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Home My WebLink About21-046From: Kathleen Lippold Firefox C1- 410 (315 (315 1. 2. 3. 4a. 5.F 6.f 7. ON 9. nan Yot d. 1 of 2 Fax: 15154532222 To: Fax: (319) 356-5497 Paas: 6 of 9 09/2212021 3:51 PM about:blank IDENTIFICATION NO. l 1 (Office Mae, awl I car - Zi - d q t. Use Only) FY OF IOWA CITY APPLICATION FOR NON MOTORIZED PEDICAB DRIVERIHORSEDRAWN (Police Department review must be made DRIVER East Washinglon Street between 8 a.m. to 3 p.m., Monday - Friday.) CIN. lona 52240-1826 1356-5040 356-5497 FAX First �! Middl last Name (Required) V ' D � d Ire L✓ G-, aid Address (Required) r y /— l S1�- W AI Tygv 6,2- Contact Information (Required) Email: Oq ✓ 1 h L,,*,o f . Cell Phone:Ve 24 410"1 Driver's License expiration date (Required): �fi �' S b. Pedicab/Horsedrawn Business Name (Required): - T44-1 o D e5 i 'rior experience in transportation of passengers: rrS �ol.'c a bb, �, lave you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewher ? A16 Two of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Deterred Suspended Plead Guilty Other 5-- - - Have you been convicted of any traffic offenses in the last five years? Alb I U. Type of offense Where When -. What happened to the charge? (Circle one) p Convicted Dismissed Deferred Deferred Suspended Plead Guilty Other ' Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When I Have you ever applied to be an Iowa City pedicablhorsedrawn driver using a different name? If yes, please provide the le(s) N� DEPARTMENT OF CRIMINAL INVESTIGATION (OCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF RE%4EW must apply for an individual Department of Criminal Investigation Report (form available upor I request) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) on Mobazed Ndlce r. Dr. tM.eApp* 031201E 9/21/21 yDr n s. 121, 7:19 PM From: Kathleen Uppold Fax: 151W32222 To: Firefox Fax: (319) 3565491 Papa: 9 of 9 I hereby certify at I V� issued to me by the Iowa De artm,P3nt f Transportation a v lid I `% h / U issued on — D Y— IS cpiring on 69 -dr - falsely -d 2r falsely answer any questions in this application, that this application may be denied. 1 agree that In I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine documents relating to this application, and I further agree that, if a license is granted, to comply at all visions of Title 5, Chapter 2, of the City Code. (Needs to be sig in front of a Notary Public) Signature of Applicant�� Date ! A21 �F Co � Myy STATE OF IOWA ) COUNTY OF JOHNSON ) I have reviewed this application, DCI report, and the State certified driving. record of this mined that there is no information which would indicate that the issuance would be detrin or welfare of residents of the City of Iowa City (Title 5, Che ter 2, City Code). gnature of Police Chief or designee this AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A PEDi IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. THE EFFECTIVE DATE WILL MATd THE DRIVER'S LICENSE EXPIRATION IF LESS Sig o City Clerk ignee� Office Use Only Approved application DCI report State certified driving record Website update dabP.dub Non 1A.lodad Hneed,.nn or. APP 2015. doc 09/22/2021 3:51 PM about.biank s license number understand that if I 3 this application, I nd all records and with all of the pro - 96 K. SMITH don Number 169568568 r!22 E21, t ant and. havµe dat r - to the safety, health VEHICLE JOS r 5-$ 2 of 2 1 9/2112021, 7:19 PM From: Kathleen Lippold Fax: 15154532222 9/21/21, 8:58 AM I To: Fax: (319) 356-5497 Background.jpeg State f Iowa Division of Crinr inal Investigation 215 E. t^ Street Des Moines Iowa 50319 Phone: 515.725.60 (6 Fax: 515.725.6080 Iowa Criminal History Recor I Check Walk -It Request Your namer R f/'f Y�- °/� dre ✓.' roll/ this can include information concerning completed deferred judaemcnts Address: form (DCI -83). is the only approved release City/State/Zip.- Lp%Gg S T : ;Q:s �✓lp :` .