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Home My WebLink About17-059CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. ) �7 - C) S -*q (Office Use Only) 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:S�P iiy YI P �ll�/r/ U,C!Jy/ Cell Phone:—��/;l / (All written communication sent via email) 4a. Driver's License expiration date (REQt b. Taxicab Business Name (REQUIRED) 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? Tvve ) o-7' What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? ILe, Type of offense Where When What happened to the charge? (Circle one) 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? o ti c Tvoe of offense Where Ann 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please A 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 he ed to me by the low CD�0rtme/tof Transport tion a valid Dri is license number S L issued onexpiring on/i—/Eunderstand that if I fa sely answer any questions in this -application, that this application may be denied. I agree that in–m6king 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) oySignature of ApplicanDate�7`- 7 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by C 6 2,r- Ste_ on this 7i0 day of DY S. MAYdt . Ca1r11 MwnOr 77SW 101P F 10`.41 S 14 otary Publi n and for the State Xf 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 C' to a City (Title 5, Chapter 2, City Code). te of river' license L� of a Ch f 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. of City Clerk or designee Date GeNTAXORMIADGEAPPL92014 me ed.DDC 0712016 c7 � Office Use Only Approved application ern - r'l DCI report _> State certified driving recordy� Website update 1 `0 cn N GeNTAXORMIADGEAPPL92014 me ed.DDC 0712016 C4JIUWA DOT www,iowadogov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 i Des Moines, IA 50305-9204 Phone: 515-244-9124 1 800-532-1121 1 Fax: 515-239-1837 www.iowadol gov Certified Abstract of Driving Record Inquiry Date: 4/20/2017 DL/ID O: 255CC3772 (IA) CDL Permit Class: None Customer C: 3745296 Class: D CDL Permit Issue Date: None Name: Newsom, Cheryl Lynn Audit k: 9904463 CDL Permit Expiration None Date: Address: 1 APOLLO PL Issue Date: 04/01/2016 CDL Permit Endorsements: None Expiration Date: 11/28/2018 CDL Permit Restrictions: None City/State: IOWA CITY, IA 522403001 Endorsements: 3 ID Status: EXP Mailing Address: 1APOLLO PL Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing City/State: IOWA CITY, IA 522403001 Supplement: CDL Permit Status: ELG Data of Birth: 11/28/1954 CDL Car[ Status: None Sex: F CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 02/11/2005 X08/03/2005 iA20 (Operating While Intoxicated Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurrence ACD Explanation JUR County 02/11/2005 IA98 OWI Test Failure ]A Accidents - Accident Involvement Indicated does NOT mean the Individual was at fault or given a citation. Acoitle n[ Date _ Case Number JUR 05/15/2016 ,920811 ]A Sanctions 'ype Effective End ACD Explanation Occurrence JUR 3UR :evoked [06/30/2005 112/27/2005 ,A98 [Owl Test Failure IA IA Name: Newsom, Cheryl Lynn DL/ID: 255CC3772 Pursuant to Iowa Code 4321.10, 1, 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, 1 have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: '• '7f IOWA D. 0. T.:�% .'zI s 4/20/2017 iy � oe UBiVEA—= Office of Driver Services ,It Iowa Department of Transportation Name: Newsom, Cheryl Lynn DL/ID: 255CC3772 Apr.18. 2017 2:09PM Div of Criminal Investigation O4/l4iz I uo:ue reiiuc' Cab of iuc:e w.p• STATE OF IOWA Criminal History Record Check Request -Form To: Iowa Division of Criminal Investigation Support Operations aureeu, I" Moor 215 E. 7a Street Des lllolnes, IOWA 50319 I am recuesthur an Iowa Criminal HlAmm Aennrd Chem- ane (FAX)31933827r o. 1401 P. . 1/3002 DC►AccountNumbert 9967-F (if applicable) Froud Yellow Cab of Iowa City P.O. Box 428 Iowa City, IA. 52244 Pbonet FAX. (319)339-7302 Last Name (menden First Name 6mdalo Middle Name 6wommndcd) '0 Lz</ ver �lA e r L L 4") Date of Birth (mabdao Gender mondolo Social Security Number recommended' 7 ❑Male li pc2O� I. amale Waiverlriformallout Without a signed welver from the subieat of the request, o'domplete criminal history record -may, not - be releamble, per Code'of Iowa, Chapter 692.2: Foremmotete crlminsi blatory record Information, as allowed by-law, always obtain a walv■rsl nature from -the sub ect of the request. Waiver Re/ease: ) htrcby Olve 11etm1e310n fur rho otiove mquauha'omcld rd conduct M tows wlminsl hlnory romrd, cheek svirh Iho oivhlon oNdWrul lnvettiasrion(DCl).MysrlminelElelorydalscone b IsmsinrdnedbytheDClmsyborelomsdssalowedb taw. WalverSiqualur . Iowa Criminal History Record Check Results (DCI useonly) As of 1 ` 1<6 a'search of the provided dame and'date of birth revealed: No Iowa Criminal History Itecord found with DCI t� Iowa Criminal History Record attached, ACI 4 DCI initials DCI -77 (08/25/10) A Received Time Apr, 14, 2017 8:19AM No,7165 Apr.18. 2017 2:09PM Div of Criminal Investigation No. 7407 P. 2/3 DCI:00324367 NAME: NEWSOM,CHERYL LYN NEWSOM,CRHRYL LYNN NEWSOHE,CHERYL LYN DOE SEX RAC 19541128 F W ADDITIONAL IDENTIFIERS SC RF ARM TAT CHEST IOWA CRIMINAL HISTORY FELONY CONVICTION DCI 00324387 PAGE 1 OF 2 DATE PRINTED - 2017/04/16 HOT WGT EYE HAIR SKN POE 504 160 GRN SRO MED MO CCH RECORD *** 01 ARRESTED/TAREN INTO CUSTODY 19841109 AGENCY: CHARGE NO- 01 ARREST DATA NOT RECEIVED TRK#: L26916401 COURT DISPOSITION AGENCY: COUNT NO- 01 IA STATUTE: IA715-6 FALSE USE OF FINANCIAL INSTRUMENT CHARGE CLASS! FELONY CONVICTION TRK#: L26916401 SENTENCE PRISON l0Y CUSTODY AGENCY: IA052015M OAKDALE IMCC A 19841109 RECEIVED CRIMINAL COMMITMENT CUSTODY AGENCY: IA077015G ADULT PAROLE SVC R 19850919 PAROLED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19690810 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 02 ARRESTRD/TAREN INTO CUSTODY 20050211 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321J.2 owl TRK#: 101433BOl CHARGE NO- 02 IA STATUTE IA124.401 POSSESS PRECURSORS TO MANUFACTURE METH TRK#: 101433802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J.2(A) OPER VER WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 FECR071485 Apr.18. 2017 2:09PM Div of Criminal Investigation No -7407 P. 3/3 DCI 00324387 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101433801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT JAIL 46H 20050003 FINE $1000 20050803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124,401(3) DISTRIBUTION OF EPREDRINE COURT CASE ID; 06521 PECR071485 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101433802 SENTENCE DISP EFF DAT SUSPENDED JAIL 365D 20050803 JAIL 365D 20050803 FINE $250 20050803 PROBATION lY 20050803 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 PCI. 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