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Home My WebLink About17-030CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa S2240-1826 (319) 3S6-SO40 (319)356-5497 FAX IDENTIFICATION NO. 1-1-03D (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 First Middle Last 1. Name (REQUIRED) Z)ltS4R l Pe IP l lO4, 2. Address (REQUIRED) r r Saa4n 3. Contact Information (REQUIRED) Email: Cell Phone: 3\q- SOA- 23134 (All written co municati sent via email) 4a. Driver's License expiration date (REQUIRED) 9 - 3 - a? b. Taxicab Business Name (REQUIRED) �(p �� Cc Oa ,-R I >;„ 5. Prior experience in transportation of passengers:5 t,� r -tom 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewvtere? `2�c Type of offense Where , When EN What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? tqf�\ 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? tktd 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 hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 9 A (o A f� A S Q 3 issued on oa of jaA expiring on r a -D3 I understand that if I falsely answer any questions in this application, that this applicati n 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`Yj W p * gl Qho p rye Date YKl1!!f f!!Hfll11Kll4Y4K4111f!!!f flllflfllHH1fl11K11ffff 1ff!lflfflHfllfKlffHlKfffffKflHlfff ilii#HHHiffHYfYklfft4H4441f f 41f:4ffYY STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and s rn to before me by �,. s�K L . ' >U_ of 5 on this Z.3 day of F-tek0�a(..r -_01-T WENM and for the Sta* of Iowa HffHH.fYMfiIHH � 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 Z(3 7 V /✓ v Signature of Police Chief or designee 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. Sig ture of City CI rk or designee Approved application DCI report State certified driving record Website update Dat Office Use Only _ C -- -/ c-) w m � 7 r„n <_, G&urnXIDRNaeocFnPPLsm,aa e� DOC 0712016 Iowa Department of Transportation Office of olitfr sarAX5 (Tolt Free) M-532.1121 PO Bou 9294, Des llAolDos, lA 50386.9204 515.244-gi24 FAX: 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 2/17/2017 DL/ID #: 846AA4543(IA) Customer #: 5084794 Name: Phelps, Susan Lee Class: D ID Status: EXP Address: 1206 E COURT ST Audit #: 7769558 DL Status: VAL Issue Date: 02/07/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 02/03/2022 CDL Cert Status: None 522403234 Endorsements: 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 2/3/1967 Mailing IOWA CITY, IA Sex: F City/State: 522403234 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 05 09 2012 685189 IA Name: Phelps, Susan Lee DL/ID: 846AA4543 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: by 2/17/2017 �..••... I VWA 81 Office of Driver Services Iowa Department of Transporation I 6✓, L I• L V 1 1. I I . J U n I I I ✓ I V V I V 1 1 111 1 11 n 1 l I I V t J L l 6 Q L I V 11 FrOM:01ty 01 10wa City Clerk Offloo 31® 3666497 Feb. 11. 