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Home My WebLink About12-2464* ►III iA memo CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa_ 52240-1826 (30) 3S6-5040 Fr -i (319) 356-5497 FAX 1. Name Authorization Number APPLICATION FOR TAXI DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Middle g /SSS/ SDGt /1 # � C , In 2. Mallin Address ..c., Last z- aL+ I,, (Office Use Only) 3. Telephone: Homes n - G3Ca - �5n --1 -) Other: li(j D i K -- 3) q - ry iiC- 4. Prior experience in transportation of passengers: �Pif41� 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type ofoe�nse Cmt�ui l� v�t.c Where When ��C}_ Mi.qfL. V/ply N 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 3 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years Type of offense Where When 9. Have you ever applied to be an Iowzk'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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) aer idrjm d9 09/2012 h eby �grti th I have issu tg Eby the Iowa Department of Transportation a valid Chauffeurs license number ori ` om y ��Ooo A . I understand that if I falsely answer any questions in this application, that this app scat �e denied. I understand that i falsely answer any of the questions in this application, that this application will 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 a license is granted, to comply at all times with all o7r� v' ' ns of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public), Signature of A�plie Date'/0 — k STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by \ "; �� ;� \rev Qe _ ��r,� On this day of O c� I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Z � SigiTature of Polic hief or designee enc/ a, ?oil Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. i��;� 2%tC� � • 7��f�}� Sicjnature of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update /G -/.7- Date /aDate deM1Jladtlnvbadgeapp2ot0.e 09/2012 Iowa Department of Transportation t Office of Driver Services (Toll Free) 800-532-1121 PO Box 9204, Des Moines,lA 50306-9204 515-244-9124 FAX: 515-239-1837 Inquiry Date: 10/16/2012 Name: Peterson, Michele Renee Address: 1556 S 1ST AVE APT 10 City/State: IOWA CITY, IA 522406035 Mailing Address: 1556 S IST AVE APT 10 Mailing City/State: IOWA CITY, IA 522406035 Certified Abstract of Driving Record DL/ID #: 152CC5965 (IA) Class: D Audit #: 5409427 Issue Date: 08/02/2011 Expiration Date: 07/19/2016 Endorsements: 3 Restrictions: NONE Date of Birth: 7/19/1964 Sex: F History Information Customer #: 4224601 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 09/15/2010 590466 IA 02/03/2011 616854 IA Name: Peterson, Michele Renee DL/ID: 152CC596S Pursuant to Iowa Code §321.10, 1, Kim Snook, 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: •"�i'4 10/16/2012 IOWA'. 9f DRIVER SE- Office of Driver Services Iowa Department of Transportation Name: Peterson, Michele Renee DL/ID: 152CC5965 Oc#.,15. 2012 2:37PM Div of Criminal Investi;ation ". Oct. 5. 2012 8:29AM City Clerk — City of Iowa City �rr�,� n r�.�1 y�, N ��y,y y,:' _-•3 �" -- . ry Jl.(�1.Y-J'4 O YO WV-t�L'• Qvhmar '91, 1storyy Record Chock Rcques� Form To,, XwA- ibblgn or CTfminallhVastlA'atfon Support OporoETons)3 rYoau, I't $Toot 219E. P &[root D axpinos,Totva 50319 (gx.