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Home My WebLink About17-162Mllla°r�� 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. V % — I Le (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 ,BUJ 3. Contact Information (REQUIRED) Email: YY) G ( t'—t-` gel. "h'Cell Phone: 51� 5OSJ U (All written communication sent via ail) 4a. Driver's License expiration date (REQUIRED) 10 / �p-0 /")0'D- %' b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When c� w What happened to the charge? Circle one) Convicte Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? `— V'J U 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? AJ 0 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 4*e(s) C- �. V\j r7 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHt�REPtEW i-- You must apply for an individual Department of Criminal Investigation Report (form availabj4poaequ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ` r w n 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify t t I. h ve issued to me by the Iowa Department of Transportation a valid Driver's license number (j 1 5)3 (3 � („ issued on -1 C: expiring on /A-a-D-ateunderstand that if I falsely answer any questions in this application, that this application 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 itle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 7 •»r�»»�:»�aa��»»»+:��+«�+r»��rere��t»a:re'+,e��«+:��++�»a��re�»�»�i»tr��Me�»»»»»»� r»r STATE OF IOWA COUNTY OF JOHNSON Subscribed afid sworn to efore me by Jy1 c, v 1 Q 1 1A l f 0i P L 4 on this day of i,CP_ Lem w� NpYN �YE2B u�^ lesI Notary Public ' and for the State of I vn 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 licenseyZ�y 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. g ature of City Clerk design Siee Date Clerk/TAXIMNBADGEAPPL92014ame W.DOC 07/2016 N Q �n �J 0 T Office Use Only �>- i C_� . .... C-) -G ::4n N r Approved application <rn -W m DCI report ESM a State certified driving record xv Website update C4 %10 Clerk/TAXIMNBADGEAPPL92014ame W.DOC 07/2016 C4J10WA00T n wvvw.iowadogov SMARTER RTER I SIMPLER I CUSTOMER DRIVEN Inquiry Date: Customer Name: 12/1/2017 4470052 Page 1 of 2 Office of Driver Services PO Box 9204 1 Des Moines, IA 50396-9204 Phone: 515-244-9124 1 8OD-532-1121 I Fax: 515-239-1837 www.iawadot.gov Certified Abstract of Driving Record DL/ID #: 013BB8496(IA) CDL Permit Class: None Class: D Mitchell, Martha Irene Audit #: 1494100 Address: 633 BEACH VIEW DR City/State: IOWA CITY, IA Convictions Issue Date: 12/15/2016 Expiration 10/22/2022 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit 522465899 Mailing 633 BEACH VIEW DR Address: None Mailing IOWA CIN, IA City/State: 522465899 Date of 10/22/1971 Birth: EXP Sex: F Convictions Issue Date: 12/15/2016 Expiration 10/22/2022 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: Johnson ID Status: EXP Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Driving While Suspended, Denied, Cancelled, Revoked Status: Johnson 09/03/2016 CDL Cert Status: None Speed CDL Med Status: None History Information Citation Date Conviction Date ACD Explanation JUR County 07/17/2011 10/20/2011 B20 Driving While Suspended, Denied, Cancelled, Revoked IA Johnson 09/03/2016 10/18/2016 S92 Speed IA Washington 04/13/2017 05/22/2017 S92 Speed IA Linn 05/11/2017 06/26/2017 S92 Speed IA Hardin Sanctions Type Effective End ACD Explanation JUR Occurrence JUR Suspended 12/16/2011 12/14/2012 D27 Violation of Probation IA Suspended 02/11/2012 02/09/2013 D27 Violation of Probation IA N 0 Name: Mitchell, Martha Irene DL/ID: 013BB8496 (IA) C1 Oryi n Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Depaftd2(t of-itansperMkion, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is.altMe aAYaccurite copy of an official