v lid Driver's license number t ! issued on 3 i expiring on 0 I understand that if I falsely answer any questions in this application, that this application may be denied. I agree t at 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 hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicar( Date r STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworn t before me by i ' `Cti i'L, r ` �� tie. -L on this day of l it Public in and for th"etState 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 �1V Signature of Police Chief or designee ta6lib 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. Sign Lure of City Clerk or designee Office Use Only ;n d Approved application••@ DCI report State certified driving record Website update Clerk[fMIDRIVBADGEAPPL92014emended.DGC 0712016 A Iowa Department of Transportation pp CODE d Driver SefvM0-5 ces {Tdi Free) 0 PD Box QM, Des IIDYtss, IA 563()6-9204 515-244-9124 0 FAX 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 12/5/2016 DL/ID #: 013BB8496 (IA) Customer #: 4470052 Name: Mitchell, Martha Class: D ID Status: EXP 07/17/2011 Irene B20 Driving While Suspended, Denied, Cancelled Revoked Johnson IA Address: 633 BEACH VIEW Audit #: 9624604 DL Status: VAL 09 03 2016 DR 592 Seed 1=ton IA 12/14/2012 D27 Issue Date: 12/08/2015 CDL Status: None City/State: CI, IA OZ AGSIY Expiration Date: 10/22/2022 CDL Cert Status: None Suspended 899 02/09/2013 D27 Violation of JA Endorsements: 3 CDL Med Status: None Mailing Address: 633 BEACH VIEW Restrictions: NONE Restriction None all to Refile DR CJl I - Supplement: R22 Date of Birth: 10/22/1971 Suspended 11/07/2012 Mailing IOWA Cn`f, IA Sex: F City/State: 522465899 owa Fine Suspended 11/07/2012 History Information of Convictions Citation Date Conviction Date ACD Explanation County JUR 09/20/2006 12/20/2006 821 Driving While Barred Johnson IA 07/17/2011 10/20/2011 B20 Driving While Suspended, Denied, Cancelled Revoked Johnson IA 12 04 2011 01 04 2032 851 No Driver's License Johnson IA 09 03 2016 l0 18 2016 592 Seed 1=ton IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Barred 05/28/2007 05/26/2011 W01 Habitual IA IA Offender Suspended 12/16/2011 12/14/2012 D27 Violation of IA Probation Suspended 02/11/2012 02/09/2013 D27 Violation of JA robation Suspended 06/25/2012 02/10/2034 all to Refile IA ,t CJl I - R22 Suspended 11/07/2012 03/11/2014 qD53Non-Payment on -Payment of IA owa Fine Suspended 11/07/2012 03/11/2014 of IA IAowa Fine Name: Mitchell, Martha Irene DL/ID: 013BB8496 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: 12/5/2016 IOWA D. 0. T..: } �3 Office of Driver Services Iowa Department of Transporation Name: Mitchell, Martha Irene DL/ID: 013888496 Dec. 1. 2016 4 : 2 0 P M Div of Criminal Investigation 12/01/2016 13:25Yellow Cab of Iowa Clty No. 07LY r. Li 0 (FAX)3193382700 P.0021003 STATE OF IOWA Criminal history Record Chock Request VOrm Tot Iowa Division of Criminal Investigation Support Operations bureau, V Floor 225 3, Vi Street Das Molnea, Jowa 30319 (515)72!-6066 (515)725-6080 Fax DCT Account Numbers _,9967-F (If epptleebie) Fromt Yellow Cab of Jowa City P.O. Box 428 Iowa City, IA. 52244 .(919)339.9177 Phone: Fax, (319)339-7302 A alit la ,Ive,41 9" Wna v.,u,mr.