2017 12:39PM Div of Criminal Invesligallon 0 Fro MlClty of Imwa' City Clerk Offioe SSVS8 07 la INV. Y 17l V. U/ V 02/17/2017 14:47 ,rasa P.0031006 No. 3906 P. 2 02117/2017 10161 x037 P.001/004 ,. STATS 01F IOW t>, I crhainal / 75 rt History �1r IOl1/P ,JI Y , rt�� eeGird Check 'c'1 I �y s To: lewd WAsion of Criminal Investigalion Support Oparatlous nureeu, I" Ploor WCI Account NuNbay: __ /'� 0 O 2 •• �' pf ulpliteEu) From; Ci()wlda'oCttr_____ DeeMoines,loe•a 50319 �� rSITg,60(e roivaL•1tyrJA.S27dn _-.-� (515)715.60§0 Pox phone: 319-35645041 Irsxs 319-356-5497 I ., .,..aetltta an Tmva P4iminal H)tlnry Record Ctteele mr, I,ael'Aame anrddclo •) First ]Name (mendmo •) Middle ]Nellie (aconwltlleeA Su Date of Birth (Inendme •) Gender mendrun) Social SecurityNumber (acamimiltd) / (39ale L�t'Fetnalc Woi.ver XnjorMallou: Wphoet a signed tvah•a - froln the sublect or the request, a complete criminal ntstory record may nor he releasable, per Code of lowo, Chapter 69�.t. For a tete criminal history record Information, as allowed by low, ebvays obtain a woh er sl nOure from the sub•ecs lrf the vaguest. J•i'Olver Releffse; t ser<6y `Iys ptnui¢sion fonae rUove reglwsliA` effidet m cenduoe mt Iowa sr)nt(ntl hiAory• icard clmtr Wlh tnoblvitfon clCllmaml . InvetliBlliOn toGJ. Any VI01ine1 h&Ion dela eeneernln6 ole le)t IS m11111/iatd DY lheDdnliyetnlnred of elletl•cA hylnx•. Wrttvel Sigltnlrfre: o.C,1 (DCI utc ongd As of ;1V')A\ 1 , a search of the pfo\lided name and date of I» dh revealed; No Iowa LMinival History Record f6uud with DO Iowa i limial History Record bunched, DG 4 ' DCI iuilials-6--r— - DCI.77 (09/25/10) n • I 7' r I Il nnt9 t arm/ a .Inln teu.[I. [vii II::)7f11n ulv of unminai investigation • From:Clty of Iowa City Clark Olflea 316 3666667 Feb. 17. 2017 12:39PM Div of Criminal.lnvestigatioo Frem:Clly 4f Iowa CI1y CIeVk 011lo6 316 3666,107 IN o. 4171 r, in 02/17/2017 14:60 648311 P.006/006 1o. 3986 P. S 02/17/2017 10f62 Ha37 P.004/004 STATE OF IOWA ^. ri Craefl@gal History Ref;oird Check Request Vornrl TO, Iowa Divislon of Crimbtal )nvemignillon support Operaftous 13mreau, I" Floor I)Cf AccoutltNumbar,-_L+oo :�L (troIP-11 t) From; CISy or)awa Clq__ my Clerk[a gfAco _:LAWW:�l. YYaarlu,c IVO "cc, Des Mnlpea, Iowa 5USt9 �,.7.i5r6066 _ raaa.Gly,-1A�324U (5I5)M-6080 Fax Fhonol 319-356.5041 _ FAR.. 519-356.5497 twm reau Aelbin al[ inu,a rri,n("al btfelnv narnrd f`hnwL ..,.. Last Name 011udatoo3 Mrst Na3ne mandalofy) Middle Name fatTmrnatd) L Date ofB;rth(nunawy) Gender(mmdnoly) 80011313ecuri Number nDommadca _ ❑Male 1 eatale Aas.0a—Aa-�lo We11V6r 1MfO IO1i01f) WithOlsl s slgnnd waiver tram the sub) oet of (bo request, a eomple(o edminol history record may not be releasable, per Codc ofrowo, Cbep(er691.7.. Vor somillde criminal history record Information, asallotted by lav, Always obtain a waiversignalvre from thesabfect of the request. ri14iW / %t OfOpSO.11..Mq errs ywu"aalun N, wr n........ 6 wOrdl Ie w,wvi all NNammmn witafy w9yo cn[cx 111th 018I)111;jDn OfOrAill)I laYnnelllnn (Dd). ADy HIITIDAI 11i]lay dela ean[[ITtI)g rd[ 11111 li m11Ot11atd by Iht GG m1y tri nietl[d Dy IDDII4d by 181Y. N/iiiver SY�ltalUre; �(1 LY1 a'I �.n n Q �_„ (DCI vso Didy) As of a search of theprovided ualne and date of b;ylh revealed: , • . ❑ No;owa Criminal history Record found with DCI ]owa Criminal History Record attaidicd, DCI tl 3S10 J DCIinitials DCI -77(06/25/(0) _Je.d.