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HomeMy WebLinkAbout14-032 Authorization Number / `/ - - 1 (Office Use Only) -_.®pt MOM APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday–Friday.) Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name 15CL C`- Lc. Ph�1��' 2. Mailing Address 1 add E, C csuLw k >1 . a Ar� 3. Telephone: Home Other: ( ( 9) 6 9 4 vZ 3 A- 4. Prior experience in transportation of passengers: 0 V2 t_S\c i .q e r 0,10 - 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ?6 55 Scor• rv-\(3��` � o,�` A C 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? N :J Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? NC" Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N-N 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) I NIS; 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number ,,2,4 Co 44 A3 . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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) � �r Signature of Applicant �(IS i,e,..Q Qf ,U��ki" Date ; — ( 9 (d y- STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by S "-S ah l— -?---- -- " ``�e S . On this y�� day of ' �`Jvvc.�r1 a.plLl �Vh � f, j otary Publi in and for the State of Iowa -7 (LI I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). Signa re of Po : Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. r iz -- k . /' -.2� -- Signature of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z" (width) and 51/2" (height) and prominently displayed to all passengers. .** ....******.....*..**.***......*****..**......*.....**......**..***.****..************...*..*..**.....*............*.....*.....*........*.* Office Use Only Approved application DCI report State certified driving record Website update clerk/taxidrivbadgeapp2010.doc 03/2013 • 1111, 1lowa Department of Transportation siw Office of Driver Services (Toll Free)800-532-1121 PO Box 9204,Des Widnes,IA 50305-9204 515-2444124 FAX:515-239-1837 - Certified Abstract of Driving Record Inquiry Date: 2/7/2014 DL/ID#: 846AA4543 (IA) Customer#: 5084794 Name: Phelps, Susan Lee Class: D ID Status: EXP Address: 1206 E COURT ST Audit#: 7769558 DL Status: VAL Issue Date: 02/07/2014 CDL Status: None City/State: IOWA CITY, IA 522403234 Expiration Date: 02/03/2022 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Date of Birth: 2/3/1967 Supplement: Mailing City/State: IOWA CITY, IA 522403234 Sex: F History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident DateCase Number 3UR 09/21/2010 591807 . .. _..__. .... _ .. ___.. 03/03/2011 _._ 621528 _...._. _ IA 05/09/2012 1685189 Nacos: Phelps, Susan Lee DL/ID• n46AA4543 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I al 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 i 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: -;4t!CIf;"' -a. 44314 2/7/2014 iIOWA* T ; �;4y�i D. O. . o I�rGing% -, ice of D elf Iowa rtment of Transportation Name: Phelps, Susan Lee DL/ID: 846AA4543 Feb. 11. 2014 8:33AM Div of Criminal Investigation No. 2645 P. 1 • 02,uo,4u.q uu:2q vet row Cab oe Iowa elty (FAX)3193382703 10.003/005 • STATE OF IOWA . Ai X11 � Criminal History Record Check • 4.2:::".11, � 5 1� c �-o'i l" Request Form °. ,,,,,,,,,, DCI Account Number:_9967-F (Itepplleahle) • To: Iowa DIvlalan of Criminal Investigation From: Yellow Cub of Iowa City Support Operations 0ureau,I"Floor P.O.Box 428 215 S.71h Street Daa Moines,Iowa 50319 • Iowa City,IA. 52244 ' (515)7254066 _ (515)7254080 Fax (319)330.9777 . ' • ' Phone: • Fars (319)339-7302 • I am requesting an Iowa Criminal History Record Check on: Last Name(ntendmoyl Flrat Name(mendelowy' •. Middle Name(recommended) • Leieck Lw . 5( i.5 1 M • Date of Birth(manaetoy) Gender(mandihy)•'` • .----7.