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Home My WebLink About18-047tr 00 1 r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (319) 3S6-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED, IDENTIFICATION NO. Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRNER (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 A le a<!�'d .n First Chi P / yzl Middle L Y-4" n 3. Contact Information (REQUIRED) Email: ; ,rv_n tkvS' ry7�JKSwCd•CellPhone: ZIF r04-9G6z, (All written mmunication sent via email) 4a. Drivers License expiration date (REQL b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: V -?S y / m OS -71 N o 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?_ T)qiaof offense ,c*Where When What happened to the charge? (Circle one) )04 r/ct-1 L.�rhs• fie, Convicted Dismissed Deferred Suspended Plead Guilty /'Other delJ O(dr.S u yc ; 7. Have you been arrested / charged with any traffic offenses in the last five years? 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? Type of offense Where When 9. Have you ever applied to be an Iowa city tpxi driver using a different name? If yes, please provide the name(s) 00 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). hereby cert that ve cis�st d to me by the Iowa pa e t of Transportation a valid Drivers license number :_ issued on 9 expiring on. $- D understand that if I fal e y answer any questions in this -application, plication, that this application may be denied. I agree fhat 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, ChaJpt�er 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applical z; fg 14 e!_44� Date STATE OF IOWA ) COUNTY OF JOHNSON ) andwo a_ to before me by L � (, . �i Q.u,, 50 UA on this �_ day of S 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). Expiratior ijdato of ve ' Ii nse Sign 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. e—a-P /1 _ce Gt !/ 7 --)-7-11 of City Clerk or esignee / Date Office Use Only Approved application DCI report State certified driving record Website update aerkrrA%IDRIVBADGEAPPL9101 Bam ded.DOC 04/2018 04A01.92IO 2018.0j9�5t wM0ab Div of Criminal Investigation 0WA193381Nya7896 P'r.vu2/002 STATE OF XOWA +ilTv�CrImbal HistoryRecord Check To: Iowa Division of Criminal Investigation Support Operations Horeau, I" Mohr 219)R. 7'o Streat Dos M018es, Iowa $0319 (515) 725.6066 (SM 725.6080 Fax I am reaneat)nv an lnwn r iminal ra'iatnn.11nn...a rh.m, nw, DCI Account Number: 99¢7-F (ifopptleabb) FYam: Yellow Cab of Iowa City P,p. Box 428 Iowa City, Ila. 57,2 44 (319)338-9777 Phone: paxi (319)339=7302 Last Name (nondawy) First Name (mmdamrr,) Middle Fume (axammended) bate of BiMh Gender (mnnda,m) Socia S/eew ' cmggmman" �0 l/ p< 9 �� QMale. V—emaleLt% 1, ,Number ! ` Wa1Ver.f rfarM d14i2,' withoat a signed waiver from'th'e joblk of the request, a domplato c1'iminal bWory retard may bot be releasabid, per Code of Iowa, Chapter 647.4, For gamnlot4 criminal bletory record lnformatlon, as allowed by law, always obtain a waiver siffnatura from the au act of the, request. W/rfYPJ'RE%OSC,Iho[obyg(va ppatlsslgntvr d,e abovo regeesdngel ffigiel [o condo Owe attadaal gizOryrteard ehedcaith the Uirhiov ofC.liadnal lava diedtn(MD. Any drhnM bWry dam!?11Cataln � t(e ' ed by tho I ased allowed by law. Wafy& Slgrraltne; t 1 v.... vaaaauuraa aaa V ao' U V \:ll 4VMYa1W PCI we only) As of 1 ' Vzl� a Search of the provided name and' date of birth revealed: , Q No Iowa Cliprinal History Record found with DCT L, ; Iowa Criminal MstoxyReoord attaohod, DCI # DCI initials /� c— DCI-77 (08/25/10) Received Time Apr, 19, 2018 4:51PM No. 1633 Apr.25. 2018 9:50AM Div of Criminal Investigation ' IOWA CRIMINAL HISTORY DCI 00324387 FELONY CONVICTION PAGE 1 OF 2 DATE PRINTED - 2018/04/25 DCIe00324387 NAME: NEWSOM,CHERYL LYN NEWSOM,CHERYL LYNN NEWSOME,CHERYL LYN DOB SEK RAC HGT WGT EYE HAIR SYN POB 19541125 F W 504 160 GRN SRO MED MO ADDITIONAL IDENTIFIERS SC RF ARM TAT CHEST CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19841109 AGENCY: CHARGE NO— 01 ARREST DATA NOT RECEIVED TRK#: L26916401 COURT DISPOSITION AGENCY: COUNT NO- 01 IA STATUTE: IA715-6 FALSE USE OF FINANCIAL INSTRUMENT CHARGE CLASS: FELONY CONVICTION TRKN: L26916401 SENTENCE PRISON l0Y ,. CUSTODY AGENCY: IA052015M OAKDALE IMCC A 19841109 RECEIVED CRIMINAL COMMITMENT CUSTODY AGENCY: IAO77015G ADULT PAROLE SVC B 19650919 PAROLED CUSTODY AGENCY: IA077015G ADULT PAROLE SVC C 19090810 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 02 ARRESTED/TAKEN INTO CUSTODY 20050211 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- Ol IA STATUTE IA3214.2 OWI TRKH: 101433801 CHARGE NO— 02 IA STATUTE IA124.401 POSSESS PRECURSORS TO MANUFACTURE METH TRK(); 101433802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO— 02 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06521 FECR071485 No.7896 P. 3/4 Aor.25. 2018 9:50AM Div of Criminal Investigation DCI 00324367 PAGE 2 OF 2 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101433801 DRUNK DRIVING SCHOOL SENTENCE DISP EFF DAT JAIL 46H 20050803 PINE $1000 20050803 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(3) DISTRIBUTION OF EPHEDRINE COURT CASE ID: 06521 FECR071485 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 101433802 SENTENCE DISP EFF DAT SUSPENDED JAIL 365D 20050803 JAIL 365D 20050803 FIN£ $250 20050803 PROBATION lY 20050803 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.7896 P. 4/4 JIUWADC)T wwwkwadotgov SMARTER I SIMPLER I CUSTOMER DRIVEd1 Omer & IewgE7.c30111 IS►rvkss PO sox 9284 I Des f i Inn IA 533W%01 Phone 515-744-9124 1 Fax 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 5/11/2018 DL/ID #: 255CC3772(IA) Customer #: 3745296 Name: Newsom, Cheryl Class: D ID Status: EXP Lynn Address: 1 APOLLO PL Audit #: 9904463 DL Status: VAL Issue Date: 04/01/2016 CDL Status: None City/State: IOWA CIN, IA Expiration Date: 11/28/2018 CDL Cert Status: None 522403001 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1 APOLLO PL Restrictions: NONE Restrict tii ent: None SupplDate of Birth: 11/28/1954 Mailing IOWA CITY, IA Sex: F City/State: 522403001 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Newsom, Cheryl Lynn DL/ID: 255CC3772 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & 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: 5/11/2018 A212e�)L Driver & Identification Services Iowa Department of Transporation