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Home My WebLink About19-051CITY F IOWA CITY 410 East Washington Slrect Iowa City. Iowa 52240-1926 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. — (Office UseOnly) APPLICATION FOR TAXICAB / M4-1'Qj jjj$�EDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday— Friday) Failure to complete the " reguir4I 11 iml4 n WI Zisleth in denial of the application CITY CLERK Last First i VIA CITY, IOWA Middle 3. Contact Information (REQUIRED) Email: 4a. Drivers License expiration date (REQU b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa Cell Phone: 3 [9— 93o ` (0q.Z V sent via 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty -� Wor 7. Have you been arrested / charged with any traffic offenses in the last five years? N C� 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 chauffeurs license been suspended or revoked in the last five years? Type of offense Where When QOl 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) NVIAKY) Cr_fKII& Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED._ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIE1lV° r_ s d, 'j You must apply for an individual Department of Criminal Investigation Report (form L available upon request). Z0 17 Ph 2° 4 7 1 hereby certify th,t I ''ave iccl,ad to me by the Iowa Department of Transportat' rjvers license number j rJS /4 C 3� issued on 61-53-do14 expiring on i ! rSl understand that if I falsely answer QI,y qu.,.,,1 I,� in this application, that this application may be denied. I agree t n rig 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, Chapt r 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date o Irl— L`'1 HH#f#fefHff#f11#ff##!!f #fyyrtf#ye#fiflf#f ##H# ##i##f/fff i4##M!#f iY#ffHlfflfflfNff fifff f 1f1f ######'I###ff lfflffffflk#Y1Hfffffffff }fff##f# f flfi STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and syaorn to before me by _�>� a ,, a �. C� ., U e on this �� day of ##fr#4Rfff+#RfffflMlrfRlfft#!ft#Lfft #4fYiiNYi*At41rtI(#y!## ##M#R#t##fi!###• 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 license 11yZ6 -z'j'5 7 Sig t e P61 Chief or designee I Dat 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. 7// 7h9 Signature of ityler or del g pe Date fffffffmfffrfffffffffffffffffffffffff�ff#f#ff#fff#ffffffffffffffrfff»f#fffffffffff»ffff###f##e#########fa#r#ffff+##a#########fff�f#ef####### Office Use Only Approved application DCI report State certified driving record Website update CIerkaMIDRN84DGEAP L9201U.vdWDOC 04/2018 OPIDWAI $IAS I SIMPLER I P08QX-9M{Desb10 t015D5f36jjd — MOW M&244 -M2 Fate 5'15439.1a57 19 JUL 17 PN 2: 4 7 Sanctions History Information Effective End ACD Explanation 08/24/2010 09/16/2010 D53 Non -Payment of Iowa Fine Ia R Occurrence JUR Name: Galvez, Sheila Janet DL/ID: ISSAC4396 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: Galvez, Sheila Janet DL/ID: ISSAC4396 (IA) 7/3/2019 14 Driver & Identification Services Iowa Department of Transportation Certified Abstract of Driving Record CITY CLERK Inquiry Date: 7/3/2019 CIT Y, IOWA Customer #: 1355769 DL/ID#: 155AC4396(IA)CDL P!0V!ermit None Class: ass: C CDL Permit Issue None Name: Galvez, Sheila JanetDate: Audi[ #: 3967428 CDL Permit None Address: 1100 Arthur St Apt F1 Issue Date: 07/03/2019 Expiration Date: CDL Perrmimi t None Endorsements: Expiration Date: 01/04/2027 CDL Permit None City/State: Iowa City, IA 522406610 Endorsements: NONE Restrictions: Mailing Address: 1100 Arthur St Apt F3 Restrictions: Corrective Lenses DL Status: Mailing Iowa City, IA 522406610 Restriction Supplement: None CDL Status: VAL None City/State: CDL Permit Status: ELG Date of Birth: 1/4/1967 Sex: F CDL Cert Status: None CDL Med Status: None Sanctions History Information Effective End ACD Explanation 08/24/2010 09/16/2010 D53 Non -Payment of Iowa Fine Ia R Occurrence JUR Name: Galvez, Sheila Janet DL/ID: ISSAC4396 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, 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: Galvez, Sheila Janet DL/ID: ISSAC4396 (IA) 7/3/2019 14 Driver & Identification Services Iowa Department of Transportation 07ru3i 2:iIy201ie.oz'iuuuwCab DCl IOWA No 9350 P. 1/2 fN0319338iiuo rmuW002 FI I C. STATE OF IOWA Criminal History Record Cheekq JUL 17 Pr Request )corm CIT IOWA CITYEIOwA To. Iowa Division of Criminal Investigation 9upport Operations Bureau, 1" iloor 215 B. 71b Street Des Moines, lows 50319 (51$) 725-6066 ' (515) 725-6080 pax T of WaAsrlrtformation: Without a signed be releasable, per Code of Iowa, Chapter e a�q ❑Male DCT Account Number: _9967-F (if spplitable) Fromi Yellow Cab of Iowa Ctty P.O. Boz 428 few a City, fA. 52244 Pbone: (319) 338-9777 Nax: (519)339-7302 I' soLneA- lo=i �; I D :r from the subject of the req%iwt, a eolnpll;te;rlmlual history record may not For complete criminal historyq-eeoril in£ormgtloA, aq allowed by haw, always rwnriweP Waiver -Release. I hereby aivc paminion fbr theeabovc mqu ,ing oTiciel to wo du (DCI). cr en Iowa criminal bamry ccwrd chcok with the DivWon ofCrlminal Invmtigadon My crimift hiccory a%= wncemibg me thu is maintained b DCIi sY be released If ellowrq by Isw. Waiver $ignalura,. b n / \ a As of a search of the provided name and date of birth revealed: No Iowa Criminal HistoFy Record found with DCI 1 • ��Iowa Criminal history Record attached,'DCI # 4 : Oi'l'`� 5 nCI initi�l��_ DCI -77 (08/25/10) Received Time Jul. 3. 2019 12:25PM No.0219 (DCtiik'gply) S•"�7c�lOjgJ' O �yt1 r • 'U LL ppMt3�:' •,i��u�„000n O Jul.11.2019 3:15PM DCI:01100815 NAME: GALVEZ,SHEILA DCI IOWA IOWA CRIMINAL HISTORY COURT DISPOSITION PENDING CONVICTION STATUS UNKNOWN DOB SEX RAC HOT WGT 19670104 F H 507 230 EYE HAIR HBO ELK ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20181028 AGENCY: IA0290000 DES MOINES CO SO CHARGE NO- 01 IA STATUTE IA714.2(1) THEFT IST DEGREE - 1978 TRW DA00BAP01 No. 9350 DCI 01100815 PAGE 1 OF 1 DATE PRINTED - 2019/0r1 L E D 91 201F90L 17 PM 2:47 MO CITY CLERK IOWA CITY. IOWA An arrest without disposition isnot 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. This response can only include public criminal history data. under Iowa law, moot 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. iowasexof fender. 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 roust 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 FA P. 2/2