-- ' 'S.octalSocurlty Number(rdeomme.lded) t CAabb3 / I 5140? . DiMale INd /male X78 AS70 Waiver Information;Without a signed waiver from the subject of the requcs4 a oomplete criminal binary record may not be releasable,per Code of lows,Chapter 692.2.For complete criminal historyrecord lnformntlon,ae allowed by jaw,always ' obtain a waiver signature from the subject ofrne request. Waiver Release:I heraby siva pcnuixston Mr dto abov monolog Meal to conduct an Iowa criminal hirtoryrecord cheek Oh the blvldon otCrimrnat Investlgallon(DCI). Any cambial history data cancetalns /that iemaint. •••by •DCl0 • release• uitawgbylam, __ — Waiver Signature: • J ,U 1 . L u I.• . , • i _ IowalCriminal History Record Check Results (Dciweonly) As of a 11 Mt* ' • c:• F- n search of the pravlded name and date of birth revealed: w f• 'TI ..r. co-11 I +CDrn LI No Iowa Criminal History Record found with DCI i —+r. CM 1:1,e� Jai M C� Iowa Criminal I•Iistoty Record attached,DCI Ii 35CP 3+0`; =c>7: ry r DCI initials . Del-77 (08/25/10) ' Received Time Feb. 5. 2014 9: 24AMNo. 8674 , Feb. 11. 2014 8:33AM Div of Criminal Investigation No. 2645 P. 2 IOWA CRIMINAL HISTORY DCI 00356308 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/02/11 DCI:00356308 NAME: CASTILLI,SUOAN CASTILLI,SUSAN LEE CASTILLO.SUSAN LASOHKE,SUSAN LEE MIELL,SUSAN LEE MIELL/SU$IE DOB SEX RAC HOT WGT EYE HAIR SRN POE 19670203 P W 506 130 BRO ELN MED IA ADDITIONAL IDENTIFIERS SC L CHK SC L FOR SC R LEG SC R SHLD SC R THGH TAT CHEST CCH RRCORD www 01 ARRESTED 19870103 AGENCY: IA0520200 IOWA .CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK$: L31555901 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VEH WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRK({: L31555901 SENTENCE brSP EFF DAT JAIL 2D 19870220 FINE $500 19870220 02 ARRESTED 19911111 . AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRIO: L31556001 COURT DISPOSITION AGENCY: IA0520150. JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L31556001 SUBSTANCE ABUSE EVALUATION • SENTENCE JAIL 7D FINE $750 , Fell. 11. 2014 8: 33AM Div of Criminal Investigation No. 2645 P. 3 DCI 00356308 PAGE 2 OF 2 • 03 ARRESTED 19950612 AGENCY: IA0530000 JONES CO SO CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE TRIO: 014024302 COURT DISPOSITION AGENCY: IA053015.7 JONES CO DIST COURT COUNT NO- 02 IA STATUTE IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014024302 SENTENCE DISE. EFF'DAT PINE $250 19970617 04 ARRESTED 19970512 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE XA321J-2 OWI 2ND OFFENSE TRKB: 028039201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT • COUNT NO- 01 IA STATUTE IA321J.2(E) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: 028039201 LICENSE REVOKED SENTENCE DISP EFF DAT SUSPENDED JAIL 1Y 355D 19970813 JAIL 365D 19970813 FINE $750 19970813 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 IDENTIFICATI N IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-THAW ENFORCEMEN GENCIES BY THE ECX. IN THE AB CE 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 02rFe6._11. 201428:33A1CabDiv of Crimi nal Investigation ' 2645 P ((•AX)3193382'iutlP.uo2ioos •,,; ': STATE OF IOWA `),: ,,,, . i,g).ra` : Criminal History Record Check -' =:a ' %legis.;.,-e. t(. ' Request Form S' '' ' rr' • DCI Account Number:_^9967-F • (If applicable) To: Iowa Division of Criminal Investigation • From: Yellow Cab of Iowa City Support Operations Bureau,1"Floor P.O.Box 428 - • 210 E.7"Street Des Wines,Iowa 50310 • Iowa City,IA. 02244 (S15)7284065 . (515)728-6080 Fax ' (319)338-9777 . ' • • Phone: • vaxt (319)3394302 • t am requesting an Iowa Criminal History Record Cheek on: • Lag Name(mandatory) First Name(monticamyY .. • Middle Name(recommended) ' Date of Birth(mandatory) —- •Gender•(manaenizy)•--•-••--h- --t --=Soclal'Scourtty Number(reoommenaaa) • Oa ' o 3 -. 