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Home My WebLink About18-022i � r 1 i �IIIPAI� Mlwrmi�� CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 5 2240-1 82 6 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) . 2. Address (REQUIRED) IDENTIFICATION NO. / a-(') z (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: (All 4a. Driver's License expiration date (REQUIRED) IQ — 2 — b. Taxicab Business Name (REQUIRED) 4� \l C coh 5. Prior experience in transportation of passengers: CellPhone:j(9 s14 -631f 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? )nense Where u� SSe:5550�� M�-«�Lw CD. c�c�. 'JeaU ce. What haiened to thelcharge?one) Convict Ismissed Deferred Suspended Plead Guilty Other Have you been arrested/ charged with any traffic offenses in the last five years? 41C� Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? Iyt) 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 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT Ci D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE You must apply for an individual Department of Criminal Investigation Report (form available upon regWdest). (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 R4ln A A A5N� issued on c9 --t t4 expiring on 0 - 3 - a a I understand 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 Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicanth 1" f l(I fo Date 1� 1fflflflMffl111f!!f}Hft1fM11tYikkk4llkiiYffflfliflflNlflflfflYfflfll1f11l11tf11llfHflY}tlflte4M:1t!llH�f11!!!1f!!!1flllfffflfflllfY,Irfify.t}f1 STATE OF IOWA ) COUNTY OF JOHNSON ) Sibed and sworn to before me by �I ^� v` L • �+ L. p� �S on this Z� day of Mf-%nc+CM -L-019) 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 OZ -03— 10 Z Z �7 Signat of Police Chief or designee 0 L -Z3 -/i 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. Signat re of City Clerk or� ignee Office Use Only Approved application DCI report State certified driving record Website update a -") �3-j Date ClwkrrwaoRivBADcenPPLe201aa�WDOC 07/2016 Inquiry Date: Name: Address: City/State: Iowa Department of Transportation CAC& d DwAw Services Po so(T011 FAN) OW -W-111211 ot 928x, Deg Rloktee, u► 5O30Gg2O4 515.244-9124 FA)t 515.239.1837 Certified Abstract of Driving Record 2/12/2018 DL/ID #; 846AA4543(IA) Customer #: Phelps, Susan Lee Class: D ID Status: 1206 E COURT ST Audit #: 7769556 DL Status: Issue Date: 02/07/2014 CDL Status: IOWA CITY, IA Expiration Date: 02/03/2022 522403234 Endorsements: Chauffeur Mailing Address: 1206 E COURT ST Restrictions: NONE Date of Birth: 02/03/1967 Mailing IOWA CITY, IA Sex: F City/State: 522403234 History Information CLEAR DRIVING RECQRD Name: Phelps, Susan Lee DL/ID: 846AA4543 5084794 EXP VAL None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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: 2/12/2018 4� Office of Driver Services Iowa Department of Transporation O Name: Phelps, Susan Lee DL/ID: 846AA4543mm N r ()Zt W 9" m o� /reb.l3. ZUlti 8:34AM Div of Criminal Investigation '2018 09:S1Ya11oV Cob of lova Clty (FA%)3193392708 STATE OF IOWA Criminal history Record Check Request Form Ta: towa Dlv4ton orc"lminal Investigation support Operations Bureau, 1tt Floor 215 E, 7 Street Du Mollies, Ia1VA 50319 (513)725.6o66 (515) 729.6090 pyx -ast Aiello (mandatory) LcS N c Iereof.Birth.on,ndaa:y .._.., L— 3� No.3598 P. 1/6 DCX Account Number: ,9967-F YrApAllgbta' jam' Tram; Yellow Cab of IoW CI P.O. Box 428 XOw CJty, XA, 62244 Phone: (319)338-9777 Tex: (3X9)339-7302 Owe Momale r• able, per Code Without p al8n d ,n Ina OU oJect of the request, a