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Home My WebLink About21-037�1 ®4 CITY OF IOWA CITY 410 East Washinston Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 21 - C37 (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 First II Middle /J0- in -e-- 2. Address (REQUIRED)"� Saul -"" R VJ c cps qI x'55 2 `4U� 3. Contact Information (REQUIRED) Email: lYr2�' jljy I`' Ua-ko.ccwi Cell Phone: q ?t3 (All written communiedtion sent via email) 4a. Driver's License expiration date (REQUIRED) 11/1) f1-zeliy b. Taxicab Business Name (REQUIRED) P—mcd -Po L�Je V- 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? Type of offense Where WW n What happened to the charge? (Circle one) N) Convicted Dismissed Deferred Suspended Plead Guilty Other: 7. Have you been arrested / charged with any traffic offenses in the last five years? Zi PS - �4�/C 7 c- _e- 74 Type of offense Where When 1 /we k) -31 :-e- /,/ r, zel& 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 a 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 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 issued to me by the Iowa pe artment of Transportation a valid Driver's license number 4 ( 'Z -Z W 3 7U issued on 99/Jf expiring on 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 Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and swom to before me by SV Lyy "c-. -5-", �S u-r_r� S on this day of LA k14 20Sl . 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 // /r/7.,p 2'3 Sipdif e Woo ice 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. ate Office Use Only - Approved application!m ro Y DCI report State certified driving record c o Website update < -n—(--! C1 CIaM MJDRN ,EA PL9 1Bamentlea DOC 04/2018 JUL/ J u l . 19. 2011 1 1: 22F1 0C1 IOWA FAX No. STATE OF IOWA Criminal History Recogd Check, i Rcqueslt Form' To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 7's Street Des Moines, Iowa 50319 (515)725-6066 PLEASE RETURN THIS FORM (515) 925 6080 Fax 1 114 12 \ I am reauestine an Iowa Criminal Hstrnv Rerl dei erl No.;669 pr 1/004 Fir - 1 E 70 ACI Account Number: 6 Ofepplioable) From:C1ty of Iowa City City Clerk's Office 410 E. Washington street Iowa C#& IA 52240 Rhone: 319-356-5041 Fax: — r - 319J56 -5497 o —� Last Name m.nd%w ktret Name (m.edat Middle Name ieumm d (e Data of Blrth (mandatory) Gender mend.w SocialSecurityNumber 0eoornma,ded) ❑Male Female 7D> �D'01J_ Waiver Information: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed bylaw, always obtain a waiver signature from the suWect of the request. Waiver Release: I heroby give permission for the above m outing official to wndnet M Iowa criminat history record check with ft Division of Criminal Investigation (DCI). My aiminal history data conuming me is mainmiaad b DCI may be released as allowed by law. Waiver signature: I,o3yaCriminal story Record Check Results (DCI kite. only) As of a search of the provided name and date of bitch revealed: I STATE OF IOWAIDPS No Iowa Criminal history Record found with DCI JUL 15 2021 IV OF CRIMINAL IP ❑ Iowa Criminal history Record attached, DCI # DCI initials .DCI -Y7 (0825/10) Received Time Jul 14 2021 4:18PM No. 5108 Jul, 19, Ml 1:IYFM JGl IUWH 110 My Y. L STATE OF IOWA AOL 10 Division of Criminal Investigation qW AGENCY NAME CttV of Iowa i'.i4 ACCOUNT NUMBER 400a -F Criminal history may appear on one name but not another. For a complete and accurate check, all names must be submitted. Do you know this individual's maiden name or any other former last names? We highly recommend that you submit all names for the following individual: =0111,111111111 ** PLEASE READ AND FOLLOW INSTRUCTIONS 1) Complete a separate Request Form for each additional last name, 2) Complete a Billing Form for the additional last names. 