1.. f fl i •OMaie . "Female Al g -ba -M1(0 Waiver Information:Without a signed waiver from the subject dike roqueat;a complete arlminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For comvinlq criminal hlstory.recoril Information,as oilowed by low,alwAya _obtain a waiver signature from the subject of the i egLueet, RuralverRelease:I hereby sive permission for the eb o rectum4 Metal loconduct antewccrlminalhistory MON aheckwith the Division ofCriminal Investigation(DCI).Any criminal history dela morning arhatIsmelnlhlnadbythe DOI he Moue ossllowedbylaw. __ waiver signature: CMOP • Iowa Criminal History Record Check Results • • (Dc,free oily) As of .a.11 l 11 , a search of the provided name,and date of birth revealed: • at - ❑ No Iowa Criminal History Record found with DCI No I i•. • _C) u" -00 M. Iowa Criminal History Record attached,DCI II 3 S(e 3 aic 3.ii a .71 o r .- • t> N . 'p' IS • • DCI initials • I- DCI.77(08125110) . • • Received Time Feb. 5. . 2014 9:24AM.No. 8614 . . Feb. 11, 2014 8:34AM Div of Criminal Investigation No, 2645 • P. 5 IOWA CRIMINAL HISTORY DCI 00356308 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2014/02/11 'DCI:00356308 NAME: CASTILLI,SUSAN CASTILLX,SUSAN LEE CASTILLO,SUSAN LASCHKE,SUSAN LEE EZELL/SUSAN LEE MIELL,SUSIE DOE SEX RAC HGT WGT EYE HAIR SKN POB 19670203 F W 506 130 ERO BIN MED IA ADDITIONAL IDENTIFIERS SC L CHK SC L FGR • SC R LEG SC R SHLU SC R THOR TAT CHEST CCH RECORD *** 01 ARRESTED 19870103 AGENCY; IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRK#: L31555901 COURT DISPOSITION AGENCY: IA0$2015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2 OPER VER WH INT OWE CHARGE CLASS; MISDEMEANOR CONVICTION TRK$: L31555901 SENTENCE DISP EFF DAT JAIL 2D 19870220 FINE $500 19870220 02 ARRESTED 19911111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J=2 OWI/2ND OFFENSE TRO: L31556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VER WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRIO; L31556001 SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7P FINE $750 Fel). 11. 2014 8:34AM Div of Criminal Investigation No. 2645 P. 6 DCI 00356305 PAGE 2 OF 2 03 ARRESTED 19950612 AGENCY: IA0530000 JONES CO SO CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUESTANCE TRK#: 014024302 COURT DISPOSITXON 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 19970512 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRIO: 028039201 COURT DISPOSITION • AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER YEN NH INT (owl) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRK#T 028039201 LICENSE REVOKED SENTENCE DISP EFF DAT SUSPENDED JAIL lY 355D 19970813 JAIL 365D 19970813 FINE $750 19970813 PROBATION 2Y 19970813 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY TRE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORC `P AGENCIES BY THE DCI. IN THE ENCE 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 INVESTXOATXON . Fe.b. 11. 2014 8:34AM Div of Criminal Investigation (Fpx)3193332iuo. 2645 P.r,uoaiDos O2'u&zula u :2nvel lOW Cob 07 I0W0 ut'y • STATE OF IOWA . r,,n,' • • Iia Criminal Histo Record Cheek • • W(/ `' 'i • 1 :• s- ' Request Form ' ;`.1.-- -:-.. ' 4 \ .f. .. :",'lin}` • DCI Account Number._9967-F . tlropplleeblo) ' To: Iowa Division of Criminal Investigation From Yellow Cob of Iowa City Support Operation Bureau,Ia FloorF.O.Box 428 215 E.tStreet • Des Moines,Iowa 50319 Iowa Clty,IA. 52244 . (515)725-6066 (515)728.6080 nix (319)330.9777 ' Phenol Fan (319)339-7302 I am requesting en Town Crlmluul RistortRecord Cheek on; • Lan Name lmandaary) First Name(awatstery)'• ,.' Middle Nome l,«cmmei,ded) . • • 1 tnsCkKc. J-1'\ Lee., Date of Blrth•(msnduo,y). Gender(mrndet iff ' SSeliil:SebuHty Number(reeommeoded) na (65( , ...../ ©Mare Womale 1 ,•cj• b de,4q7&?• Waiver Information:Without a signed waiver from the subleet of the request;an complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2,For complete criminal historyrecord lure rmalloa,as allowed by law,always obtain a waiver signature from the subject of the request. • Weber Release:Ihmetygiro prnolulon " abovercltuesan nlelsltoconducteniowicdmiaelhiHorymord chockwnhtheDlvbOhtani Investigation(DCh_Any criminal history dstacon gmodaeirm _ ythhJo Imylbdrdleusdasetlowedbylaw. • Waiver Signature. l • •• .. Iowa Criminal History Record Check Rejults (DCI tug only) ` t C 'C u•, As of `\l `k 4 ,a aeeroh of the provided Dalmo and date of birth revealed: - m C G, co (i+-2 i I 9 Pri ❑ No Iowa Criminal History RecordfoundwithDCI —1 `n7d0 • (7):0 „ urn . fit a • o • 3 S(0 304 Iowa Criminal History Record attached,DGI# =p• tv 3”" r .