•!,V.V. Last Name (Mandatory) ��wr.w-+nv�n �••• First Name mandato , - Middle Name ra"mmAded Date of Birth mandato Gender (mandatory)SO lal l9eeurl TVumber tenoatmenae pat ;)-I 10 ❑Male Female ej S Waiverlrypior4allon, Without a signed waiver from the subject of the regpest, a complgte grlmiom history record tney no history.reeor(i Informarloo, as allowed by)AW, always be releasable, per Code of Iowa, Chapter 692.2. For comoldift criminal obtain a waiver signature from the subject of the re ubl' WaiverBeleasm I hereby give parm61101 narthe above requesting $meld to conduct ae Iowa criminal hiAoryraeord check with the Division of Criminal Invrtlaaden (DCI, Any otmind history date mneaming me 0 I ie maintain$$ by the odi may be relined as alloyed by law. Waiver Signature: Iowa Criminal History Recotd Chock Results (DCl we mlr) As of search of the provided name and date of birth revealed: } ❑ No Iowa Criminal History Record found with DCT Iowa Criminal History Record attached, DCI # 7- _.. w DCI initiala�� 00 ACT -77 (08/25/10) Dec. 1, 2016 4:20PM Div of Criminal Investigation 12/01/2016 13:25Yel low Cab of Iowa City tt/Nov•23. 20.161•_I:I0PMCabDiv of Criminal t•nvestigetion STATE OF I0'4 Criminal History Reco Rr� ars west For. OW date Of bldh OUW surnames or dates of bifth nilft P►OdUM different results. Tel yews Dlvlrlon otCrlminAl 1AY91116etlon Support Operations Burili V Floor 21419, 71° 91reel TOO Datmolnef,lown 90a1p (919) 729.60p66 TNI Tfe)'v. 616 PAX -- PLEA 11•fi�sl/(p �'(nrl�y .........-.1-.. -_ I-.... n_,_,__. t],.—, a ----A nu -1. w.,, No. tlh1Y r. I/O (FAX)3193382708 P.003/003 (FAX)3163aerNo. 8775 P. ip2/DD2 A d Check Aoaoant Number: „••_,9967-F pr■yruAtetn ami allow Cab29fioowA C P,O, fox , Iowa City, 1A, 52244 nal 691 (sip) s3MR12 a r ama m, F ret Namo Ind le Mid N mo wo mkid) 1 -0 Data of Birt meedn Gander mandal4 t?oelol ero-u i CNu'mbo re4ommeneee !�¢ T V 1 3 d I.. I� ❑Mala otgala Walver InforMa lon7 Without a signed waiver from the lubJeot of the regyert, a oompleto arlminal hletory record may not be roleasable, per Cods or Iowa, Chaptor 692,2. For com lel arlminal hllloty'raeard Infarmar(en, as allowed bylaw, o)Ways oblaill u WAIV r ollitilillura from the jublopi of ro so Walvar Release; t hrmoy give p41mh110A for Ina Awt 10400 0 4111to 1101111U111,111 law 1 erlmin111hl41o1y ra49rd 9111149W1111 1111 Dlvblon of C IMIA41 Inviedpiton(CCO. My anmlA11 blilwy d9U 90A14m1e1 rive Oil 4161 a 11und ar Wewrd by 111w. Wofvlr'SIQMarural As of f a i d l a saaroh,af the provided name and data of birth rovesledl No Iowa Criminal Mlatory Reoord found wldt DCI ❑ Iowa Crlm(nal History f aaoyd AttAohAd, ACI DOIInitials,L,.Q== I _` I)Ci-77 (08/25/10) Rtceived Time Nov, 22, 2016 MIM I No. 6671 xmm w:. only) I 1 -0 I 11.1 I .Q ->.c. 4. 2016 4:20PM Div of Criminal Investigation IOWA CRIMINAL HISTORY NISDEMSANOR CONVICTIONS ONLY No.8529 P. 3/6 DCT 00643779 PAGE 1 OF 4 DATE PRINTED - 2016/12/01 OCI:00643779 NAME: S8AL6,MARTNA.IRENB DOB SEX RAC HGT WGT EYE HAIR SKN POB 19711022 F B 505 220 BRO BLK ARK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT BACK TAT R ARM TAT R SHLD CCH RECORD •** 01 ARRESTED 20018504 AGENCY: IA0520200 IOWA CITY PD CHARGE NO— 01 IA STATUTE IA3210-2 ON TRK#: 100231001 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA321J.2(A) OPER VBH WH INT (OWI) / 16T OFFENSE COURT CASE ID: 06521 OWCR058729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100231001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D COMMUNITY SERVICE 25H REVOKED 02 ARRESTED 20020912 AGENCY! IA0520200 IOWA CITY PD CHARGE NO— 