record currently in the custody of said office, and that I have been authorized by the Directerdr he Waa DepMent of Transportation to so certify. r n 4 Mr _. In witness whereof, I have caused my signature and the seal of the Department to be set upon thisz 'bcumencf*at Ankeny, Iowa this date: W 12/1/2017 P„��•• T• cvi r, t•/v1^'oterVJ, ui vi inti naI tovcot igat lvn IY O. M1 r. o/I - 12/01/2077 16:G., .,9e'. ..x/009 STATE OF IOWA 0 (Criminal History Recolyd Check Request Form”' To: loWa Division of Criminal Investigation support Operations Bureau, isr Floor 215 E. 7ta Sheet 00 Moines, Iowa 50319 (515)725-6066 (515) 725-6080 Fax Criminal 1bI 'L, - Waiver be releas Gk DO Account Number: f�u'Z– 4 (itoppliuble) Front Gfty oflowa City City cleric's Office 410 E. Washington street TOM City, IA 52240 Phone: 319-356.5041 Fax; 319'35&-5497 — ®Male VFentale -� tic, ✓V 3oaial securi Number (mcamm, l l3g4 c"q 1oc73 rMlrlion; Without a signed waiver• from the subject of flit request, a complete criminal history record may not per Code of lova, Chapter 692.2. For comaitte criminal history record Information, as allowed bylaw, always :r a;¢n_ature from the subfect of the ranuett Waiver Aelease: I hereby give Famil len for the above requesting official ro conduct an IoYva criminal history iccosd ehtea widt the Division of Criminal hwestieation MCD. Any eAminol hienry A.,,.•n �:ro m, u,..:, mal a,. s,. oeY.,,y w,.ee.,w u.1l o Y In A F'. Iowa Criminal History Record Check Results —Li 11a As of search of the provided name and date of birth reveal�io lowa Cl•iminal history Record found with ACT r'viIowa Led Criminal History Record attached,DCI #:L�.r'DCI initial DCI-77 (08/25n0) Received Time Dec, 1. 2017 1:40PM No. 0792 Y e b l 1. LV i l L. 10 1 In Y l v V I b I I III ) n a l 1 11 V C S l 1 6 n l I U 0 110. 1 0 0 1 r. I/ I rn;L,.Y .1 Iu Wn r 1ny Olae• vuioo .las W9 M6 4e/ 12/01/2017 16;04 #301 P.002/003 tem STATE OF IOWA € Criminal History Recgyd Aleck 0I `. 3 f,$) Request Podia Tn: Inme hbdalnn of C..imleol Iryeoft6otiou Support Operations Bureau, 10 Floor 215 k, 7" Street Des Moines, Iowa 50319 (515)725.6066 (515) 725.6050 Fat Name DCl Account Number: Icv2-�� (if apIUICAbIt) aYU m: U1 OI 101V81itV �.— City Clerk's office 410 F, Washington Street lova City, IA 52240 Phone: 319-356.5041 Fax; 319-356-5697 Dat e(�of Birth Nande(ory) Gender (mandatory) Social Securi Number (mommendid I v ;Ld" � I DMale Female SY /D t3 Waiver 11 formafi0fr: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For com >lete criminal history record information, as allowed by law, always obtain alvet si¢natu ware from the subiect of the reauacr WRlver Release; I hereby give permission for the above requesting officnl to conduct en low" criminal history record check with she DNhic, afCrimmal Investigation (DCI), Any uiminsl histoy dela conocming .. shat is maims Mi,i ied by the DC1 may be released as allolved by low. W lvei, Iowa Criminal Hist or Record Check Results �} As of �� 1 a (DCl a:c Duty) search of the provided name and date of birth r '61iled: "' ® No Iowa Criminal history Record found with DCT �';`i; =lc _ ir Ur_itiy o -hit Iowa Criminal history Record attached, DCI # b� 7 C? �" tm C-3 _ j �'= "' r m n ; DCI initials- nz DCI -77 (08/25/10) Received Time Dec. 1. 