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Home My WebLink About18-089CITYF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO.'q (Office Use I nly) 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 Ek err, •j P_ l j 2c.Jtje�1, r)r p- 2. 2. Address (REQUIRED) i0 7 r 2 8 t H S� lii Lcv a ii r e i x 5�7 e l 3. Contact Information (REQUIRED) Email:btu-(iNn . „c _ S c.r l 7ct7 ct a�S�m Cell Phone RJ9 2/2-0&9 a (All writ n communicatio enths via email) Middle 4a. Driver's License expiration date (REQUIRED) _ OB' I /'(I 20 2- b. b. Taxicab Business Name (REQUIRED) -1-p�e- _L_f_oLo Co --t-, 5. Prior experience in transportation of passengers: n bone 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? y*0' S Type of offense Where When O UT /)I, - o�{r'rP �a Oct��" 200 -3, rn uscah he Flub I k c. -I mi ar- ( , .sem-1, e . +� ")� a )01 � --11 ,;�r What happened to the charge? iA zo-ar Convicted D' missederre Suspended Plead Guilty Other Have you been arrested / charged With any traffic offenses in the last five years? /Jj') N Type of offense Where S yyh4F What happened to the charge? (Circle one) I j J -D,�a a Convicted Dismissed Deferred Suspended Plead Gulf (ser 0 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five year& 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) 04/2018 41 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 D partment of Transportation a valid Drivers license number l 1 ZZ y yS issued on i tot expiring onr561 Zo 3. I understand that if I falsely answer any questions in this application, that this ap lica ion may be denied. I agr a 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 Applicantwenn.4CV7u Date 9 2oi� STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 5non this _� day of Lb n. c Q 'Go/ 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). o Expiration date of Dnv licens —1q- Z02 3 `= ij r1j �D Signa of Police Chief or designee Date-: z �_ )17 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 Clerk or Osignee Office Use Only Approved application DCI report State certified driving record Website update 2,'7— / E Date claWAADRNBAocEAPM92oi8am "ee°.°oc 0412018 Aug,24. 2018 3:57PM Div of Criminal Investigation No -0565 P. 1/6 0812412018 14:52 Yellow Cab fA)W9 MI 2708 ' P.0051006 T15P WWA triwod 6f Crt"Al TZ(vesttgation. besJllbines�'roike 503]9 (5151.125. 1 EstFox TAT$ OF IOWA RequwtForm- tam re uostiu m Iowa',kviaord thtek -ori % DC1Ad6Dunt N,d1nber —.0'967-� Of . Wa gtL• � F;Q, BOX 4;8, ltowk.C-hy, =,'32144 ,part (31 339-7502 tras Me b",j F.lr .Na),mo Sh G5 ;�;5 r -a 1)2te,0.fB"ft6th'( d ❑ Ic �Nbcr (�m No, 10WPL Cts, bMf,J4,%toq lkc;oTd found with DCI. —jr- -=F be rele2,i". hW-h1Wry.1.,ecq'j �,00i...mAttons,2S allowed by law, always t1ke m4nost.- . . . ... . , :1. 1 1 :.- - . .. i9to 4,00*ct 44. qwep NAM . h* dd*4h*; 1;;'10WaQ6Ming1,T-rft0,yR.0jdg. Dcr.4 ~+018 L40 as= am, �%Jtjwory maw. (L-Uhle jRksuffi- As of 00 seixcb -of t1be p.4114.4 tow And due of revt%W' G5 ;�;5 r -a ❑ Ic No, 10WPL Cts, bMf,J4,%toq lkc;oTd found with DCI. —jr- -=F 1;;'10WaQ6Ming1,T-rft0,yR.0jdg. Dcr.4 ~+018 L40 as= cn te- W - f: Dcx Wtiau co DCI -77 C08f2-5ZIp) 06ug-24- 2018A:u3:57PM Div of Criminal Investigation i vviw Cab .9;40AM D• it. 01, - crizziflf't -# sl 44673 No -0565 P. 4/6 TAXM9=2M PAMMOG No. 444.5 4F 1/4 04awsuo Top. .9.67.TP, ,9uppart. j�i . 8-twe, JIM 0. golk Otro X51 t? Su�Q'Pat aft. TWO siu Mit 7 w tin .. ................ 41 AS: �P_ 3 . IZ4� Aug.24. 2018 3:57PM Div of Criminal Investigation ADDITIONAL IDENTIFIERS SC L THOR SC R HND CCN RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20031005 AGENCY: YA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J-2(2)(A) OWI TRK#: M00230101 CHARGE NO- 02 IA STATUTE IA726-6 CHILD ENDANGERMENT TRK#: M00230102 COURT DISPOSITION AGENCY: IA070015LT MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI COURT CASE ID: 07701 AGCR027893 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00230101 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040127 REVOKED 20040914 PROBATION 18M COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 02 IA STATUTE: IA726.6(6) CHILD ENDANGERMENT/NO INJURY CHARGE CLASS: NON CONVICTION TRK#: M00230102 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040106 PROBATION 18M 20040106 DISCHARGED FROM 20060829 DEFERRED JUDGEMENT 02 ARRESTED/TAXEN INTO CUSTODY 20040619 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA123.46 PUBLIC INTOX TRK#: M00344201 COURT DISPOSITION No.0565 P. 3/6 IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCT 00708890 PAGE 1 OF 2 � 3 DATE PRINTED- DCI:00708840 D 2018/08/24 NAME: SURLINGAME,SHERRY ELIZABETH cJl BURLINGAME,SMBRRY HLIZIBETH DRVORE,SHERRY DOB SEX RAC HOT WGT EYE HAIR SKN POB 19710814 F W 411 116 GRN BRO IA 19711114 ADDITIONAL IDENTIFIERS SC L THOR SC R HND CCN RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20031005 AGENCY: YA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA321J-2(2)(A) OWI TRK#: M00230101 CHARGE NO- 02 IA STATUTE IA726-6 CHILD ENDANGERMENT TRK#: M00230102 COURT DISPOSITION AGENCY: IA070015LT MUSCATINE CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2 OPER VEH WH INT OWI COURT CASE ID: 07701 AGCR027893 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: M00230101 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040127 REVOKED 20040914 PROBATION 18M COURT DISPOSITION AGENCY: IA070015J MUSCATINE CO DIST COURT COUNT NO- 02 IA STATUTE: IA726.6(6) CHILD ENDANGERMENT/NO INJURY CHARGE CLASS: NON CONVICTION TRK#: M00230102 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20040106 PROBATION 18M 20040106 DISCHARGED FROM 20060829 DEFERRED JUDGEMENT 02 ARRESTED/TAXEN INTO CUSTODY 20040619 AGENCY: IA0700000 MUSCATINE CO SO CHARGE NO- 01 IA STATUTE IA123.46 PUBLIC INTOX TRK#: M00344201 COURT DISPOSITION No.0565 P. 3/6 � 3 D cn cJl Aug -24- 2018 3:57PM Div of Criminal Investigation No.0565 P. 2/6 AGENCY: IA070015J COUNT NO- 01 MUSCATINE CO DIST COURT IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION COURT CASE ID: 07701 SMCR029640 CHARGE CLASS: MISDEMEANOR CONVICTION TRRH: M00344201 SENTENCE FINE DCI 00708840 PAGE 2 OF 2 DISP EFF DAT 20040708 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, -BUREAU OF IDENTIFICATION I9 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 NOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION p Li G �� 06Aug,r'24. " 20184:ua'3-5vwuwPwMC8b8Div of Criminal Investigation 1—aw STAU OF IOWA Ci M.tAal Mtoryr Roeml-Cheek. 00,00tr D ca Mof.h'&L ltiyM. SpIl La-4ee OR J Jfl 11 -7/ be No. 0565 P. 5/6 fA=O=dm V.UUsfoos DCI:AcOouzitNumber; 996-7—P (Tf 4pj11c14w)— From: Ytltofy.Gxb aribipacitir * . r-.V.3Oxj2S 16wit Cht. TA. Th"Pr it= (310-39-730Z qF, / - V'V- g,7 / -c> nation; al Ailawad byjiw, ilways wallyeri? 11' de CY%hnfii�oOc ibatayquMu�gp&' Wkoffaiudzoftye+oof orb1RVMttPO$*�i.�& Obi Irt, G-) L As of dft* Of tbP WOVIOed m=c OW date ofbir0i mvwed: Ln R! r -n NO IOWA Cf 81:fttOfY.ReO]rd fOund withDC1 TZ2 . Iowa CrlmidHkory Rewd ata Ilii d, ):)Cr# y r c cn -n Q Aug -24. 2018 3:58PM Div of Criminal Investigation No.0565 P. 6/6 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, If any, an application must be filed pursuant to Iowa Code section 232.147(18), Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.lowasexoffender,com/, However, even though some information is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record, In order to request the release of confldentlal juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). lag w �2 m cJ1 CJ'1 410WADOT4 SMARTER I SIMPLER I CUSTOMER DRIVER VUWW.IOWBC�Ot.GjOV DrN4r B ldermication somm PO Dox 92041 Des Moines, IA 503069204 Phone 515244-9124 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 8/20/2018 Name: Orr, Sherry Elizabeth Address: 702 W 8TH ST City/state: MUSCATINE, IA 527612924 Mailing Address: 702 W STH ST Mailing MUSCATINE, IA city/state: 527612924 DL/ID #: 811zz4845 (IA) Customer #: 3962554 Class: C ID Status: EXP Audit #: 2160018 Issue Date: 09/19/2017 Expiration Date: 08/14/2023 Endorsements: Restrictions: Date of Birth: Sex: NONE Corrective Lenses 08/14/1971 History Information CLEAR DRIVING RECORD OL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Noma: Orr, Sherry Elizabeth DL/ID: 811zz4845 _ g m CJ q ;-�yC) G Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & identification Services, Iowa Dep drt It oRransp on, 7 N do hereby certify that I am the custodian of the records held by Driver & Identification Services, that Sfil t1s1a tA,@and curate copy of an official record currently In the custody of said Office, and that I have been authorized by-d4pire Clizir of tlk Tdwa Department of Transportation to so certify. O -- Y ccJI In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at nAnkeny, Iowa this date: Name: Orr, Sherry Elizabeth DL/ID: 811zz4845 8/20/2018 A2zk�� Driver & Identification Services Iowa Department of Transporation