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Home My WebLink About18-068CITY F IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX IDENTIFICATION NO. j5-0 L9R (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 First Middle Last (� 1. Name (REQUIRED) \ , oi- \n C. t 7 �l �'e L� ► �Q 2. Address (REQUIRED) 3. Contact Information (REQUIRED) Email: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: -�SaeA yetke7W Cg1.-t 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Tvce of offense Where When C'Q(\-�rottlzA SybLdayAte 7y 0 What happened to the charge? (Circle one) n -G N �r m M (n in Convicted Dismissed referredSuspended Plead Guilty Other Have you been arrested / charged with any traffic o enses In the last five years? Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPlead Guil Other l 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Nb Tvce 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) (SECOND PAGE 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 !MMcg(t�fy that I have issued to me by the Iowa Department of Transporttion a valid Drivers license number } k (� q 1 _T1_1 issued on '4((kilY, xpiring on 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 front of a Notary Public) Signature of Applicant (:4: xyd4L , VJiYD h. Date T -,)k - (co �«�r�in»•H�x�mer�y�rw��:�+++r+��aykrir��kr`+�++e�sx�w��r«��«�+t+��:��:��r��+irNrr`�+�+++++.�� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sword�r to before me by i mx� 7-S "�_)i0 on this o� day of -iu\ &. Z017�i. V ENDY S. m I have reviewed this application, DCI report, and the State certified driving record of this appli;a h�e det wed that there is no information which would indicate that the issuance would be detrimental to the safe 'Oth W welfare-ef resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). ;7_ i rrn Expiration date of Driver's ' nse C, - 7 Sig e of Police Chief or designee (-n7- Z y /p`I 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. S gnat re of City Clerk or esignee Office Use Only Approved application DCI report State certified driving record Website update 7- ;� 4 -) � Date Clw' Axi°R'va'DCEnraem'se"'&-°ea.DX 04/2018 Jun.15. 2018 10:46AM Div of Criminal Investigation No -4469 P. 1/3 06!14/2018 14:20 Yellow Cab (FAX)319 338 zmb vmu21002 3193393765 mercy ho5p1ta I cls 12; 16:31 06-14-201$ 1 STAIR OFIOWA COMinal History Record Clieck , Request j'orlal DCI Account Number, _9967—F " •I ((tapDllcab(e) To: Iowa Divplatl UrCrlminal Inviatjgatfoa From; Xellow Cab of xvwA Ciri Support Street FO. I"{?leor )i•0. Box 428 215 E. 76 Street Aes Moines, Iowa 50319 0wa City, V. 9.2244 (515) 725.6066 (915) tU080 pax (3I9) $89:i777 Phone; Fax:. (319)339=7302 I_a_m requesting an Iowa Criminat 344M4." V.— a 2 r2 Last N'amr tmrndw ii153 st I Lame (Tanaetet» 1�(fddla Name r aommm - Datee of Birth (mu dwryi ;' Gend'er (mandatory> AsCCISI- ' Number Oocooaomde4> -I. /��.0 � Ct �.:��`>.... s [jMala �emale /eoq r •: �f C7 1 �1.�1-• 1 `1 ��` LT}aiva! Xt{forhfat44h; Without a signed `tatrer from the subject of theregpesy a complete grimlual history record Way not be releasable, per Code of Iowa, Chapter 692.2. For 6k'MgleiS criminal hlstory•recoFd•lo(orwafion, as allowed by law, .zjW1ys ohta(nR Waiver sl Hato re lrom tbasUb wt.of the hoast, Wa6YehIZC18flS2;Ihvcbygin p—ss(cnfo 6"eye t=1yr=rdclukwith0pplv151cmofCr(rAlaAl Innsakm (DCT)• Any etlMlnal I4SX* data conoMOa mo that i!1 tnain*C4 by fht DQ may be M=W 4111" by kw, l aEverSlgnatura,1 14 '11\1j a AAA4ALLfA{Ayl°I.0{y' AVG6.V J•u ,--rrcur�A`C, LLa(DCl Wmly) As of `1 a'seary of the provided name and dote of birth revealed: d I\I0 Iowa giminalHisio} Record found with DCI — Iowa Criminal History 'ecozd attaahed'DCI H � `� `',N3 �rrm� bCI it itials ' w l� CA DOI-77 (08/25/10) Z0011 0'd auncQ61YA-6 g8201011aAytZl 91OV114190 RP t IvP(I imp .Inn. 14. 161R ):IUM Nn.4361 dun.15. 2016 10:46AM Div of Criminal Investigation No.4469 P. 2/3 IOWA CRIMINAL HISTORY DCI 00619756 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2010/06/15 DCI:00619756 NAME: HOAGLIN.ELIZABETH HOAGLIN,ELIZABETH JANE DOB SEX RAC MGT WGT EYE HAIR SKN POB 19780726 F W 505 150 BLit RED MED IA ADDITIONAL IDENTIFIERS TAT R ANKL TAT UR ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20001117 AGENCY: TA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401 -3-DBLIVBRY SCHEDULE II TRK#: 100080801 CHARGE NO- 02 IA STATUTE IA706-1 CONSPIRACY TO DELIVER TRK#: 100080802 COURT 131SPO9ITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(1)(C. CONTROLLED SUBSTANCE VIOL. COURT CASE ID: 06521 FECROS6246 CHARGE CLASS: NON CONVICTION TRK#: 100080801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20010608 PROBATION 3Y 20010608 DISCHARGED FROM 20030801 DEFERRED JUDGEMENT o COURT DISPOSITION 0 m AGENCY: IA052015J JOHNSON CO DIST COURT^C„C') C COUNT NO- 03 IA STATUTE: IA124.401(1)(C; { CONTROLLED SUBSTANCE VIOL. n COURT CASE ID: 06521 FECRO56246 '�•ry7 CHARGE CLASS: NON CONVICTION O _ V TRK#: 100080803 :-- y' Ln SENTENCE DISP EFF DAT cit 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 COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION No. 4469 P. 3/3 N O_ O� m _Gr m a s � ui C4010WADOT SMARTER I SIMPLER I CUSTOMER DRIVENwww'iOWadagov "K a WarNB .Mn smim PO Box 9204 I Dea Moinm IA SOU&SM phone. 516244.917A I Fax: 5i5 -239 -INT 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 STH ST APT D Restrictions: NONE Restriction None Supplement: Date of Birth: 07/26/1978 Mailing CORALVILLE, IA Sex: F City/State: 522411885 History Information Convictions Citation Date on Data �03/02 ACD Ex lanation Coun JUR 16 S92 Seed Chickasaw IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. N Name: Brown, Elizabeth Jane DL/ID: 787PP9173 0 m pt? G Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa DeparAnnElt� of nspor�n, do hereby certify that [ am the custodian of the records held by Driver &Identification Services, that thlMs�-Cj truFand adiu��'�ra"�te copy of an official record currently in the custody of said Office, and that I have been authorized by tV6F"ct= f th0Iiiida Department of Transportation to so certify, Ij� =D Cn 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: 3 r� OF Name: Brown, Elizabeth lane DL/ID: 787PP9173 6/14/2018 Driver & Identification Services Iowa Department of Transporation N O C:) �' aO p � r F n� Cit