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Home My WebLink About17-057� r I CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3191356-5040 (319)356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. /'7—S�-) (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 3. Contact Information (REQUIRED) Email: l (All written 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) Middle sent via email) SdN b Cell Phone: 31q - S,74 - 3cF 0 7 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? TXpe of offense r,)Rgam(� cowl; Where aWhen 1 ab l( + 1 a 9fJtl' 5S ter (qay s (Ar rS zto .7- aaof �'U S at happened to the charge? (Circle one) SConvc PO IS C vic� aU 1s 0o Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? �'l 0 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? Type of offense p4 N✓\ 04U(N&CA W here✓� W hen 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, ✓l0 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND ST DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIO Cn You must apply for an individual Department of Criminal Investigation Report (form available'uI:ion request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 t:,)��I hereby certfy ,that I have issued to me by the Iowa Dep rtme t of Transport i n a all Driver's license number ct=tN\1rks issued on 03 19 eVpiring on I understand that if I falsely answer any questions in this application, that this application may be denied. II gree 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 proy sions (pf Title 5, ChAp er 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant) Date `l / STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by��.�(7�� on this day of "n 1 l_i WENDY S. Public in ynd for the State of 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). Expire n dat o river' license Rl 1 fl 10�� Sig ture of PdfieeChilff or designee I � 1 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. Signa of City Clerk or designee Ik:j CIeM1JrAXIDRNBADGE L92014am ded.DOC 07/2016 N O +++++xxxlxxx*xxxxxx!!r!!!xrlrY!!rxliY+#####{{{+{{x+x#{{{{xxxxxxx!lxxxlxxxrxxlrlxYr4lYi44i{++{{+++x+++{#+{+frlxxrrrrxfee9rrrrxrrr+rrr++++##xxxxxr a .J Office Use Only =0 .� Approved application rn = DCI report o� CJ, 0 State certified driving record A Website update ut m I CIeM1JrAXIDRNBADGE L92014am ded.DOC 07/2016 I �j Iowa Department of Transportation pp Office of Dfiver 3einrxes {Tdl Freel OW 32-1721 PO Sox 9304, Des Mairm, 1A 5QMDG9204 515-244-9124 FAX:615-239-1037 Convictions Ckation Date Certified Abstract of Driving Record ACD Inquiry Date: 3/15/2017 DL/ID #: 242AD3839 (IA) Customer #: 5401729 Name: Milster, Elizabeth Class: D ID Status: EXP 06/29/2011 Gayle D53 Non -Payment of IA IA Address: 604 WOODSIDE DR Audit #: 8323092 DL Status: OTH APT 6 01/02/2017 03/05/2017 D53 Non -Payment of IA IA Issue Date: 08/05/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/15/2022 CDL Cert Status: None 522463453 Endorsements: 3 CDL Med Status: None Mailing Address: 604 WOODSIDE DR Restrictions: NONE Restriction None APT 6 Supplement: Date of Birth: 9/15/1974 Mailing IOWA CITY, IA Sex: F City/State: 522463453 History Information Convictions Ckation Date Convletian Dake ACD Ex lanatlon Coun 7UR 108/11/2016 09 28 2016 592 Seed lJohnson IA Sanctions Type Effective End ACD Explanation Occurrence 7UR JUR Suspended 06/29/2011 03/13/2014 D53 Non -Payment of IA IA Iowa Fine Suspended 01/02/2017 03/05/2017 D53 Non -Payment of IA IA Iowa Fine N 0 Name: Milster, Elizabeth Gayle DL/ID: 242AD3839 >a n 3v Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departf ffl{Df 7&po tion, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a�mand�fcuratm of an official record currently in the custody of said Office, and that I have been authorized by the Direct'' 1771h _% e IDeceftifent of Transportation to so certify. C L.), �.VJ 1- Ln m 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: IOWA D. 0. T. Name: Milster, Elizabeth Gayle DL/ID: 242AD3839 3/15/2017 Office of Driver Services Iowa Department of Transporation N o_ O J �`r m o� w Mar.20. 