�7ae,6a66 (5]s)1as-Gogo $aYc I am reouostfng an Iowa Crimfnef Htsror4 Record Cheok No, 9433 P. 2 No. 2897 P. 2 MlAccount M)mber: ' (ienppuraereT� WOW •� OF T01WA MY CITY CLERIT9 0:0109 410 R Td' EaTJLCZON f3 TOLTA (.7TP' TOFJA X240 k'lioner R�9—asf;—sn41 17Akf 319_3j6—_5/i 47 —� 0 5oc3a] �eourii�Ntlmb er WnfY¢r-AY7ff0Ynlad0?1, WI(itoatns(OneawhAycrikom,tftesubjectoftfroYequelt,acomptatsoVimfnofhts(oryrecordmnynot bo rolaasablc, per Code orYap�a, Chaptcr692.2.FbrromPTola,'orinrtnaJhistotyreeord lnfotmnttorr, arallmvod by idw, always WdtY¢Y�CrB(Y5E11hefcDygfVepere(ssronlDrfionDovere4ques4nsoafofetrocon of iownor(mfial nroryt old cAakwilhLheDivisronofCAMInef lnvasflAerfon(DCp. AgVeffmhlnfhrcforydmneoncamin nfomadsm taint eytho 0 nyWrcf a nlfow D ew. , WaIYCP.SLg31dl G � Iowa Criminal roo. afa only) .:. Ibl. -- c� As o£ a searoh of fb provided name and data of l5ft h�fevealed: >^1 No16waa-IminalI�Iotory.Record£oundwlth= =' l.t' Towm61minalMatoVReeordatfaded,)7CZ#� .t bC� uaifials Rcraiwcrl t•ir>"(lrt 5 9019 R!99AM Na.46fl1 Oct.15. 2012 2:37PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 00438639 FELONY CONVICTION PAGE 1 OF 6 DATE PRINTED - COURT DISPOSITION 2012/10/15 DCI:00438639 AGENCY: IA052015J JOHNSON CO DIST COURT NAME: BRONSON,MICHELE OPER VEH WN TX70WI BRONSON,MICHELE RENEE CHARGE CLASS: M MEANOR CONVICTION BRONSON,SHELLIE RENEE SENTENCE PETERSON,MICHELE RENEE DXSP EFF DAT JAIL 2D THOMAS,MICHELE RENEE FINE $500 19920625 DOB SEX RAC HOT WOT EYE HAIR SKN POB 19640719 F W 505 160 BLU BRO MED DE ADDITIONAL IDENTIFIERS SC L ARM TAT BREAST TAT L ANKL TAT L SHLD TAT NECK TAT R SHLD CCH RECORD *** 01 ARRESTED 19920502 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L41844901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 1 IA STATUTE IA321J.2 OPER VEH WN TX70WI CHARGE CLASS: M MEANOR CONVICTION TRK#: L41644901 SENTENCE DXSP EFF DAT JAIL 2D 19920625 FINE $500 19920625 02 ARRESTED 19930417 XORNCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 ONI TRK#: 005970701 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VEH WH INT OWI TRK#: 005976701 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19930604 03 ARRESTED 19930607 AGENC A0520200 IOWA CITY PD NO 01 IA STATUTE IA321J-2 OWY 2ND No,9433 P. 3 W.15. 2012 2:37PM Div of Criminal Investigation TRK#: 003910001 CHARGE NO- 03 IA STATUTE IA321J-21 DRIVE WITH LICENSE REVOKED TRK#: 003910803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO' 01 STATUTE IA321J.2 OPER VEH WH INTI/3 CHARGE CLASS: F�L CONVICTION TRK#: 003910801 LICENSE REVOKED SENTENCE FINE $750 PRISON 5Y COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 �� DRIVING WHILE REVOK CHARGE CLASS MIS MEANOR CONVICTION TRK#: 003910803 SENTENCE JAIL 10D 04 RECEIVED 19931029 AGENCY: IA052016M OAKDALE IMCC CHARGE NO- 01 IA STATUTE YA003910803 OWI 3RD TRK#: L41845001 INMATE #: 1035881 CHARGE NO- 02 IA STATUTE IA321J-21 DRIVE WITH LICENSE REVOKED TRK#: L41645002 CHARGE NO- 03 IA STATUTE IA321-261-2-A LEAVE SCENE OP INJURY ACCIDENT TRK#: L41845003 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA32IJ. 2(C) OPER VEH WH INT (OWI) / 3RD OFFENSE CHARGE CLASS: FELONY CONVICTION TRK#: L41845001 SENTENCE PRISON 5Y COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE IA321J-21 DRIVE WITH LICENSE REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION DCT 00438639 PAGE 2 OF 6 DISP EFF DAT 19931029 19931029 DISP EFF DAT 19931029 DISP EFF DAT 19931029 No. 9433 P. 4 061.15. 