— DCI Initials • DCI-77(08/25110) • Received Time Feb. 5. 2014 9124AM No. 8674 • • Feb, 11. 2014 8: 34AM Div of Criminal Investigation No. 2645 P. 8 IOWA CRIMINAL HISTORY DCI 00356308 • MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 2 DATE PRINTED- 2019/02/11 DCI:00356308 NAME: CASTILLI,SUSAN CASTILLI,SUSAN LEE CASTILLO,SUSAN LASCHKE,SUSAN LEE NIELL,SUOAN LEE NIELL,SUSIE DOB SEX RAC HGT WGT EYE HAIR SRN POB ' 19670203 F W 506 130 BRO RLN MED TA ADDITIONAL IDENTIFIERS SC L CHK SC L FOR SC R LEG SC R SHLD SC R THGH TAT CHEST CCH RECORD srw 01 ARRESTED 19070103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 • OWI TRK#: L31555901 COURT DISPOSITION AGENCY: 1A0520153 JOHNSON CO DIST COURT COUNT NO- 01 TA STATUTE IA321J.2 OPER VER WH INT OWI CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L31555901 SENTENCE . DISP EFF DAT JAIL 2D 19870220 FINE $500 19870220 02 ARRESTED 19911111 AGENCY: 1A0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE TRIO: L31556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VW! WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRIO: L31556001 SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7D FINE $750 ,Feb. 11. 2014 8: 34AM Div of Criminal Investigation No. 2645 P. 9 DCI 00356308 PAGE 2 OF 2 03 ARRESTED 19950612 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 7.9970617 04 ARRESTED 19970512 AGENCY: XA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRKH: 028039201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE IA321J.2(B) OPER VEH WH INT (OWI) / 2ND OFFENSE CHARGE CLASS: MISDEMEANOR CONVICTION TRIM): 028039201 LICENSE REVOKED SENTENCE DISP' EFF DAT SUSPENDED JAIL 1Y 355D 19970813 JAIL 365D 19970813 . FINE $750 19970813 PROBATION 2Y 19970813 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OP CRIMINAL INVESTIGATION, BUREAU OF xDENTIFICAT 0i IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON-LAW ENFORCEME GENCIES BY THE DCI. IN THE AB CE 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 Feb. 11. 2014 , 8:34AM Div of Criminal Investigation No. 2645 P. 10 . eYT-..-,.LU IM VO1<Y TtlI I VW Cab ul luwe LI cy (1♦AX)31933a2/Uri F',U05/005 . • . STATE OF IOWA vI 51;;, hnvn t Criminal History Record Check ' ( a • ti.,' '�' Request Form \ _• r: DCI AoeouutNumber:`9967-F ' (Irappllceble) To: Iowa Division of Criminal Investigation From: Yellow Cab of Iowa City Support Oporatlons Burcau,11 Floor . P.O.Box 428 215 B.7W Street • ba Moines,Iowa 50319 Iowa City,IA. 52244 • (513)725.6066 . (515)725.6080 Fax (319)338.9171 . Phone: Ban (319)339-7302 I ant mouestingpn Iowa Criminal Historniteoard Cheok on: . • .Last Name inundatory) First Name(mreddo,v)•• •Middle Name(rvccmmeaded) • Date of Birth(ohedeory/) . • --�--, Gender(inwaalo,yi•'',..`,.,,._ '--- -• •8oc161 Seourltyy Number�7 (n/mmus cd) ' • r—Oa2• ./o?�- [( 9101 • ❑Male Minnie 47 - (Jc — 757( Waiver Ipforn:aliort:Without a signed waiver from Um suhJnct of the request;a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692.2.For complete criminal histnryrecord information,as allowed by law,always obtain a waiver denature from the sublet!ofthe request. • Waiver Re/ease:rhersbyski p nIalontbrtheab erequesting MOM tocoaduoteaIowa minimabinotywend ohcdcwhitthe Dhletrtnteriminei Jnvaagmlon(DCI), Any criminal historydem meaning that bmdnah,ad by the DCI may eased a lowed dbbylaw. Waiver Signatures uJ�.).�ll(/• t • 1h •,{!i✓ . • Iowa Criminal History Record Check Results (not a..only) As of 'aI t % l t "t ,a search of theprovided name and date of birth revealed: c r,, p No Iowa Criminal History Record found with DCI to c; r;' pq aF:aI:1 Iowa Criminal History Record attaohed,DCI# 5 v, T Y" N 75 DCT initials •r DCI.77(08/25/10) • Received Time Feb. 5. 2014 9:24AM No, 8674