2011 9:16AM Div of Criminal Investigation No.6000 P. 1/3 0311ts12uI 1413b Yel low Cab or Iowa City (FA%)31933e2/uts v.uuV002 STATE OF IOWA Criminal History Record Check Request Form To: Iowa Division of Crlminal Investlgation Support Operations Bureau, 1" Floor 215 E. 7" Street Dos Molnes, Iowa 50119 (515)725.6066 (515)725.6080 Fas DCI Account Number:.;9967-F (llipplleable) Frorrll Yellow Cab Of IOWA Cites PA Box 428 Iowa City, IA. 52244 (319) 3389777 Phonol Fox. (319) 339-7302 all, ro iwat LJA an a v. unn.......... I Lost Name mendue First Name mendoic - Middle Namn (reeommendod 1. z esti C� a Date of Birth (inundatory) Gender (mandato Soeial.Security Number raoommended I 7(4 ❑Male Female S S ' 7- a 343 Waiverinformatton: Without a signed waiver from the subject of the rogpos4 a eomplato Rrlmloel history record may not history•r000rA Information, as allowed by low, always be releasable, per Code of Iowa, Chapter 692.2. For pomolate criminal obtain a waiver s) nature from the subject of the request. Walver Release; I hemby glvo ponnlaslon fof the above r SlInjurRill to corAci an Iowa orlmlnal history record check will, die Dlvlrlon OfCrlminal Inveellgellon (oi Any criminal hlstorydala con Ing ma that malnlal a by e I may be re)oued all allowed by law, Waiver •SigAO(are� .. Tows Criminal Higory Record Check Results (DCt see only) As of 3JA) 17 a search of the provided name and date of birth revealod: -'N • a ❑ No Iowa Criminal History Record found with DCI -n Ll� Iowa Criminal History Record attached, DCI H 5 9 1'7� :--�C, iyD r. m DCI initials Q un Cn DCI -77 (08125/10) Roroivod Timo Mar 16 1017 1 -;IPM Nr, 6AA1 Ma.r.20. 2017 9:16AM Div of Criminal Investigation No -6000 P. 2/3 IOWA CRIMINAL HISTORY DCI 00514269 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2017/03/20 DCI:00514269 NAME: MILSTER,ELIZABETH GAYLE DOB SEX RAC HOT WGT EYE HAIR SKN POB 19740915 F W 502 175 BLK BRO FAR MO ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ANXL TAT L HIP TAT NECK TAT R ANKL CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19951222 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSE SCH I -MARIJUANA TRK#: 018652401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSS SCHEDULE I MARIJ COURT CASE ID; 06521 SRCRO40094 CHARGE CLASS; NON CONVICTION TRK#: 018652401 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960415 PROBATION 365D 19960415 UNSUPERVISED COMMUNITY SERVICE 20H 19960415 DISCHARGED FROM 19961212 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20150715 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA716.5 CRIMINAL MISCHIEF 3RD DEGREE TRK#: 1A00L7902 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT v COUNT NO- 01 IA STATUTE: IA716.6(2) o CD CRIMINAL MISCHIEF 5TH DEGREE Damage Under $200 *12 -ma' T —n COURT CASE ID: 06521 AGCR109112 C-) CHARGE CLASS: MISDEMEANOR CONVICTION n t0 r TAK#: 1A00L7901 :ern -p T 1 •1 RESTITUTION 'p =rO SENTENCE DISP EFF DAT -rte` GW yr TIME SERVED 9D 20151210 la cn O� JAIL 9D 20151210 COMMUNITY SERVICE IN LIEU OF PYMNT, COMM SERV 20151210 Max. 20. 2017 9:16AM Div of Criminal Investigation No. 6000 P. 3/3 DCS 00519269 PAGE 2 OF 2 AT FEDERAL MIN WAGE (7.25) 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 N O r W cn M