complete prlmin9l history record may not tin a wale, per Codo of lows, Chapter 692,2, For e talo a welver el If Ch fe sub ae t: cri�"ingl historyracord Information, es allowed by jaw, alwayst of the re nest.Release: ) her,ligation(OC , r ryalon for Ilio,bora naumling omalel to canduu en 10*4 erlminel hntory reeard eheok with the DtvlAlon orCriminal 1) M erlmrnAl hlno den eonamtne me shot 11 malaleined by the DC[ nuy be released as allowed by law, )Yalver Slgnarure: �i0wa Criminal Tlfvtor• Record Check Rea++rts a' If a search of the provided name and date of birth reyca1 td: r. t . 0 No Iowa Criminal History keeord found with DCI ff 1 1 Iowa Criminal History Aeeord attached, ACI # I T —n 3� c� r ra 0 DCI Initials F m DCT -77 (08/25/)0) _ r;_. C.l 19 .. ...'. Fe b. 13. 2018 8:34AM Div of Criminal Investigation No. 3598 P. 2/6 DCI:00356308 NAME: CASTILLI,SUSAN CASTILLI,SUBAN LEE CASTILLO,SUSAN LASCHKE,SUSAN LEE MIRLL,SUSAN LEE MIELL,SUSIE DOB SEX RAC 19670203 F W ADDITIONAL IDENTIFIERS SC L CHK SC L FGR SC R LEG SC R SHLD SC R THGH TAT CHEST IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY HGT WGT EYE 506 130 BRO DCI 00356308 PAGE 1 OF 2 DATE PRINTED - 2018/02/13 HAIR SKN POB BLN MED IA DISP EFF DAT 19870220 19670220 CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19870103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI m TRK#: L31555901 0 COURT DISPOSITION O1 AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 ODER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31555901 SENTENCE JAIL 2D FINE $500 02 ARRESTED/TAKEN INTO CUSTODY 19911111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRK#: L31556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WH INT (OWT) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31556001 SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7D FINE $750 DISP EFF DAT 19870220 19670220 T/L O �c) T m N (i`fL m 0 O1 Feb.13. 2018 8:34AM Div of Criminal Investigation DCI 00356305 PAGE 2 OF 2 03 ARRESTED/TAKEN INTO CUSTODY 1995D612 AGENCY: IA0530000 JONES CO SO 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/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 014024302 SENTENCE DISP EFF DAT FINE $250 19970617 04 ARRESTED/TAKEN INTO CUSTODY 19970512 AGENCY: TA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRK#: 028039201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VRH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; 028039201 LICENSE REVOKED SENTENCE DISP EFF DAT SUSPENDED JAIL IY 355D 19970813 JAIL 365D 19970813 FINE $750 19970613 PROBATION 2Y 19970813 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 No. 3598 P. 3/6 O e1 Feb.13. 2018 8:35AM Div of Criminal Investigation '02/12/2016 09:51YelloY Cab of Iowa City No. 3598 P. 4/6 (FAX)3193362709 P.003/005 STATE OF IOWA Criminal History Record Check Request Form Tor Iowa Division ofCrlminal Investigation Support Operations Bureau, I" Floor 215 B. 7r4 Street Das Molnes, Iowa 50319 (515)725-6066 (515)725-6080 Fax I am reaueatina an Iowa Criminal Hlcrnru Reer.rd rh.ntr ^n. DCI Account Number: —9967-F (IlapPlltable) Fromi _ Yellow Cob of Iowa City P.O. Box 428 Iowa City, L4. 