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Home My WebLink About19-077r 1 P t CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED: IDENTIFICATION NO. (Office Use O ly) 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 First Middle 3. Contact Information (REQUIRED) Email: Cell Phone: (All written communica t via email) 4a. Drivers License expiration date (REQU b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged With any misdemeanors and/or felonies in this State or elsewhere? f�c Type of offense Where r When ow ' N 0 What happened to the charge? (Circle one) ry nvicted Dismissed Deferred Suspended Plead Guilty Other Ler 7. Have you been arrested / charged with any traffic offenses in the last five years? �l/ / % Type of offense Where When What happened to the charge? (Circle one) 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? Type of offense Where When 9. Have you ever applied to be an Iowa Cif�taxi driver using a different name? If yes, please provide the name(s) FOR 04/2018 j 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 REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). I hereby certify that I have �i sued to me by the Iowa Dep rtment of Transportation a v li Drivers license number 5� C 17 issued on D / xpiring on ` .understand that 'rf I falsely answer any questions in this application, that this applicatio m be denied. agree that in m king 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 Xter2, of the CityCode. (Needs to besi ed in frontofa Notary Public) Signature of Applicant Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ['a 4' L_ �eLcJSe)M� on this day of L 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 Drivepsliaense i 1 Z e) -27 1 / Signatyre of Police Chief or designee Date, c� AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN jCWA CFTY F6kiNO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. -. C.D Si natu of City Clerk or de$ignee Date J ',1 Office Use Only Approved application DCI report State certified driving record Website update C1erkrrAXIDR1V9ADGEAPPL92019amentled.DOC 04/2018 UU)"14V is iu.ic Tuvvw LLD 9-AXPIUMUL ua r.uuceuvc STATE OF IOWA Criminal History Record Cheek Request Form Mail or Fax completed forms to: lows Atvtelon of Crimbal lnreNdPtlon Support Opamdow Bureau, l" Floor 215 E. 7" street D" Maine& Iowa 90319 (515) 72$.6066 (5157 725-6080 Fax .. U•1_hw,�. DCI Account Number. 9967-F (daPPtieabte) ' Sand radia to: Name Yenow Cab of low$ _ Addrma P.O. Box 428 Iowa City, lows 52244 Pbo$e (310)338-9777 Fax $19.39964142 AC1-77 (updated 06-26.2018) Received Time Sep. 30. 2019 10:03AM No, 1692 o b < co /"� A DCI:00324387 NAME: NEWSOM,CHERYL LYN NEWSOM, CHERYL LYNN NEWSOME,CHERYL LYN DOE SEX RAC 19541126 F w ADDITIONAL IDENTIFTERS SC RF ARM TAT CHEST IOWA CRIMINAL HISTORY FELONY CONVICTION HGT WGT EYE 504 160 GRN CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 19841109 AGENCY: CHARGE NO- 01 ARREST DATA NOT RECEIVED TRK#: L26916401 2 COURT DISPOSITION , DCT oo324387 PAGE 1 OF 2 DATE PRINTED - 2019/10/07 HAIR SKN POE SRO MED MO AGENCY: COUNT NO- 01 IA STATUTE: IA715-6 FALSE USE OT FINANCIAL INSTRUMENT CHARGE CLASS: FELONY CONVICTION TRK#: L26916401 SENTENCE PRISON l0Y CUSTODY AGENCY: XA052015M OAKDALE IMCC A 19841109 _ RECEIVED CRIMINAL COMMITMENT CUSTODY AGENCY: IA077015G ADULT PAROLE SVC E 19850919 :. PAROLED CUSTODY AGENCY: IAP77015G ADULT PAROLE SVC C 19890610 1 DISCHARGED FROM CRIMINAL JUSTICE SYSTEM 02 ARRESTED/TAKEN INTO CUSTODY 20050211 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 : IA STATUTE IA321J.2 OWI TRK#: 101433801' CHARGE NO- 02 7 IA STATUTE IA124.401 POSSESS PRECURSORS TO MANUFACTURE METE TRK#: 101433802 COURT DISPOSITION AGENCY: IA0520151? JOHNSON CO DIST COURT COUNT NO- 02 f IA STATUTE: IA321J.2(A) OPER VNH WR INT (OWI) / IST OFFENSE COURT CASE ID: 06521 FECR071485 9 N 0 CJ. n .A O n r° W cx� DCI 00324387 PAGE 2 OF 2 { CHARGE CLASS: MISDEMEANOR CONVICTION TRK$: 101433801 DRUNK DRIVING SC$OOL DISP EFF DAT SENTENCE 20050803 JAIL 48H FINE ..� $1000 20050803 COURT DISPOSITION AGENCY: IA052015i, OHMS MUCO DIST COURT COUNT NO- 01 iA DISTRIBUTION Of YPHZDRINE COURT CASE ID: 06521 FECR071405 CHARGE CLASS; MISDEMEANOR CONVICTION TRX#: 101433802 DISB EFF DAT SENTENCE ` 10050003 SUSPENDED JAIL i 365D 20050803 JAIL 365D •n 50 O O 20050803 FINE 'i 1Y 20050803 -7 PROBATION An arrest without din osition is not an indication of guilt. This record; < mB�ntained by the Iowa Division Of Criminal Investigation, Bureau Of�Gi�— 1 „ Identification is a public record but Can only be released to non -law o IV enforcement agencies )5y the DCI. W clude public criminal history data. Under Iowa Iaw, co This response can only in most juvenile records!are confidential. Confidential juvenale court records, if any, cannot be included in this response, A signed release authOri"tion is not sufficient t0 gbtaln 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 (1B) . \""��;;unumuvu�ngp/i `•�.P`o ,065ttffQfl0'r ��7'.. Additionally, criminaD history data concerning convictions '^, pteein..• '0,' juvenile sex o£fenees 'ican be found on the Iowa Sex offend 'S�jFietry:i0,� .'rM•`::� http://wwW.ioWasexoffander,com/ . However, even though so a Aformat4.') s •; e,/` rds for Juvenile Ci ll on this site, the actual recos ;ebe -wfth confidential and any donfidential juvenile records cannot�roVi¢Q; ..�; this record. In ordaa to request the release of confideni� �uv iS.k records, if any, an application must be filed pursuant to 'ds0 Cpaa section 232.147(iB). 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 OFIYOUR INQUIRY. DIVISION OF CRIMINAL RJVESTIGATION /( i 4 i C10WA00T SMARTER I SIMPLER I CUSTOMER DRIVEN wwvi Amadot gov Drlvw S IduAll itiOn Sonlim PO Box 9201 i Des Mane. IA 503D&92U Phone.. 515-244-91241 Fax- 515239-1837 Certified Abstract of Driving Record Inquiry Date: 10/17/2019 DL/ID #: 255CC3772(IA) Customer #: 3745296 Name: Newsom, Cheryl Class: C ID Status: EXP Lynn Address: 1 APOLLO PL Audit #: 3616448 DL Status: VAL Issue Date: 02/15/2019 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 11/28/2027 CDL Cert Status: None 522403001 Endorsements: NONE CDL Med Status: None Mailing Address: 1 APOLLO PL Restrictions: NONE Restriction None Supplement: Date of Birth: 11/28/1954 Mailing IOWA CITY, IA Sex: F City/State: 522403001 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 05/15/2016 920811 IA ^� Name: Newsom, Cheryl Lynn DL/ID: 255CC3772 `=ice Co +r-� Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Depant omansporEation, do hereby certify that I am the custodian of the records held by Driver & Identification Services, that this is a trw. 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: 10/17/2019