(I. LVII Flo m:Cl\y II:)MIn Ulv OT 6rlmindl Investigation FromlCl\y or Iowa City Clerk dtilec Social Securiti, Plumber neeennnenoun 319 36e6497 ❑hfnle I.X645ntale Feb. 11. 2011 12:391"41 Div of Criminal Investigation of lew0 Gley Clerk 011100 319 3666487 To: Iowa Division of Criminal No. 4151 P. 2/6 02/17/2017 1d;4e 406.28 P.004/00e No, 3986 P, 3 cA/17/2017 10;02 0037 P.ee2/004 STATE, OF WWA Crbmnal Histary Redoyd C9ae;ak Request (Form DC7 Accounl Nombel:, _LT OCj ,�." praVplis+hlc) Proem }•15 )i, �'" Slrect � 41a �. tyashhn ren 3trect �. Dcs Moillcs, Iowa 90319 ____�c�?25.6066 [Dine-Cif-IA.�E2Ra0 ___ - (515) 935.6080 Pax likelier 319-356.5041 Fax; 319.356.5497 1 am reouestine an Iowa Oriminal Ifislo v Record Check on! Last Nalne(mende(ory) VirsName (m+nealery) Mid1dleNaroe(roeomm�need Dale of Birth (manoalosy) Gender (nlaneeloly) Social Securiti, Plumber neeennnenoun ❑hfnle I.X645ntale y a —A Waipephifor mtiotr: Wiwaol asigned u•aiverfrom the subject of (he request, a coinplelecrianlnal hlslory record may not be veleasahle, per Code of Iowa, Chopler 692.2. For corn le(e criminal history record hl(ormat(oml it allowed by law, always oblaht a waiver si natm'e from u1e sub ee(ef the re ucsl. Imaliyolon (CCU, Any aim)nel hislo,y den sonetrohq nee llul b meNmdeed by @e DO mlybe mltued as nllollzd by law. Waiver 5igiratrrre: (uCi Ilse oel)9 As of ci1 rl\ I% , a search of the provided name and dale of birth revealed: No lown Criminal liislory Record found will DCl Iowa Criminal I-lisloty Record at(aehed, DO d &S(P DCT initials— I)GI-/7 (054A/1U) ,. r• r i Y9 nnrb 4 Arno 11 AA4A Rv,v, c i s LV i I i i.' J n in V i. V i v i i III i iia i 1 11 v c a 1 1 5 a I i V 11 11 V I Y 1 7 I r, )/ b PeOm:C11y or Iowa City CIeYk Orrice 396 3666407 02/17/2017 14:49 0638 P.006/006 _ Feb. 9, 1017 12:39P. Div of Criminal Invesligalion No. 3986 P. 4 crO en:Clly Of loan ally Cierk Oerlee 010 6666467 02/l7/2017 10:62 Ions./ P.002/004 tGIIL tl 11 ,'WA #10'e Criminal History Record Check To: Iowa Division of Crindnal lllvos(igotlon Supporl Opera(iops liurealh la Glnor ury KY DuMolnes,Coaa 5019 .L...... .G/. (515) 775.6030 Pal( 1 a01 ro0uneein0 sn meas rononnl Vielnrn RcrnrA a h.A,n— PCI Account Nanlberl r i O O 6raavreehm) 'Prom: _Clio! Iowo GH __ CItyCIorIPsQlpcn "� `-` Philme: 319-356.5041 Par; 319-356.5497 LastNalne(lwndamsy) FII-MMIltle(mandno d Middle Name(lecola).1dld) Date of Birth(minaalon) r`veftder(meddem) Social 5ecul-IONuWbereecnamendcd) a. � �Iv);ele Female _ Walvarlpforfnallo w W1dsolil in signed Waiver from the subject of the request, a comp tele criminal history record m oy not be releasable, per Code of Iowa, Chapler 692.1, per 0111010e crlminal history record informatton, at allowed by Inw. alw2)'1 ' obtain a waiver sl •nature from the sub eat of (herequest. Waivor lldgaSe:I hucby elve pclmisslco for 0c above npoiing ofnciat 