� 5 s' t../q 5-0 2 Ars- Phone PhoneNiimher.' /S='3'21 -7Y'7 Page: 9 of 9 09/21/2021 9:13 AM Fill to all shaded areas. Last Nametpdw,,fmmrtlatoy) 11lrst. fName Poi,,,, A+ nrbe(man&tto ) lYlmnlefVaRlC 3egutuln Nmnbre (recgnmendad) PPa�� fi ✓I �� "ULC Vt Ual tit re""n'. reumw. ua.na.a.M 1 venuel-{renuro{manu aryl Uva.ana getu :u.Y. t. a Pl eau U U r`1 7 e- ale ❑ Female Release Authorization: Without a signed release from the subject of dte recli test, a complete criminal bkoty record may not be releasable, per Code of i Iowa, Chapter 692.2. for complete criminal history record information, as. allowed by law. obtain a sig ed release'fmm the subject of the request T hereby audnmize an.'lowa criminal history,rccord cheek anmyself with the:Divisi it of Criminal Investigation'(DCO. Any criminal:histoiy data concerning me that is maiumined by the DCI maybe released as allowed.by law. 4 understand this can include information concerning completed deferred judaemcnts and arrests without dispositions. -This form (DCI -83). is the only approved release authorization form for this purpose. - I Release Authorizatioo:Si nature / W-. Results As - �' date birth .R,i,,l111e.4 Ir , c Zo-y``'s, < � y to of _, a name and of check) revealed'. 0 ....: 4r -• � A lir - SPS c. o rrecord found zY - 11 ❑ Record attached, DCT # Y cnR'inxy = a : N 0` DO initials C`_ 0) Receipt Number of requests x $15.00 per last name = Tota amount $ Method of payment: cash money order check off, MasterCardVisa (Last 4 dig Cardholder's name DCI initials -C-C,- DCI -83 (01/09/19) 1/1 From: Kathleen Lippold Fan: 15154532222 To: . D SMARTER I SIMPLER I CUST( Inquiry 9/20/2021 Date: Customer 1952764 Name: Lippold, David, Address: 2545 SE 1st St City/State: West Des Moines, Convictions Citation Date 10/05/2018 Accidents - Accident Accident Date 02/14/2014 Name: Llppold, David Andrew Pursuant to Iowa Code §321.10 certify that I am the custodian t official record currently in the ct Transportation to so certify. In witness whereof, I have Taus this date: Certified DL/ID #: Class: Audit #: Issue Date: Expiration Date: Endorsements: Restrictions: Restriction Supplement: Date indicated does 976AA8700 (IA) Fan: (319) 356-5497 Page: 7 of 9 09/20/2021 5:05 PM )T www.iowadot.gov R DRiVEP! Driver & kientrtieation Services PO Box 9204 1 Des Moines, IA 5D30&9204 Phone: 515-2-14-9124 1 Fax: 515-239-1837 of Driving Record = 700 (IA) CDL Permit Class: None 502658304 Mailing 2545 SE 1st St Address: Mailing West Des Moines, City/State: 502658304 Date of 5/8/1966 Birth: Sex: M Convictions Citation Date 10/05/2018 Accidents - Accident Accident Date 02/14/2014 Name: Llppold, David Andrew Pursuant to Iowa Code §321.10 certify that I am the custodian t official record currently in the ct Transportation to so certify. In witness whereof, I have Taus this date: Certified DL/ID #: Class: Audit #: Issue Date: Expiration Date: Endorsements: Restrictions: Restriction Supplement: Date indicated does 976AA8700 (IA) Fan: (319) 356-5497 Page: 7 of 9 09/20/2021 5:05 PM )T www.iowadot.gov R DRiVEP! Driver & kientrtieation Services PO Box 9204 1 Des Moines, IA 5D30&9204 Phone: 515-2-14-9124 1 Fax: 515-239-1837 of Driving Record = 700 (IA) CDL Permit Class: None IA Darcy Doty, Driver & e records held by Drii fy of said office, and J my signature and the CDL Med Status: None Information CD Explanation Miscellaneous 4 Seat Beit Violation JUR County IA Jasper IA Dallas mean the individual was at fault or given a citation. Case Number 785970 itification Services, Iowa Department of Transportation, do hereby Identification Services, that this is a true and accurate copy of an I have been authorized by the Director of the Iowa Department of I of the Department to be set upon this document, at Ankeny, Iowa A CDL Permit Issue None Date: 2954739 CDL Permit None Expiration Date: 07)03/2018 CDL Permit None Endorsements: .... OS 8/2022 CDL Permit None Restrictions: M rcycle ID Status: None Corrective Lenses DL Status: VAL Noe CDL Status: VAL CDL Permit ELG Status: CDL Cert Status: Non -Excepted Intrastate IA Darcy Doty, Driver & e records held by Drii fy of said office, and J my signature and the CDL Med Status: None Information CD Explanation Miscellaneous 4 Seat Beit Violation JUR County IA Jasper IA Dallas mean the individual was at fault or given a citation. Case Number 785970 itification Services, Iowa Department of Transportation, do hereby Identification Services, that this is a true and accurate copy of an I have been authorized by the Director of the Iowa Department of I of the Department to be set upon this document, at Ankeny, Iowa From'. Kathleen Uppold Fax :15154532222 To: Name: Lippold, David Andrew DL'/ID: 976AA8700 (IA) Fax: (319) 356-5497 Page: 8 of 8 9/20/2021 d9 �� Driver & Identification Services Iowa Department of Transportation 0912012021 5:05 PM