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Home My WebLink About19-023I r t 0- = -so 3f `�III�� _ CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX IDENTIFICATION NO. (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 Last (�(10� �J5 r 1. Name (REQUIRED) LM S 61 Yl First Mitirlip 2. Address (REQUIRED) aaSQ S.EZ�JP_r4tc�e Of5� In Y1 ( tEtt fA aa4� 3. Contact Information (REQUIRED) Email: (A"QS S l igltlft ma' ( _ga ell Phone: 'j1q Sq4 3 IS (All written communications t viewemail) 4a. Driver's License expiration date (REQUIRED) C)oi -00 b. Taxicab Business Name (REQUIRED) �t 5. Prior experience in transportation of passengers: q r S 10 I nW V 2h MAR 2 5 2019 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elii retia% "a Type of offense Where When 6Ir') I rnwa rd`14 h7 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? N (\ Type of offense What happened to the charge? (Circle one) Where When 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? N1r) 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) Na\ (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 certfy that I have issued to me by the Iowa Department of Transportation a valid Driver's license number 8 4 b AA 54 3 issued on oa - o-7- 14 expiring on U a -o3- aa . 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 .A11,00n XOQ FA01no Date D 3 -.76 - (q r STATE OF IOWA ) COUNTY OF JOHNSON ) City Clerk Iowa City, Iowa Subscribed and swore to before me by 5u �C. LA L . �l < on this LL day of 1An`I Q_ �� I4 — P and for 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 Driver's nse —q7 o 2-03 Z��2 -9 7 Sign'attire 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. 3-1�5-1� of City Clerk q designee Date Office Use Only Approved application DCI report State certified driving record Website update a&VTMIMR 94DGFAPPL92018amer W DOC 04/2018 Mar -21.2019 4:08PM DCI IOWA 03118/2019 13:21 Yellow Cab No. 1236 P. 1/7 4FAM19 330 2708 P.0031005 STATE OF �O'VVA a Criminal ]history Record Check. 1 r Request Form.,• ACI Amount Number: 9967-F ,. t (lSappllwale) To: Iowa Division arCrlminal investigation J Brom: Yellow Cab oflorva Ct tv Support Operations Burs' I0 Floor y a g.0. Box 428 2IS It, 7 Street Dry Melner;Iewa 50319 r' MAR 2 5 1019 Iowa City, IA- 522144 �— - (sis) 725-6066 ' (SIS) 725-6080�Fax City Clerk (319) 338-9777 II :p 16wa City, Iowa pbones 'Y F=. (3191§3-9-7302 I am rcquesting requestingan I6wa CriminaJ Iii` K=td Check on: Last Name mandat First Name (m.ndeter»' Middle Name C ..e dedy 0 Date of Birth mwwatorn f Gender datnry . Social•Sec Number (neaammcndo // ❑Male— Waiver•lnforrrtatlon: Without a signed waiver from the subject of the Mgvest, a cos)plgte criminal history record 4 y bo be releasable, per Code arfowa, Chapter 692.2. For oar plate ariminat history•recoro information, ey alldwed bylaw, always obtain a walver sl ata • re aµb1 the 9ect of the request. Walver.Release: i hereby give Potmissfogfbr the above rogvating official to oondoet an Iowa ccimitnl hisroryxcord check with tie Division of Crlmfna I Inneedgadon (DCO, Any erhnlnal history data ebm=' ing me Thal is mainteinad by the DCU maybe rolgnod as alloweq by law. WaiverSignaturer.'' l&.11Y) n //I.OQ Pha,PC,I 1 I Iowa CriJninal istoryRecord Check ResUlts (Drfaseontyl As of A , a e0arch of the provided name and date of