2017 1:40PM No. 0192 uec. 4. [uir [:4ynn u i v of 1,riminai investigation IOWA CRIMINAL HISTORY DCI 00643779 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 4 DATE PRINTED - 2017/12/04 DCI:00643779 NAME: SEAL9,MARTHA IRENE DOB SEX RAC RGT WGT EYE HAIR SKN POB 19711022 F B 505 220 BRO BLK DRK IL ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT BACK TAT R ARM TAT R SHLD CCH RECORD •WW 01 ARRESTED/TAREN INTO CUSTODY 20010504 AGENCY: IAOS20200- IOWA CITY PD CHARGE NO- 01 IA STATUTE IA3211-2 owl TRW 100231001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (Owl) / 1ST OFFENSE COURT CASE ID: 06521 ONCROSS729 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100231001 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D COMMUNITY SERVICE 25H REVOKED 02 ARRESTED/TAKEN INTO CUSTODY 20020912 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 Owl 2MD OFFENSE TRK#: 100655601 COURT DISPOSITION AGENCY: IAOS2015J JOHNSON CO DIST COURT COUNT NO- OS IA STATUTE: IA321J.2(A) OPER VzX WE INT (Owl) / IST OFFENSE COURT CASE ID: 06521 OWCRO63252 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100655601 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DEFERRED JUDGEMENT PROBATION 365D REVOKED JAIL 70 DISP EFF DAT 20010625 20010625 20010625 20020603 No. !00 t r. U t N 0 O � n D� � N �rn v O DISP EFF DAT APPEAI.;ib E 20030417 20031A'7 20030417 20040604 ueC. 4. tui+ [:(+yrni u i v of 1,riminai investigation DCT 00643779 PAGE 2 OF 4 FINE $1000 , 1 03 ARRESTED/TAKRN INTO CUSTODY 20021006 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-21 DRIVING WHILE REVOKED o � TRK#: 100681101 Q 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 DISP EFF DAT FINE $1000 20030417 04 ARRESTED/TAKEN INTO CUSTODY 20031017 AGENCY: IA05202oo 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 OPFENDER - 1976 COURT CASE ID; 06521 AGOR066791 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100983901 SENTENCE DISP EFF DAT JAIL 7D 20040312 FINE $500 20040312 05 ARRESTED/TAKBN INTO CUSTODY 20040224 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVE WHILE BARRED TRK#: 101096301 COURT DISPOSITION AGENCY: IA052015J JOHN$ON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID: 06521 AGCRO67915 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101096301 SENTENCE DISP EFF DAT JAIL 7D 20040312 no. /ou r, j/ t N 0 :*C-)rn , 1 ��- f rl m o � r Q W ,D V G �. T Lv II L.97I'1 I/IY U 011III I IIaI I11VC ZI II,ga 11011 DCI 00643779 PAGE 3 OF 4 IN O. 1001 f. 4/ / FINE $500 20040312 06 ARRESTED/TAKEN INTO CUSTODY 20060128 AGENCY; IA052DI00 CORALVILLE PO CHARGR NO— 01 IA STATUTE IA321.551 DRIVING WHILE BARRED TRK#: 101765501 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 01 IA STATUTE: IA321.174A OPERATION OF MOTOR VEHICLE WITH EXPIRED LICENSE COURT CASE ID: 06521 AGCRO74975 CHARGE CLASS: SCHEDULED TRAFFIC VIOLATION TRK#o 101765501 SENTENCE DISP EPF DAT FINE $50 20060505 07 ARRESTED/TAKEN INTO CUSTODY 20060901 AGENCY: IA0480000 IOWA CO $0 CHARGE NO— O1 IA STATUTE IA321.561 DRIVING WHILE BARRED TRW 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#: 076183801 SENTENCE DISP EFF DAT APPEAL DATE SUSPENDED JAIL 120D 20070531 20090531 JAIL 120D 20070531 FINE $625 20070531 COURT COSTS 20070531 PROBATION 20070531 00 ARRESTED/TAKEN INTO CUSTODY 20060920 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED TRK#: 101981101 p C-) COURT DISPOSITION � :4 AGENCY: IAO52015J JOHNSON CO DIST COURT c-)—< COUNT NO— 01 IA STATUTE: IA321.561 --1� -<r- DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 COURT CASE ID; 06521Es AGCR077279 ZE CHARGE CLASS: MISDEMEANOR CONVICTION 3- F� R7 �/ G-7 �. 1►k=� iffiffti V G l• T• ( V I I (. l V 111 V I I V 1 .1 I'll 111 P I 1 I I v � a l 1 60.LI V I I DCT 00643779 PAGE 4 OF 4 TRK#: 101981101 rn SENTENCE D1SP EFF DAT FINE $650 20061220 09 ARRESTED/TAKEN INTO CUSTODY 20080304 �O AGENCY: IA0520500 NORTH LIBERTY PD 3 CHARGE NO- 01 IA STATUTE IA321.561 DRIVING WHILE BARRED HABITUAL OFFENDER - 1978 GS TRK#: 1A003K401 1071 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 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 20080523 AN ARREST WITHOUT DISPOSITION IS 140T 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 IYV. IVV I I . J/ I T C:) rn �nN Cr� �O �}ry ! s 1 G1 3 m> GS 1071 cC,,--