52244 (319) 336-9777 Phone: Fax: (319) 339-7302 Lost Naha tmandaloy) I First Nasno (mandatory) Middle Name reoammende S `,O Date of Birth mnnderery) I Gander mandala social -Security Number (recommended) _ �Mnleamalo Walver Inforination: Without a signed waiver from the subject of the request, a complete criminal history record may not be releotobit, per Code of Iowa, Chapter 692,2. For earn vlat arlmtrial history recor(1 information, as Allowad bylaw, always obtain a waiver signature from the cub act of tho rd uaat. WaIVBY .Release: 1 herabyalve permbslon forthe above requaidna official ro ennduat an Iowa criminal history rmerd ehaekwhli the Plvlelm ofCilminel Invutlaillon (DCO, My criminal history data oohoemiee me Net Is milnistned by the DCI may be ralaued ae allowed by low, Waiver Signature: 4 eR(danKt Qh A o a As of a search -of the provided name and date of birtthh%rovoaled: No Iowa Criminal HistoFy Record found with DCI t•". Iowa Criminal History Record attached, DCI DCI -77 (0110/10) DC1 Initials n r. I . .w nn,n .n nA.r1 1. 'AAA (DCI uu only) Feb.13. 2018 8:35AM Div of Criminal Investigation • 02/12/2016 09:51yellow Cab of Iowa City STATE Olf IOWA nj y11119O�f �, ,.Criminal History Record '1.,AisFz' Request■ s To; Iowa Dlvldon or Crlminul Investigation Support Opers(Ions Buraau, ]"Floor 215 P. 7" Street Dat Molucs, Iowa 50319 (315) 725-6066 (515)725-6080 Fax No -3598 P. 5/6 (FAX)31933I127O9 P-004/005 DCI Aeoount Number: _ _ 9967-F (If eoDlltAble) From: Yellow Cab of Iowa CL P.O. Box 429 Iowa City, IA. $2244 (319) 338.9777 Phone: Fax: 619) 339.7302 4Gender Last N.9mo (mandnio andma MSDate of Birth (mAndne o ) Soclal•Securi Number rocommenaed3—�01 Male Female Ala n a-, Waive), Ihforination, Without a signed Fvalyer from the subject of the request, a compietif criminal history record may not be releasnble, per Code of lows, Chapter 692.2. For co criminal history record Information, as allowed by law, always obtain a Waiver l:innn h, rc trnm fl,n e„6,..... ------ Waiver Rejease; I hIrib yelve permission for the ebovo requesting onftolal to eonduct an IOWA orlmlnel history record check wllh the ❑Ivalon or Criminal Inv eellaut101t (DCT), My erlminhI history dein oonot ming mo thm Is molfttOned by the ICI may be rcloosod AA Allowed by IAw. Waiver Signature: Iowa Criminal History Record Check Res (Dcltog only) As of a scaroh of the provided name and data of birth revealed; 'moi — 4'. ❑ No Iowa Criminal History Record found with DCI OTwy.. ... r�r; ElIowa Criminal History Record attached, DCI 9 r � m •' �,;•: DCI initials DCI -77 (08/25/10) fl I T r .9 11.1 .,, nn.,, „ noon Feb -13. 2018 8:35AM Div of Criminal Investigation -02/12/2019 09:52Yellow Cab of Iowa City No. 3598 P. 6/6 (FAX)3193382708 P. 005/005 STATE OF IOWA 4) Criminal History Record Check ' Request Form Tot Iowa Division Or Criminal Investigation support operations Buroil u, IN Floor 215 E. 7" Street Den Molnbs,lowo 40319 (515)125.6066 (SIS) 72$.6080 Fox DC1 Account Number: —9967-F (1(PbPOceble) From-, Yellow Cab'ofloFyn City P-0- Hox 428 Iowa G'ity, IA. 82244 Phenol(319) 338-9777 Fnx: (3x9) 339-73D2 .........._ JOGIaI•Mccurl NLl! ber(moommend, Male l�Femallei Waiver Ir{/armatlon: Without o sl®had waiver from the sub a be releasable, por Code of Iowa, Chapter 692,2, For o 1 c! ofthe request, a complete Grlminal history record may not p lQp]Q criminal hlstory.reeord information, as allowed by low, always obtain o waiver d nature from fhb sublect oreha rPm,nrr_ WalVer Jt ejeaSe: l hereby dive perm(se)on for une above requti ameial to oonduol an taws criminal htrtbry record bheck with the Olvblbn ofCrlmtnel Imcinl3idon (DCO, My criminal ll data eonaemin8 me that Is miludned by the Dal tray be mleued as en"'y"owra by law, Wa/ver Slgnalurdr 4owa Crimllnal His ry Record Check Results - (DCI we only) A9 of a search of the provided name and date of birth rovealed: r'i r; 13 No Iowa Criminal History Record found with DCI ❑ Iowa Criminal History Record attached, DCI t! 5 0' 7 to ra, DCI initials o L I DCI -77 (08/25/10)