birth revealed: ISIrATE OF I 1OWA/D ® 140 Iowa Cdrri il@ Aistory Record found with DCT Y B 2019 d IV F CRIMAVAL INVEI Towa Criminal Mei 4D.iy Record attached, DCI inilials�� l b;CI I., DCI -77 (08125110) 6., 4.sroC1 u. nrn-i 0... ,,.A T�... M., to 11110 P,C 97 Mar.21.2019 4:08PM DCI IOWA No.1236 P. 2/7 03118/2019 13:21 Yellow Cab ffAX)119 338 2708 P.004/005 k ,a cm a mT. /1T r�xxr a VIL _ - v �, Hca. x �v vi' t v v v •rte Criminal History Record Ch-eck. ° Request Form j ;� -1 F¢. yt DCI Account Nudtlber; ^9967-F .1 v 1pplicabis) To: Iowa Division or Crfminal,Investigation From: Yellow Cab of lowi Support pperatlonsBureau, I".Floor P.O. Box 428 215 E. 7'a Street Des, Moines;'lowp 50319' n Iowa City, IA. 522¢4 (515) 725-6066 ' i City (515) 725-6080) ax 5 1019 (319) 338-977'1 MAR 2, Phone, City Cle(k Fax: (319j339-7302 Iowa I am re uestin an Iowa Criminal Isis R 1 eWywL kbn: j Last Name maadatoy) I+Yrst Name (mandato ' • Nii d1e Notme (r mmandad)• Date of Birth (mandato Gender (mandato Social;Securi Number reawmeadG // ❑Male 91peluala Waiver rnfor Kation: Without a signed waiver from the subject vfthe reypest, a completo Criminal his ory record may no be releasable, per Code of Iowa, Cha(iter 692.2. For com Leto criminal history•record information, as aimed by Jaw, aJvvays obtain a waiver signature from the sub ect of there uest. Wa&llrReiease; l hceeby glva permissloa'for the above raqueeting oitimal to conduct an Iowa criminal historyr000rd check with thl Dtvklan of Criminal Invecdgatlon (DC. Any criminal b1nory dare c&dming me that Is mdnm�lnnod by the DCT may be rolcaxd as allowed bylaw. • Waiver Signature: Al mnn/1 tltf8• P�'L�e �, I Iowa „r�IninalRstory Record Check Results (pct asa cnry) As of :)Ll,(Q a gWch of the provided name and datdof birth revealed: IS O IOtNA;i)t ® No Iowa CriminelAistory Record found with DCI M R 8 2019 .j; DIV OF Iowa Criminal HistOY Recordf attached, ACI # 3S�o3 QP RI NAL. iNV^;' i b'CI initials r DCI -77 (08/25110) I r; _. a-. 10 nAln J, JtioAl a. n�n1 Mar.21.2019 4:08PM DCI IOWA No.1236 P. 3/7 0311912019 1321 YelloW Cab (FA1)319 mil 2708 P.0051005 STATE OF IOWA Criminal History Record Check. Request Form 4 Por DCT A000unt Number: _,967-F .l (( applioablc) To: Iowa Dlvlslon or Criminal investigation From; Y'allow Cab of Iowa City Support oporatloDsBureau, 1° }rloor ._ P.O. Box 428 215 S. 7's Street �- Des Moines;7owa 50319 MAR 2 5 7019 Iowa City, IA. 52244 (515)725-6066 (515) 725-6080, Fax City Clerk (319) 333-9777 Iowa )?hone: Iowa City, Pax. (319)' 39-7302 i I am reeuastina an Iowa Criminal I3isiory Record Chcek on: Last Name rimilamry) First Name mandatary)' Kiddle Nama (rc ommbl ded)' 50.t� Date of Birth (mandno Gender mandatory) 'Soeial•Seauri Number (Reammenda ❑Malo I Fernale : eZ Waiver Informations without i stoned walver rrom the subject of the request, a complete criminal hlal4ory record may no be releasable, per Code orlowe, Chapter 692.2. For com_.. pletQ crlminal hlstory.recor¢ Informatlon, as allowed bylaw, always obtain a waiver sl nature froin the subject of the request Waiver Release: i hereby `lve permission for the above retiucadne official a oonduw an lows crlmina) history record oheokwith the nivalm of Criminal Inveadastlon (DCT). Any wlminN history data ccar�mlng mo that 0 maintained by the DCl maybe rclaaabd as allowed by law. Waiver Signature: �4 �Ca 92 ^�_ — _---�-r- I Iowa Qr-imilaal11istory Record Ch ck Results F IWA/DPS I (DCl uaa only) As of 311.1 a search of the provided name and date of birth revealed: STATE ❑ No Iowa Crim'inal.History Record found with DCT MAR 1 S 2019 DIV OF CR Iowa Criminal Hi Record attached, DCI # -33P G MINki- INVEST DCI initi'els�.