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Home My WebLink About18-060 ' IDENTIFICATION NO. /1:5 --a LOC) (Office Use Only) ._war®ptat j,, rl�l 'es AW101111.14" APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday—Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required"information will result in denial of the application Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Last ;� Middle 1. Name(REQUIRED) ) fOLAD 2. Address (REQUIRED) \ '(Y\C%`i LIQ Q6, ;) 3. Contact Information (REQUIRED) Email: t�tv41J \OCCA-L%A \a C't0 ' ell Phone: -Sic). ef>S -O (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b.Taxicab Business Name (REQUIRED)_ ye(iOct) CIA) 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? C Type of offense Where When / J L 7 L -T -DC7 O i T r ' t-r-� -v rt + What happened to the charge? (Circle one) _ N Convicted Dismissed ( Deferred Suspended Plead Guilty Othe' 7. Have you been arrested/charged with any traffic offenses in the last five years? �/e (J Type of offense Where I When peeck•ryl, Cin ; CkbCt COO tr\ .f DQf 01 What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead ice,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 taxi driver using a different name? If yes, please provide the name(s) \�C (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). I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number P Ct 1�3 issued on •N �l i t,U' expiring on _-1) j `B . 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 froccnt of a Notary Public) Signature of Applicant&,..0{ z g31 7--CL.1/-\, Date (4 2C)/( <1 N G7 ********************************************************************************* *********************tr k** *******�k#f************ C� G STATE OF IOWA COUNTY OF JOHNSON ) N scribed and sworn to before me by ` ��c ^ "`4n ""1 ' ` day of L onC4s - � -73 Notaryblic in and for t Stag of Iowa ` w cr 7131)..R) 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 Dr.ver' =is e 7- z ` /8 • 6-zo -/5 Signature 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. Signature of City CI:Ii' or designee Date *t'********#*********M**********************************************************************IF********************r****************************** Office Use Only Approved application DCI report State certified driving record Website update ClerWTAxIDRIVBADGEAPPL92018amended.DOC 04/2018 r SMARTER I SIMPLER I CUSTOMER DRIVES 'ID""ad°wwwgov driver 8 ldsnttf ratan Seniors PO Box 9204 Des Moines,IA 59306-9204 Phone 515-244-9124 I Fax 515-239-M37 Certified Abstract of Driving Record Inquiry Date: 6/14/2018 DL/ID#: 787PP9173 (IA) Customer#: 5036102 Name: Brown, Elizabeth Class: C ID Status: None Jane Address: 512 5TH ST APT D Audit#: 9845660 DL Status: VAL Issue Date: 03/09/2016 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 07/26/2018 CDL Cert Status: None 522411885 Endorsements: NONE CDL Med Status: None Mailing Address: 512 5TH ST APT D Restrictions: NONE Restriction None Supplement: ;J ca Date of Birth: 07/26/1978 Mailing CORALVILLE IA Sex: F D "'•1• City/State: 522411885 n 4 NO r— History Information rn Convictions �? v w Citation Date Conviction Date ACD Explanation County 7UR 02/01/2016 03/02/2016 S92 Speed Chickasaw IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR 01/01/2017 969840 IA Name: Brown, Elizabeth Jane DL/ID: 787PP9173 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: ai1,1 uF tai 6/14/2018 Driver � Identification Services l f4t DoCA.2•'�' Iowa Department of Transporation ation Name: Brown, Elizabeth Jane DL/ID: 787PP9173 O _ -dry Cn G r 1 r- rn C�x N C.) c1t Jun. 15. 