3) Submit payment for each additional last name. 4) Return this document with the Request Form that was returned to you asking for additional names. 5) Forms can be found at www.dps.iowa.sov Comments: _{ C= Thankyou Iowa Division of Criminal Investigation =gym -0 m DO Initials Date v JUL/'JuI. 26.,2021 9: '2ANj DCI IOWA FAX No. STATE OF IOWA Criminal Histoey ]( ecudl Check Requegi J<''oryfi To: Iowa Division of Criminallnvestigation Support Operations Bureau, V Floor 21s D. 70' Street Dos Moines, Iowa $0319 (513) 72e 6066 (31S) 725-6000 rax I am requesting an Iowa Criminal History Record Cheek ow No. UP Pr --I/ 12-3 DCI Account Numbs-: , r pfappkabk) FlratName (meudaiory) F)•omt Ctty of Iowa City o City Cleric's Office 410 E. Washington 5lhenCl r— Date of Birth (mandakry) Iowa City, IA 52240--1 7 o ❑Male Female Phone: 319-756•So41 0 �� '' r -I Pax:----------- obtaki a waiver sl noture from the subject of the reguest. Cil Lost Nanto mondmo FlratName (meudaiory) MiddIbNeane(roconnnended) Date of Birth (mandakry) Gwider (mvdatory) ,SOeial Security Number (reeomnrended) ❑Male Female ( 3 -9 Waiwrlf formatioft: %Vithout a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. Fm• complete criminal history record information, as allowed by law, always obtaki a waiver sl noture from the subject of the reguest. WaeVel* release: I hereby g/ve pemisSlon (ar lbs abover sting oReia(to conduct ry lona ainunol history ecord d eeA a lh lire f)h•ieion of Criminal br %Ggation (t)CI). Any crimind IlWary date coacmlhrg meiateieed by the coy be mlowed as olloarod by Imv. Waivel' IaPH(ftllt' ' ; ;n+cRRlrinl • O' 0 en Iowa Criminal History Mod Check ReSUILS = l nl r As of '1,, a search of theprovided ftatAe a[ul date o irdli�j gptf • � lnal P Sultse C ® No Iowa Criminal History Record fouad with DCI`-• see '°•. dt F' < o „ h/r/yalllat`No L n q �orya Criminal. History Record attached, DCI # b DCI laitiais—ioz., Received Time((Jul, 20. 2021 4; IOPM No, 6042 JUL/'"W 1` 26. 2011 ��9:33AN UCI IUWA FAX No. No. 6IU1 p%SIZ3 VIAILV� STATE, OF IOWA Criminal History AReco,rd (Check I� \" �1 Re9luest Form `( DCI Account Plumber: _ Li W -2- — F (ifapplieaUle) To: Town Divielou of criminal BlvalfiPtion From: C(ty of Iows City Support Operation$ 8111reau, I" Moot City Clark'e Office 215 P. 70 Street dle L Washingtou Street Das Moines, Iowa 60319 0 — (515) 725-6066 Iovin CRY, IA 522d'A;' (515)725-6000 Fan Phone: 319-356-5041- 1 ar 319-356-5497 t I aur re uesting an Iowa 01111inal Histol Record Check on: Laat Na1M (mandmoy) Mkit Naiino owdamy) Middle Name rwommon Iowa CliminalHistory Record 0 Results "•: �- � (D(Mneonty) 410�4�F- g,fvns 64iwAIA -JA�E- Date of Dil'th (maodaroy) Gender (md,doeay Social Secaft Number (reaomnunded) a Waiver liVoiYfmtioll. Without a algnod tvilivsr from the aubject of the request, a emnplete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For eoemlete cl•fmfnal bietory roeord iufornintion, as allowed by law, always obtain a waiver si aiura fl'ont the sub act olthe r nest Wnivei' %{¢f¢ll9¢: C horoby glva yamdaelai (er Iha nbora r Hing ofiald to wndual an Iowa crlmL al hislary aheel n;lh [hu Division ofuimiaol layestlaallon(DCO• Any Rimbsal 11610" dasaem,cendngm , smMaWnedbyl may be rdeosed m all by lw. Wtti!vtr Stg�tafftre: "'"'" 'rC�°"'<' Received Time(Jul.20.)2021 4:10PM No. 6042 Iowa CliminalHistory Record 0 Results "•: �- � (D(Mneonty) a, 10< As of � - Z j,-1 a sealrAl of the provided 1 me C Zrf1A%eN ltd: o Da D a. esultsr a ® No Iowa Criminal History Refold foetid wit zk- o O �'ymm�nrS�,aV.