—_ l DCI -77 (08/25/10) p_ _.,,.., r:-. If.. 10 Wn 1.11 00 bl„ nhn7 Mar.21.2019 4:08PM DCI IOWA Ns 1236 0311'8/2010 13:20 Yellow Cab O'AX)919 338 2706 ) R6 STAkE OF •. P 11 WhR 11 Criminal History Record B �Ia �. Request Vorm To: P. 4/l P.002l005 DCI k000unt Number: �9?67-x', . .� (Ifoppticaht 10vva D1Ylolon of Criminal lnvestlgatltge a a �T .., From- Yellovi Cab oflnwh Clty F.0. $ox r{28 Support Operations Buremt 1" Floor 1 L L 215 B. 7" Street L) Du Moines;7owa 50319 Iowa City, TA. 522kA (515) 723•6W MAR 2 5 1019 (615) 725.6080„Fax (319) 338-9777 1 City Clerk Phone% ; I Iowa City, Iowa 19 3 9-7302 Fax: I am requesting an Iowa Criminal Hiftory Record Check on: ' Last Name (mandatory) ' .First Name LmattmL I Middle Vskme (ruommended i bate of Birth pma„detm» Gender (mandato ) ; 'SoClal•8eeuri Numbex (rocowneada Waiver Information: Wltilour a slened walver from the subjeataf the request, a complete prlminal history record spay no be releasable, per Code AfXowa, Chapter 692.1. For complete criminal ItWoryFeeoro information, as allowed by law, always obtain a waiver slitnature from the sub ect of the to uast. Waiver Release: i hereby give parminiot for the above requesting of iGial to conduct an Iowa orlminal history record acdc with thl Division of Criminal Investigation (!)Cr) Any adminnl history data eSnoemlng me that is maintained by the DC1 may be rolassod aallowed by law. Waiver Signature. �ay I M Yi Ci[ q� �� A L ,,,� ` . • � I - Lv Iowa Crimihal;11istory Record Check Results T j (DClu us only) As of �' , a search of the provided nine and date of birth revealed; 10 Iowa Cxlintnal ,Aistory Record found with DCI ' STATE OFIW Y: /CIPS AGAR 1 E 2019 ❑ Iowa Crir&i i :Histj'rY Record attached, DCT # _ �� OF CRIMINAL NI\T';T Diel initials DCI.77 (08115110) ; Mar.21.2019 4:09PM DCI IOWA IOWA CRIMINAL H19TORY MISDEMEANOR CONVICTIONS ONLY DCI:00356308 NAME: CASTILLI,SUSAN CASTILLI,SUSAN LEE, CASTILLO,SUSAN LASCHKE,SUSAN LEE MIELL,SUSAN LEE MIELL,SUSIE DOB SRX RAC HGT WGT 19670203 F W 506 130 ADDITIONAL IDENTIFIERS SC L CHK SC L FGR SC R LEG SC R SHLD SC R THGH TAT CHEST DCI 00356308 PAGE Y OF 3 DATE PRINTED - 2019/03/21 EYE HAIR SKN POP BRO BLN MED IA DISP EFF DAT 19870220 19870220 No. 1236 P. 5/7 CCH RECORD www 01 ARRESTED/TAKEN INTO CUSTODY 19870103 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI TRX#: 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 JAIL 2D FINE $500 02 ARRESTED/TAKEN INTO CUSTODY 19911111 AGENCY: IA0520000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA321J-2 OWI/2ND OFFENSE . TRK#: L31556001 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WE INT (OWI) / 2ND OFFE148E CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: L31556001 .. SUBSTANCE ABUSE EVALUATION SENTENCE JAIL 7D FINE $750 DISP EFF DAT 19870220 19870220 No. 1236 P. 5/7 Mar.21.2019 4:09PM DCI IOWA DCI 00356308 PAGE 2 OF 3 03 ARRESTED/TAKEN INTO CUSTODY 19950612 AGENCY: IA0530000 JONESCO SO CHARGE NO- 02 IA STATUTE IA124-401-3 POSSESSION/CONTROLLED