2018 10:46AM Div of Criminal Investigation No, 4469 Pr 1/3 O6!1412016 7 4:zo Yegvw Cab (FAX)319 338 ziva v.0021002 31933937eS mercy hospital cls 12;16;31 06-14-20i5 2/2 ' a , ', ;l ? • '. � ,STATE JIOWA `` kItr i i;:01:,..:',24:,, • P';•:!!''...;:i" :'; ',.. ,4,',,!.:.:::;:).:-4.:>•i;.° .,. , :, C41334(81 H 1J34(8H [ ory Record Check . ;tf�. •:i' _'!I ?;t3.A ` ., • • • \E, 'rRequest Form _ L4,� ::_;�< 4 .-.,..,:4*.„:...-5' - ,tib . • • • Moots: • it Aoit Number: 9967 •r (ifappltctb(e) To: lows Division of Crit tln Xnvee tgndoa . From; 'Yellow Cab of Iowa City Support Opera Hon s•B ueau,L1'door k-7).-ii-ox 42$ x15 E.7"Street Des Moines,Iowa 50319 • (515)725-6066 owe City, - SZZ (515)7125-6080 Fax • C319)33S-9777 • phone: • ' Fax:. (319)339=7302 • • I am r .uestin- an Iowa Criminal Hi • Record Check ott: Last Name t witliso • ;first Name(na�detey)'• bLfl( lE Name(Yceornmen...� 'r 1 t6 • Date of:Birth(manda(ory} •;Gender(mandatory)• Social.•eo• . 'Z u be ceo• , y / (I) K4L:I . c •• , ,rte/� _• -4.r -„ �`3 =� NYaieemale_ '-7 C7 1 gL,- woo 0 Waive%n{formaii4n Without a signed 'ptver frorry the 3ubieet of the rev en,a eompiete criminal h ••:ry recta may not be releasable,per Code of Iowa,Chapter 692.2,For oym]vle1g criminal bistory•rocohd•iD(ormation,a$allowed by rzo,zl*ays obta(tt a waiver Si_nature from the sub eot.of the r-'(test. • ' • Waiver Release;I hereby give pairnai(eo for trepbova rtquerrinr officio)to conduct an Iowa criminal bi.no7yretard check with Op ptvislse of Criminal • Invettlpgen(DC). any criminal tilnky data wncemide me that it inginpinr4 by Om DQ may be tt•JOLIttil aa.allowe by kw; • Waiver S'ignaturs,. l•S�I.t� `;C ') .1 .... fi(�'t(f 1'�.) -i • x • Iowa crizriinaI History Record Check Results • ••_•—,�•-• r (UC7 use only) As • of. C.1.- )5--)4/- ,a•stare 'of the provided name and date of birth revealed: ' . 1)/, ' d No Iowa Crmi al Histojy Record found with DCI . 4_, roma Criminal History 'ecozd atalo 'DCI ti o/ ! `+,.. . • . rCbCI initials . t . • . :,:‘, c • DCI-77 (08/25/10) '' Z001Z I O'd HOLZ BU 6E(X(lMlA qg3 inoneA it L:21. ti I.1 8 t oZf9a RoreivtA Time Jun. 14. ?01R i: 1�iPM No. 417 • Jun. 15. 2018 10:46AM Div of Criminal Investigation No. 4469 P. 2/3 IOWA CRIMINAL HISTORY DCI 00619756 NON CONVICTION PAGE 1 OF 2 DATE PRINTED- 2018/06/15 DCI:00619756 NAME: HOAGLIN,ELIZABETH HOAOLIN,ELIZADETH JANE DOB SEX RAC HGT WGT EYE HAIR SKN FOB 19780726 F W 505 150 BLU RED MED IA ADDITIONAL IDENTIFIERS TAT R ANKL TAT UR ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20001117 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 -3-DELIVERY SCHEDULE II TRK#: 100080801 CHARGE NO- 02 IA STATUTE IA706-1 CONSPIRACY TO DELIVER TRK#: 100080802 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124 .401{1) (C: • o CONTROLLED SUBSTANCE VIOL. a COURT CASE ID: 06521 FECR056246 *C') C , f CHARGE CLASS: NON CONVICTION 73'--4 .."*"••••TRK#: 100080801 p SENTENCE DISP EFF DAT :7.1C1 ,0 rn DEFERRED JUDGEMENT 20010608 3 PROBATION 3Y 20010608 N DISCHARGED FROM 20030801 W DEFERRED JUDGEMENT dn COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 03 IA STATUTE: IA124 .401(1) (C: CONTROLLED SUBSTANCE VIOL, COURT CASE ID: 06521 FECR056246 CHARGE CLASS: NON CONVICTION TRE#: 100080803 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010608 PROBATION 3Y 20010608 DISCHARGED FROM 20030801 DEFERRED JUDGEMENT 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 . . . • Jun. 15. 2018 10:47AM Div of Criminal Investigation No. 4469 P. 3/3 COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION • ro t3 O m n C r ITi Z � Q N rn