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HomeMy WebLinkAbout18-042 4 IDENTIFICATION NO. I _ j (Office Use Only) EmzIATait 461, 447 lib .6_ III on :Mr APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday) 4 I 0 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX t Middle Last 1. Name(REQUIRED) �rsr2_a Ujp�.(n (aI jI e {ll�) z.„ 2. Address (REQUIRED) (.D()q Lt Jt od s,c41.1 r l OLL.W ej? i 14 n 9q 3. Contact Information(REQUIRED) Email: fc'ZM q/,4 (10 11)16,-1 - Cc)&- Cell Phone: 361- 5-g -390 7(All written communican sent via email) 4a. Driver's License expiration date (REQUIRED)I, q" IS _ aU a a b. Taxicab Business Name(REQUIRED) re l\oi..1 C VD 7,ciLJF 5. Prior experience in transportation of passengers: q yeC�C' ef (Ut CG to 5 6 0-P /Dr) c,r)cre c)bI9 6. Have you ever been arreste /charg d with any misdemeanors and/or felonies in this State or elsewhere? I Type of offense 57 0Q Where When '9,k1° a0) Poss �a�; ' 199 %o C' \-� ) 3 lie C111 Ced Q2apt ( 7octwOi7 p, G.,`k" &ley 1 . u.� � c P c ca What happened to the charge?(Circle one) Ut'rJ�e�r�e aO i3 C�aP C-. S `7`! Convicted Dismissed Deferred Suspended, lead Guilty Other CFO Pd 7. Have you been arrested/charged with any traffic offenses in the last five years? 0 Type of offense WhereSirWher1,., r —1 What happened to a charge?(Circle one) (-)-G co (- _ Convicted Dismissed Deferred Suspended lead Guil ' 1-6Xh4N rn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five N Type of offense Q W hereW hen 110 P Y \e1,4 Pr) L (11)41 Cow d (AO✓1� Or Irl % / I I 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) n 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 ryd-Do S b b I :9°wl -tk"° SS°d 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 21) a (} p `38"3 R issued on 3/9 /I-2 expiring on q . I understand that if falsely answer any questions in this application, that this app icat�ion 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 prove sions2f Title 5, Ch ter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant w Date 7 ) 9 PP � f l / ***********M****M********************************NM*******************f**************************#AARAAA********!**f********M************** STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by Ll ; -Z-eat a-,. 1-k I t on this J , day of Ai. c , 7_01.or . WENDY S.MAYER A 0 Commission Number 729428 „„ ..•. Ex,ires Notary Public in nd for the State of to•a ********************A AAAA k***#**************Intnt.******AnHe** ************************************************************** 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 D ' is ense 9- fr- ZaLZ 7 cy-/a-/� Si. ''re of Police Chief or designee Date 1 AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOffik CITL9R NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. -- --1 �.... c) • C) — r Sig ature of City Clerk or signee N 0 ******************************************************* ******** Office Use Only Approved application DCI report State certified driving record Website update CIerl TAxIDRNBADGEAPPL92014amended.DOC 07/2016 7Mar. ,� 292018311 � 11 : 38A CabDiv of Criminal Investigation No. 1372 P. 1/3 (FAX)319 338 2708 P.0021002 • STATE OF IOWA • 1'• 9 • :� rF1 ,� •zCrtnjual History Record Check . . . ,-1 � Y/ • DCX Account Number: 9967..E (if applicable) To: lows Division of Criminal lnvestigailon - - From: Yellow Cab.ofIowa City Support Operations Bureau, 1"Floor • P.O. Box,428 215 E. 7th Street • Des Moines,Iowa $0319• Iowa City,IA. 52244 (515)725-6066 • (S15)725-6080 Fax (319)338-9777 • , Phone: Fax: (319)339-7302 I am re•uestin. an Iowa Criminal Fiero Record Check on: Last Name (mandatory) First Name (mandatory) Middle Name recommended • • M(I Sje1C- • z 0..kr .• Gc2 • I...Mlr. Date of Birth (mandatory) Gender(mandato 'Soc1al•S•cum Number(reoomrended) ) T t 7 — .) 6 (4 DML•1 ale Female - I • �S� 7. . cA3q3 Waiverinformatlon:'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 complete criminal hfstory.record information,aa allowed by law,always obtain a waiver sl nature from the sub't:ct of the reuest. • • Waiver Release:I herebyilve permission for c above requestin:41o131 to conduct an Iowa crimt•a istoryrecord check with the Division otCriminal Investigation(DC1), Any criminal history data oono tng mo that it ma fined by th a 1 may be WOW-• • ellowe4 by law. / - Waiver Signature: _4 _, _...L._..,_ 1 . Iowa Criminal History Record Check Results • D =O (DcI1sE'a11ty) As of 3. 29 - I. 2 . , a search of the provided name and date of birthrevealed.:-1 . M = 0 Cl No Iowa Criminal History Record found with DCI >. N w XIowa Criminal History Record attached, DCI# 5142-69 DCI initials • ;P3' DCI-77 (08/25/10) • • Received Time Mar. 21. 2018 12: 59PM No, 6254 . .Mar. 29. 