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRX#: 100655601 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 OWCR063252 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100655601 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D REVOKED JAIL 7D DISP EFF DAT 20010628 20010628 20010628 20020603 DISP EFF DAT APPEAL DATE 20030417 20031017 20030417 20040604 ev DISP EFF DAT APPEAL DATE 20030417 20031017 20030417 20040604 .Dee, a. 2016 4:20PM Div of Criminal Investigation FINE $1000 03 ARRESTED 20021006 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-21 DRIVING WHILE REVOKED TRK#: 100681101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE ID: 06521 SRCRO63497 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100681101 SENTENCE FINE $1000 04 ARRESTED 20031017 AGENCY: IA0520200 IOWA CITY PD, CHARGE NO- 01 IA STATUTE IA321.561 DRIVE WHILE BARRED TRK#: 100983901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCRO66791 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100983901 SENTENCE JAIL 7D FINE $500 05 ARRESTED 20040224 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE IA321,561 DRIVE WHILE BARRED TRK#: 101096301 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321,561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCR067915 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101096301 SENTENCE JAIL 7D No, 8529 P. 4/6 DC1 00643779 PAGE 2 OF 4 DISP EFF DAT 20030417 DISP EFF PAT 20040312 20040312 DISP EFF AAT 20040312 .Dec. }. 2016 4:21PM FINE 06 ARRESTED 20060128 AGENCY: IA0520100 CHARGE NO- 01 DRIVING WHILE BARRED TRK#: 101765501 COURT DISPOSITION Div of Criminal Investigation $500 CORALVILLE PD IA STATUTE IA321.561 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA S'T'ATUTE: IA321.174A OPERATION OF MOTOR VEHICLE WITH EXPIRED LICENSE COURT CASE ID: 06521 AGCR074975 CHARGE CLASS: SCHEDULED TRAFFIC VIOLATION TRK#: 101765501 SENTENCE FINE $50 07 ARRESTED 20060901 AGENCY: IA0480000 IOWA CO SO CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED TRK#: 076183801 COURT DISPOSITION AGENCY: IA048015J IOWA CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06481 AGCR009124 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 076183001 SENTENCE SUSPENDED JAIL 120D JAIL 120D FINE $625 COURT COSTS PROBATION 08 ARRESTED 20060920 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED TRK#: 101981101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AOCR077279 CHARGE CLASS: MISDEMEANOR CONVICTION No. 8529 DC1 00643779 PAGE 3 OF 4 20040312 DISP EFF DAT 20060505 DISP EFF DAT APPEAL DATE 20070531 20090531 20070531 20070531 20070531 20070531 P. 5/6 Dec. Y. 2016 4:21PM Div of Criminal Investigation No.8529 DCI 00643779 PAGE 4 OF 4 TRK#:.101981101 SENTENCE DISP EFF DAT FINE $650 20061220 09 ARRESTED 20080304 AGENCY, IA0520500 NORTH LIBERTY PD CHARGE NO- 01 IA STATUTE IA321,561 DRIVING WHILE DARRED HABITUAL OFFENDER - 1976 TRK#: IA003K401 COURT DISPOSITION AGENCY, IA052025J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE• IA321,561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCROB2542 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A003K401 SENTENCE DISP EFF DAT SUSPENDED FINE $625 20080523 FINE $625 20080523 SUSPENDED PRISON 2Y 20080523 PROBATION 2Y 20080523 SUPERVISED PRISON 2Y 200BO523 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 IB BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION P. 6/6