2012 2:37PM Div of Criminal Investigation No -9433 P. 5 DCI 00438639 PAGE 3 OF 6 TRK#: L41645002 SENTENCE DISP EFF DAT JAIL 10D 19931029 CONCURRENT W/CT 01 & 03 19931029 COURT DISPOSITION AGENCY: IA052015J JOHNSON COD COURT COUNT NO- 03 IA STATUTE IA321-261-2-A LEAVE SCENE OF INJURY ACCIDENT CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L41045003 SENTENCE DISP EFF DAT JAIL 1OD 1993/029 CONCURRENT W/CT 01 & 02 19931029 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 04 IA STATUTE IA719.8 FURNISH CONTROLLED SUBSTANCE/INTOXICANTS TO IN74ATE COURT CASE ID: SR36086 CHARGE CLASS: FELONY CONVICTION TRK#: L41845004 SENTENCE DISP EFF DAT CONCURRENT W/CT 01 19960716 PRISON 5Y 19960716 CUSTODY AGENCY: IA05201SM OAKDALE IMCC A 19931124 RELEASED ON APPEAL BOND CUSTODY AGENCY: IA052015M OAKDALE IMCC B 19940816 RECEIVED RETURNED FROM APPEAL FOND CUSTODY AGENCY: IA077035C MITCHELLVILLE ICIW C 19941228 RELEASED BY COURT ORDER CUSTODY AGENCY: IA077035C MITCHELLVILLE ICIW D 19941230 RECEIVED RETURNED ON ORDER CUSTODY AGENCY: IA077 SG ADULT PAROLE SVC E 19951003 PAROLED CUSTODY AGENCY: XA052015M OAKDALE IMCC F 19951221 PAROLE REVOKED FOLLOWING FINAL REVIEW HEARING CUSTODY AGENCY: IA077035C MITCHELLVILLE ICIW G 19960716 Oot.15. 2012 2:37PM Div of Criminal Investigation RELEASED BY COURT ORDER CUSTODY AGENCY: IA077035C MITCHELLVILLE ICIN H 19960716 RECEIVED RETURNED ON COURT ORDER CUSTODY AGENCY: IA077015G ADULT PAROLE SVC I 19970113 PAROLED 05 ARRESTED 19940812 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA719-0 FURNISHING CONTROLLED SUBSTANCE TO INMATES TRK#: 012456701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA719-8 FURNISHING CONTROLLED SUBSTANCE TO INMATES CHARGE CLASS: FELONY CONVICTION TRK#: 01245670/ SENTENCE PROBATION 3Y PRISON 5Y REVOKED 06 ARRESTED 19970800 AGENCY: IA0340100 CHARLE CITY PD CHARGE NO- 02 IA ATUTE IA708-3A ASSAULT/ PEACE OFFICSA TRK#: 023139702 CHARGE NO- 03 IA STATUTE IA7 -1 INTERFERENCE WITH OFFICIAL ACTS TRK#: 023139703 COURT DISPOSITION AGENCY: IA034015J FLOYD CO DIST COURT COUNT NO- 02 IA STATUTE IA708-3A(4) ASSAULT ON POLICE OFFICER CHARGE CLASS: MISDEMEANOR CONVICTION TRK#( 023139702 SENTENCE JAIL FINE COURT COSTS COURT DISPOSITION AGENCY: IA034015J COUNT NO- 03 60D $250 FLOYD CO DIST COURT IA STATUTE IA719-1 DCI 00430639 PAGE 4 OF 6 DISP EFF DAT 19941230 19941230 19960716 DISP EFF DAT 19911020 19971020 19971020 No. 9433 P. 6 4t.15. 2012 2:37PM Div of Criminal Investi;ation DCI 00438639 PAGE 5 OF 6 INTERFERENCE WITH OFFICIAL ACTS DISP EFF DAT CHARGE CLASS: MISDEMEANOR CONVICTION 2M TRK#: 023139703 FINE $500 SENTENCE CONCURRENT DISP EFF DAT JAIL 60D 19971020 CONCURRENT COURT DISPOSITION 19971020 FINE $250 19971020 COURT COSTS W/CT 02 19971020 07 ARRESTED 19990311 FAILURE TO AFFIX DRUG TAX STAMP AGENCY: IA0340000 FLOYD CO SO CHARGE NO- 01 IA STATUTE IA124-401-1-D POSSESSION MARIJUANA W/INTENT TO DELIVER TRK#: 016837301 SENTENCE ' CHARGE NO- 03 IA STATUTE IA453B-12 $2500 FAIL TO AFFIX DRUG TAX STAMP W/CT 01 TRK#: 016837303 PROBATION 3Y COURT DISPOSITION AGENCY: IA034015J FLOYD CO DIST COURT COUNT NO- 01 IA STATUTE IA124-204-4/M POSSE99 SCHEDULE, I/MARIJUANA/1ST OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 016837301 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 2M 20000313 FINE $500 20000313 CONCURRENT W/CT 03 20000313 PROBATION 2Y 20000313 COURT DISPOSITION AGENCY: IA034015J FLOYD CO DIST COURT . COUNT NO- 03 IA STATUTE IA453B-12 FAILURE TO AFFIX DRUG TAX STAMP CHARGE CLASS: FELONY CONVICTION TRK#: 016837303 LICENSR REVOKED SENTENCE ' DISP EPF DAT FINE $2500 20000313 CONCURRENT W/CT 01 20000313 PROBATION 3Y 20000313 PRISON 5Y 20000313 CREDIT W/TIME SERVED 26H 20000313 No. 9433 P. 7 Oct.15. 2012 2:37PM Div of Criminal Investi;ation No.9433 P. 8 DCI 00438639 PAGE 6 OF 6 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