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Home My WebLink About20-041� r CITY IOWA CITY 410 East Washington st,t Iowa City. luau 52240-1826 (3 19) 356-5040 (319) 356.5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 20-M (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 applicatfo Last �t 1 -54c4-- 2. Address (REQUIRED) 18 y 3. Contact Information (REQUIRED) Email: Firstt Middle I S/� '#4 r Zp- SaaC-/6 44098 f) 9ma: (• CONCell Phone: 3(9- 599- 3yo -7 II wntten communicatim sent OR emain 4a. Driver's License expiration date (REQUIRED)_ b. 5. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Yes Type of offense Where W hen W1>SS � �44�i fi%tna �nw �•�t I ��o � - �{ What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? h O 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? 0 0 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) U10 (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 ZlD S6p1:"(4. �1`6 Co;nv,cl�c� ao l t/ 141z ,,14 �sY�'sSeC� oofq - +omppa CO U CD Uiz N = N 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 certliy that I have Issued to me by the Iowa Department of Transportation a valid Driver's license number d ria R 3 V12 9 Issued on - I I - expiring on�D�, 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 1 further agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of y of Title5, Chapter 2, of the City Code. (Needs to be signed In front of a Notary Public) LA1 A Signature of Applicant _ Date 1'/? Oc,? () Kh}k**kt****k*kt*+Mkkk}kkKKHMKtM*KKKK*kttt}tk*k*Rkk*i[kkthkK#KhRRR*kkkKKk**k*K+Kt}k*}k*}**K*RKKK*h,F*Y*iRkR*RMRK*}'t*KhkI,K:F*K*WethrthtthkHlkNK STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public In and for the State of Iowa K*YnYFKk*kK**#KkYki:Y+K*kk+MrH**iRi*+*1t4kt#*RMS*y,W,#A****,kMMk***k**kkk**M4#kK+M*#,Yh*Yt#Kkk*RR##MK****Fh*+**Yk#k**A#**t*R*fi# I have reviewed this appilcatlon, 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 la`'Zp Signature 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. q ��, YYt,t 27c Il e� �o= - Signa ure of City Clerk o designee Date Approved application Office Use Only DCI report State certified driving record Website update ClerNfA(IORNBADCEAPPL92018amended.DOC nd/,)r11 A STATE OF IOWA Criminal History Record Check Request Form man fM= to: Iowa AMft of GYlminai Darecttgrgon s%part Opesaftm Bureau, I- Moor 215 YC, 7a stmt Da Mn9aes, Iowa 50319 (SM 725-066 (515) 725.6060 Fax DCX Account Number. ,t(ni'f7 (Kappuabk) Nawo Address -Y—Fik x Oaf _ LM W LO .b -]1M. Iowa Criminal ,Iffisto.ryRecord Che Results Ae of a search of the provided male and dare of birth revealed: ❑ No Iowa Criminal history Record found with DCI VL Iowa CAMiUal History R000rd attached, D DCI initials_ ACI -77 (upd*d 06.26-2018) Received Time Oct. 2. 2020 3:12PM No -7743 Pagel oft m CL CD w z 3 o N aq z LL e 2 W Uo U w F w O > 0 Pagel oft IOWA CRININAI, HISTORY DCI 00514269 MIBDENEANOR C0NVICTION8 ONLY PAGE 1 OF 2 PATE PRINTED - 2020/10/06 DCI:00514269 NAME: MILSTER,ELIZABETB GAYLE DOB SEX RAC HGT WGT EYE HAIR SKN POB 19740915 F W 502 175 ELK BRO FAR MO ADDITIONAL IDENTIFIERS TAT L ANKL TAT L HIP TAT NECK TAT R ANKL PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRRBTSD/TAKEN INTO CUSTODY 19951222 AGENCY: IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA224-401-3 POBB BCH I-NARIJOANA TRW 018652401 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124-401-3 PUBS SCEEDULE I M11RIJ COURT CASE ID: 06521 SRCR040094 CHARGR- CLASS: NON CONVICTION TRK#! -018652401 SUBSTANCE ABUSE EVALUATION SENTENCE -. DISP EFF DAT DEFSRR$D JUDGEMENT 19960415 PROBATION 365D 19960415 �' UNSUPERVISED COMMUNITY SERVICE 20H 19960415 DISCHARGED FROM 19961212 DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20150715 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 02 IA STATUTE IA715.5 CRIMINAL MISCHIEF 3RD DEGREE TRK#: IA00L7902 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA716.6(2) CRIMINAL XXSCHIEF 5TH DEGREE Damage Under $200 COURT CASE ID: 06521 AGCR109112 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00L7901 RESTITUTION SENTENCE DISP BPP DAT TIME SERVED 9D 20151210 JAIL 9D 20151210 COMMUNITY SERVICE IN LIEU OF PYMNT, COMM SERV 20151210 DCI 00514269 PAGE 2 OF 2 AT FEDERAL MIN WAGE (7.25) 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. This response can only include public criminal history data. Under Iowa Law, most juvenile records are confidential. Confidential juvenile court reoorde, if any, cannot be included in this response. A signed release authorisation 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 232.1,47 (18) . Additionally, criminal bistory data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry! httpz//www.iowaBe=ffender.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 COVLRS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION no(� . �..... .. •,� . `�' c� tcr/+a crimes ; :history) tom' i�dw[•` :e C410WADOT otgov SMARTER I SIMPLER I {USTOMER DRIVEN 'i ad Pllhw i Wr1ltlAcaplwt entilna P+D Bb:19Qd11 Trios Mahtsc, lA 60bDGli2W pit W- 515W"1241 igr SVQW1W Certified Abstract of Driving Record Inquiry Date: 10/2/2020 DL/ID #: 242AD3839(IA) Customer #: 5401729 Name: Mister, Elizabeth Class: D ID Status: EXP Gayle Address: 1840 S Gilbert St Audit #: 2979564 DL Status: VAL Apt 1 Issue Date: 07/11/2018 CDL Status: None City/State: Iowa City, IA Expiration Date: 09/15/2022 CDL Cert Status: None 522404311 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 1840 S Gilbert St Restrictions: NONE Restriction None Apt 1 Supplement: Date of Birth: 09/15/1974 Mailing Iowa City, IA Sex: F City/State: 522404311 History Information Convictions Citation Date Conviction Date ACD Explanation lCounty JUR 108/11/2016 109/28/2016 S92 Seed Johnson I IA Name: Mister, Elizabeth Gayle DL/ID: 242AD3839 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: o4'4a6Ni ac r14 10/2/2020 Q "Ao A7b, 1\ O Driver & Identification Services