2018 11 : 39AM Div of Criminal Investigation No. 7372 P. 2/3 IOWA CRIMINAL HISTORY DCI 00514269 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2018/03/29 DCX:00514269 NAME: MILBTBR,ELIZABETH GAYLE DOB SEX RAC HOT WGT EYE HAIR SKN POB 19740915 F W 502 175 SLK BRO FAR MO ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT L ANKL TAT L HIP TAT NECK TAT R ANKL CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19951222 AGENCY: IA05220400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA124-401-3 POSE SCH I-MARIJUANA TRK#: 018652401 COURT DISPOSITION AGENCY: IA052,015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 POSE SCHEDULE I MARIJ COURT CASE ID: 06521 8RCR040094 CHARGE CLASS: NON CONVICTION TRK#: 018652401 SUBSTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 19960415 PROBATION 3650 19960415 UNSUPERVISED COMMUNITY SERVICE 20H 19960415 DISCHARGED PROM 19961212 DEFERRED JUDGEMENT o as 02 ARRESTED/TAKEN INTO CUSTODY 20150715 -11 n b AGENCY: IA0520200 IOWA CITY PD ›. CHARGE NO- 02 IA STATUTE IA716.5 C)-‹ CRIMINAL MISCHIEF 3RD DEGREE --.}C') Co T TRK#: 1A00L7902 �� "0 1 •, COURT DISPOSITIONS AGENCY: IA052015J JOHNSON CO DIST COURT N COUNT NO- 01 IA STATUTE: IA716.6(2) Q CRIMINAL MISCHIEF 5TH DEGREE Damage Under $200 COURT CASE ID: 06521 AGCR109112 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00L7901 RESTITUTION SENTENCE DISP EFF DAT TIME SERVED 9D 20151210 JAIL 9D 20151210 COMMUNITY SERVICE IN LIEU OF PYMNT, COMM SERV 20151210 •Mar. 29. 2018 11 : 39AM Div of Criminal Investigation No. 7372 P. 3/3 DCI 00514269 PAGE 2 OP 2 AT FEDERAL MIN WAGE (7.25) 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 .r. © fO c' a - r 3 m D N 0 Iowa Department of Transportation ilfC83Office d Drn�er Servrc�s (Toll Free)800532-1121 U PO Box 9204,i3es Moores,LA 503069204 515-2444124 FAX 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/27/2018 DL/ID#: 242AD3839 (IA) Customer#: 5401729 Name: Milster, Elizabeth Class: D ID Status: EXP Gayle Address: 604 WOODSIDE DR Audit#: 1705811 DL Status: VAL APT 6 Issue Date: 03/28/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/15/2022 CDL Cert Status: None 522463453 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 604 WOODSIDE DR Restrictions: NONE Restriction None APT 6 Supplement: Date of Birth: 09/15/1974 Mailing IOWA CITY, IA Sex: F City/State: 522463453 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/11/2016 09/28/2016 592 Speed Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 01/02/2017 03/05/2017 D53 Non-Payment of IA IA Iowa Fine 1.-3 _ _o CD ae 4.11.1111. Name: Milster, Elizabeth Gayle DL/ID: 242AD3839 C'J--C — 7<( -12 — Pursuant to Iowa Code§321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmerarrtati o hereby certify that I am the custodian of the records held by the Office of Driver Services,that this is a tr 3ntJ agate c f an official record currently in the custody of said Office, and that I have been authorized by the Director of the ImiNDepartment 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: itiett 3/27/2018 n *i 1 tr pe".€0446.4410easee, V.D 0 Ti � Office of Driver Services Iowa Department of Transporation Name: Milster, Elizabeth Gayle DL/ID: 242AD3839 fr11111) Iowa Department of Transportation Once d Diver Services (Toil Free)800.532.1121 83 PD Sex 6204,Des Haloes,IA 50306-9204 515-2444124 qIIIIIP FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/27/2018 DL/ID#: 242AD3839 (IA) Customer#: 5401729 Name: Milster, Elizabeth Class: D ID Status: EXP Gayle Address: 604 WOODSIDE DR Audit#: 1705811 DL Status: VAL APT 6 Issue Date: 03/28/2017 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/15/2022 CDL Cert Status: None 522463453 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 604 WOODSIDE DR Restrictions: NONE Restriction None APT 6 Supplement: Date of Birth: 09/15/1974 Mailing IOWA CITY, IA Sex: F City/State: 522463453 History Information Convictions Citation Date Conviction Date .ACD Explanation County JUR 08/11/2016 09/28/2016 S92 Speed Johnson IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 01/02/2017 03/05/2017 D53 Non-Payment of IA IA Iowa Fine O D--f — Name: Milster, Elizabeth Gayle DL/ID: 242AD3839 ---IC-,J C° rim =ern r –0M Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Departmart rac portatilDo hereby certify that I am the custodian of the records held by the Office of Driver Services,that this is a glia and afc rate copy of an official record currently in the custody of said Office, and that I have been authorized by the Director of the Io vQDepartment 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: s y :My 3/27/2018 1?' IOWA D. O. T. "fi7-6466')C4114441:1 h � Office of Driver Services Iowa Department of Transporation Name: Milster, Elizabeth Gayle DL/ID: 242AD3839