SUBSTANCE TRK#: 014024302 COURT DISPOSITION AGENCY: IA053015J JONES, CO DISI COURT COUNT NO- 02 IA STATUTE: IA124-401(5) POSSESS CONTROLLED SUBSTANCE/MARIJUANA CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 014024302 SENTENCE DISP EFF AAT FINE $250 19970617 04 ARRESTED/TAKEN INTO CUSTODY 19970512 AGENCY: IA0520200 IOWA ;CITY PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI 2ND OFFENSE TRK#: 028039201 COURT DISPOSITION i 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 TRK#: 028039201 LICENSE REVOKED SENTENCE DISP EFF DAT SUSPENDED JAIL lY 355D 19970813 JAIL 365D 19970813 FINE $750 19970513 PROBATION 2Y 19970813 No.1236 P. 6/7 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. C(:"- Mar.21.2019 4:09PM DCI IOWA No. 1236 P. 7/7 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 hxetory data concerning convictions for certain juvenile sex offenses Can be found on the Iowa Sex offender Registry: http://www.iowasexaffender.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 confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). 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 Iowa Govcmmert Orrvino Exit Confirmation Please keep a record of your Confirmation Number, or print this page for your records. Confirmation Number IOWDOT006880446 Payment Details Description Department of Transportation http://www.lowadot.gov/ Payment Amount $7.00 Payment Date 03/15j2019 Status PROCESSED Payment Method Payer Name Susan Phelps Card Number *7379 Card Type Visa Approval Code 661698 Confirmation Email yciowa68@gmail.com Billing Address Address 1 PO BOX 428 City/Town Iowa City State/Province/Region IOWA Zip/Postal Code 52244 Country United States C4001 4iUWADOT SMARTER I SIMPLER I CUSTOMER DRIVE?1 tivtivw•'iowadot,aV Drive# B ldeMdfcation Services PO Ecx 0-104 i Des Mines, IA fth&60 9204 Plane 51;i-244-91251 Fax515�239-1[837 Certified Abstract of Driving Record Inquiry Date: 3/15/2019 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 Expiration Date: 02/03/2022 CDL Cert Status: None 522403234 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 02/03/1967 Mailing IOWA CITY, IA Sex: F F I LE City/State: 522403234 History Information MAR 2 5 2019 CLEAR DRIVING RECORD City Clerk Iowa City, Iowa Name: Phelps, Susan Lee DL/ID: 846AA4543 Pursuant to Iowa Code 4321.10, 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: Name: Phelps, Susan Lee DL/ID: 846AA4543 3/15/2019 Driver & Identification Services Iowa Department of Transporation ( _J iY#4 D OZ wwtiv.iawadot. ov SMARTER I SIMPLER I CUSTOMER 0140)111 g Driver B Identification services PO Box 9204 1 Des M. tnm IA 5DX65,26 Prone'. 5f5-2S3-31711 Fax 51"239-1837 Certified Abstract of Driving Record Inquiry Date: 3/15/2019 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 Expiration Date: 02/03/2022 CDL Cert Status: None 522403234 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1206 E COURT ST Restrictions: NONE Restriction None Supplement: Date of Birth: 02/03/1967 Mailing IOWA CITY, IA Sex: F City/state: 522403234 History Information a CLEAR DRIVING RECORD u MAR 2 5 2019 Name: Phelps, Susan Lee DL/ID: 846AA4543 Cliy, 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: Name: Phelps, Susan Lee DL/ID: 846AA4543 3/15/2019 L�LIL- C Driver & Identification Services Iowa Department of Transporation