The URL can be used to link to this page

Home My WebLink About18-040� r l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) 3. Contact Information (R IDENTIFICATION NO. I QTS_ (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 via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) A& 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? Type ofoffense f Where When Z 3rn C( I I( 1% 1/-Z3—// What happened to the charge? (Circle one) ),Convicted Dismissed eferreduspended Plead Guilty Other Fi11L' 7. Have you been arrested / charged with any traffic offenses in the last five years? T TTpe of offense Where mrhnn vvdt iwPwimu to the cnarge r tuircie 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? no 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 th�me(s) rV/t CJ m ,---1 7p ' 1 DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT��.q�RTIFIED � =t DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE om RRIEWr rn T (n You must apply for an individual Department of Criminal Investigation Report (form avaip� upon req ), :5- CJ (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTAR i� 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I her gby �r� tnDt l have issued to me by the Iowa De a t of Transport�ti n v I' river's license number jol i�Q� issued on expiring on D 1 understand that if 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 Applicant WhY I'U 1. I `WWW` ^ Date 1NHft1Nlf1fH11!l1NlN111111f11HNlfttHHlf�ft4Yf'Y#'f f #NNNNIHNNN#Nf-f1N111f111NIf11f Iflt#lH1t#ttfNNflf f 1NNNffN#N11f 11f1N STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by dA to on this t o day of 0 Y,JENDY S. b1AYER Comnuwo^ Numbe 28 u_ n�..n arM� � IMOfk 1g Notary Public in a fort tate of wa I,#f##fRR#Y#R1#R##1f#Nf1##1:RR1t*#fR#h111f#ff-#1##H#f#Ht##fHNfN#####1f}N#Nfi11t#RfHffi'#!N#f#-#i-Y#'YY#f#frM#f ###Nffli#f1#-Y1N###f#HNf#f ##H#4 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 Dri se Oz -&I- Z3 ign of dolicehief 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. Sigirfature of City 4—Lil- klyc - C erl or designee f 1HH}YNf4}#N#N###4}f#Yff f 1f11HHf1fHtN#4H#}}#Hf f 111fYf 11H#Hfl1H#H1f}NY#HHHN11NYf11HN11fYNH#NYfNNff111flNHfHN11H! Office Use Only Approved application DCI report State certified driving record Website update pe1M/iAXIDRN DGEAPPLg2t110ementleO.DOC 07/2016 N O rn -o rn 71: Q �x w v 07/2016 4018,3:48PM�tprtDiv of Criminal�Investigation 04/06/2019 17:2 No, 8360.6. P.�.1�3 iooa STATE OF IOWA cirifrainai History Record CheeR Request Form ' /J s DCl Account Number: Orapplicable) To: lowisDivision of Criminal Investigation Support Operations Ball I" Flour 215 C. 7"' Street Dee Moiuet, Iowa 50319 (515)725-6066 (515)725-6080 Fax I am reouestinc, an Iowa rr6h;eal 1-t;ctn,v rh.M, From: City of luwa Citv _ City Cleric's Office 410 E. Washington Street lova City, IA 51240 Phone: 319-356-5041 Fax: 319-356-5497 Last Name (mandatory) First Name (mm,datory) Iiziddle Na,ac preonnnenaee) t lL02 'e, Date of Birth (mandatory) Gender (mandatary) Social Securi Number (meoam,ended) U� ❑Male Female 7 _ AM Walver Arnjornlafionr without a signed waiver from the subject of the request, it complete criminal history record may not be releasable, per Code of Town, Chapter 692.2, For complete criminal history record information, as allowed by law, always obtain a waiver sl nature from the subject of the request, Waiver Release: I hemby give penn;rsion for the all regaeaAng official to Conduct an lora aminal history room check with Ne Divfsioe of criminal hwcAgatioo (DCI). My criminal history dais coil ing me lhai is maintained by the DCl maybe released at allowed by law. l/I/�73/i Waiver. Signature: 9 (DCl we only) As of� (Si , a starch of the provided name and date of birth revealed: rp a s n —p ❑ No lotva Criminal History Record fottnd with DCT --t C-) -< o Q I _tn Iowa Criminal History Record attached, DCI # �lp rn rn A o� w DCI initials A -c 3' DCI -77 (011/25/10) Received Time Apr. 6. 2016 4:42PM No.6927 Apr. 9. 2018 3:49PM Div of Criminal Investigation No -8360 P. 2/3 IOWA CRIMINAL HISTORY DCI 00936802 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED - 2018/04/09 DCI :00936802 NAME: BURRIER,SHANNON MARIE MARQUEZ, SHANNON MARIE WEBBR,SHANNON MARIE DOB SEX RAC MGT WGT EYE HAIR SKN POE 19880201 F W 506 125 BLU BRO IA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT FOOT TAT R FT CCN RECORD �wW 01 ARRBSTED/TAKEN INTO CUSTODY 20110815 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE XA708.7(3) HARASSMENT / 2ND DEG. - 1989 TRK#: 1AOOCHT01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.7(4) HARASSMENT / 3RD DEG. - 1959 COURT CASE ID: 06521 SRCR095245 CHARGE CLASS: NON CONVICTION TRW 1A00CHT01 RESTITUTION SENTENCE DISP EFP DAT DEFERRED JUDGEMENT $65 CIVIL PENALTY 20111123 PROBATION lY 20111123 UNSUPERVISED PROBATION NOT TO DCS DISCHARGED PROM 20120605 DEPERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20180105 AGENCY: IA0520500 NORTH LIBERTY PD CHARGE 00- 01 IA STATUTE IA708.7(4) HARASSMENT / 3RD DEG. - 1969 TRK#: IAOOQ0001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT o COUNT NO- 01 IA STATUTE: IA708.7(4) m —0 HARASSMENT - 3RD DEGREE - ConuauniCete �"n g COURT CASE ID: 06521 SMSM106703 -4 CHARGE CLASS: MISDEMEANOR CONVICTION n"� O • TRK#: 1A000U001 T �("- '0 i „ SENTENCE DISP EFF DAT m 3 Q � FINE $100.0 20180206 O 3 W �D Apr. 9. 2018 3:49PM Div of Criminal Investigation DCI 00936802 PAGE 2 OF 2 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 NDN -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 TNOUIRY. DIVISION OF CRIMINAL INVESTIGATION , No.8360 P. 3/3 N O C_) O 3f - o r M -o M � v _ CIJIGWADOT Driver & Identification Service P.O. Box 9204, Des Moines, I 50306-9204 Inquiry 4/10/2018 Date: Customer #: 5309323 Certified Abstract of Driving Record DL/ID #: 322AE6312 (IA) CDL Permit Class: None Class: C Name: Marquez, Shannon Made Audit #: 1244999 Address: 729 MICHAEL ST APT 72 Issue Date: 08/20/2016 Endorsements: Expiration 02/01/2023 None Date: City/State: IOWA CITY, IA 522465513 Endorsements: NONE Mailing 729 MICHAEL ST APT 72 Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522465513 Supplement: City/State: Date of 2/1/1988 Birth: Sex: F History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: EXP DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County 10/24/2016 11/27/2016 M42 Improper Lane (changing lanes) IA Johnson Accidents - Accident involvement indicated does NOT mean the Individual was at fault or given a citation. Accident Date JUR Case Number 10/24/2016 '.IA 947483 Name: Marquez, Shannon Made DL/ID: 322AE6312 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Ddver & Identification 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: Name: Marquez, Shannon Marie DL/ID: 322AE6312 (IA) N C? 4/10/2018 O_ n v 2 o I� Driver & Identification Services Iowa Department of Transportation D iSJ