� tiotl y we. Criminal History Retold attachod, DCl # l _e� m DCI initials, _ y Received Time(Jul.20.)2021 4:10PM No. 6042 Jul 2b.2021 9:JJAu DCI; 00663610 NAME: BXKDBR,SHAUNA JANE LOCKE,SHAUNA JANE DOB SEX RAC 19771105 F P' ADDITIONAL IDENTIFIERS TAT BREAST TAT L WRS TAT R LEG UGI IOWA IOWA CRIMINAL HISTORY DCI 00663610 NON CONVICTION PAGE 1 OF 2 CHARGE NO- 01 IA STATUTE IA124-401-5 DATE PRINTED - POSE OF CONT SUBS NARIJ 2021/07/26 HOT WGT EYE HAIR SKN POB 500 170 BLU BRO FAR IA No, 6/U/ Y. j/1Z CCH RECORD *** 01 ARRESTBD/TAKEN INTO CUSTODY 20020208 AGENCY. IA0060000 BENTON CO SO CHARGE NO- 01 IA STATUTE IA124-401-5 POSE OF CONT SUBS NARIJ TRK#: 054165801 COURT DISPOSITION AGENCY: IA006015J BENTON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06061 SRCR008188 CHARGE CLASS: NON CONVICTION TRK#: 054165801 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT 20020722 PROBATION lY 20020722 UNSUPERVISED PROBATION PLUS COSTS DISCHARGED FROM 20040129 DEFERRED JUDGEMENT 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 o enforcement agencies by the DCI. CD o � r- rn � v I FTI Ju . & M] Y:JJAM Uc1 1VWA INo. DIV/ f. W IL 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(19). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa sex Offender Registry: http://www.iowanexoffender.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 n-< r =4m ED x `(L 04091 A DOT SMARTER I SIMPLER 1 CUSTOMER DRIVEN uvuvw.lowadogov DrNer & IAMBlleatbn servkes PO Box 72041 Des Moines, IA 6030& 6 92U Phone 5152.41-91251 Fax 5155-2391837 Certified Abstract of Driving Record Inquiry Date: 7/28/2021 DL/ID #: 841ZZ8370 (IA) Customer #: 1295814 Name: Burns, Shauna lane Class: C ID Status: None Address: 3820 JOHNSON AVE Audit #: 3201031 DL Status: VAL NW Issue Date: 09/15/2018 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration Date: 11/05/2023 CDL Cert Status: None 524054443 Endorsements: Motorcycle CDL Med Status: None Mailing Address: 3820 JOHNSON AVE Restrictions: NONE Restriction None NW Supplement: Date of Birth: 11/05/1977 Mailing CEDAR RAPIDS, IA Sex: F City/State: 524054443 History Information Convictions Citation Date Conviction Date ACD Ex lanation County JUR 11/14/2018 12/11/2018 N01 Fail to Yield Right of Way Unn IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 13UR 111/14/2018 11079605 IIA N_ E Name: Burns, Shauna Jane DL/ID: 841ZZ8370 n —i (") O fl-.-. � m i '( { Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of Driver & Identification Services, Iowa Dejart entbf pvrhi Tranjation, IV do hereby certify that I am the custodian of the records held by Driver & Identification Services, thatffiis 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 DifRtor 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: O FILED 1011 JUL 30 FM 2: 16 CITY CLERK IOWA CITY. IOWA 8 v €o � a_ m w O FILED 1011 JUL 30 FM 2: 16 CITY CLERK IOWA CITY. IOWA . ti this date: 7/23/2021 Name: Hamrick, Chadwick Aaron DL/ID: 769YY2955 CV C' % 4 <T 4 C:) aS � CI O_ h� Driver & Identification Services Iowa Department of Transporation