10 tonoov an town c(lmhlel abteq• ncord chick ailh me INvbioo o f011mbal fuvudglion lDCq. Myaimixel history don edneunl6;melEa lsmelmslned by Ne Uel msybe mlgsed asalmgsd ty ls,v. Cl -I If Waiver Slgnalure:�,p� ��pQ IDCI we only) As of t a�1�1 a search of the provided name and date of birut revealed: 1. ® No Iowa Criminal Hisloq ltetord found with DCI. Iowa Criminal Hisift Accord attached, DCl #35 ,-606 ' ;, y' ' • DCl initialsAC— A^ , I C— nn.I t A mj a on,n f, Isv. L1. zv II 11. JJ nIYI v I v u v I111111aI IIIVtSLl6dtlUll 01 ARRESTED/TAKEN INTO CUSTODY 19870103 AGENCY: IA0520200 IOWA CITY PD IOWA CRIMINAL HISTORY DCI 00356300 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 COURT DISPOSITION DATE PRINTED - COUNT NO- 01 IA STATUTE: IA321J.2 2017/02/21 13CI:00356306 CHARGE CLASS: MISDEMEANOR CONVICTION TRK((: L31555901 NAME: CASTILLI,SUSAN JAIL 21) CASTILLI, SUSAN LEE $500 02 ARRESTED/TAKEN INTO CUSTODY 19911111 AGENCY: IA0520000 CASTILLO,SUSAN CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFPENSH LASCHKH,SUSAN LEE TRK#: L32556001 COURT DISPOSITION MIELL,SUSAN LEE AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 MIELL,SUSIE OPER VEH WH INT (Owl) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION DOB SEX RAC HOT WGT EYE HAIR SKN POS 19670203 F w 506 130 BRO BLN MED TA ADDITIONAL IDENTIFIERS SC L CHK SC L FOR SC R LEG SC R SHLD SC R THGH TAT CHEST DISP EFF DAT 19870220 19870220 ". gI7I r. q/0 CCH RECORD v** 01 ARRESTED/TAKEN INTO CUSTODY 19870103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 Owl TRK#: L31555901 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WE INT Owx CHARGE CLASS: MISDEMEANOR CONVICTION TRK((: L31555901 SENTENCE JAIL 21) FINE $500 02 ARRESTED/TAKEN INTO CUSTODY 19911111 AGENCY: IA0520000 JOHNSON CO 50 CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFPENSH TRK#: L32556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (Owl) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31556001 SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7D FINE $750 DISP EFF DAT 19870220 19870220 ". gI7I r. q/0 �re,D,LI. LVII II,DDMVI uiv of wiminai investigation 110,4IuI 7io DCI 00356306 PAGE 2 OF 2 03 ARRESTED/TAKEN INTO CUSTODY 19950612 AGENCY; IA0530000 JONES CO 50 CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE TRK#: 014024302 COURT DISPOSITION AGENCY; IA053015J JONES CO DIST COURT COUNT NO- 02 IA STATUTE: IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIHUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 0140243D2 SENTENCE DISP EPP DAT FINE $250 19970617 04 ARRESTED/TAKEN INTO CUSTODY 19970512 AGENCY: IA0520200 IOWA CITY PO CHARGE NO- 01 IA STATUTE IA321J•2 OWI 2ND OFFENSE TRK#: 020039201 COURT DISPOSITION AGENCY: IA0520156T JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 028039201 LICENSE REVOKED SENTENCE DISP EFP DAT SUSPENDED JAIL lY 355D 19970813 JAIL 365D 19970813 FINE $750 19970813 PROEATION 2Y 19970613 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDRNTIFICATION 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 1 ,